Senior Manager, Member Claims

At Collective Health, we’re transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design.

As the Sr. Manager of Member Claims, you will oversee the entire Member Claims function, ensuring operational excellence, continuous process improvement, and alignment with the broader organizational goals. This leadership position will require a focus on optimizing performance across teams, building and evolving processes to support significant growth, and mentoring the next generation of leaders within the organization. You will be a key driver in shaping the future of our Member Claims operations, contributing to strategic initiatives that enhance the overall member experience and help us scale efficiently.

What you'll do:

• Strategic Leadership & Operational Excellence:
  
• Own the Member Claims function, including strategic planning, process development, and overall performance management.
• Lead the design, execution, and optimization of key claims adjudication processes that meet evolving business needs.
• Ensure the team meets and exceeds performance targets related to claims accuracy, timeliness, and efficiency.
• Identify long-term strategic initiatives to scale the Member Claims function, supporting company growth and operational excellence.
• Provide thought leadership and solutions to solve complex problems that arise from the rapid growth and complexity of the business.
  
  
• Team Management & Development:
  
• Lead and mentor a team of 5+ Team Leaders, ensuring that they have the resources and skills needed to drive team performance.
• Focus on leadership development, coaching, and performance management to ensure Team Leaders are equipped to support and develop their teams.
• Champion a culture of continuous improvement, ensuring all team members contribute to and benefit from opportunities for professional growth.
• Foster a collaborative, high-performance environment that aligns with company values and contributes to organizational success.
  
  
• Cross-Functional Collaboration & Strategic Initiatives:
  
• Collaborate closely with other departments (e.g., IT, Operations, Product, and Regulatory) to drive cross-functional projects that impact the broader organization.
• Work with senior leadership and stakeholders to prioritize initiatives and resolve issues that affect Member Claims’ performance and capabilities.
• Lead efforts to integrate innovative solutions, improving both member satisfaction and operational efficiency.
  
  
• Process Improvement & Scalability:
  
• Continuously analyze claims processes, identifying bottlenecks and inefficiencies, and champion process improvements to streamline workflows.
• Ensure that claims processes are scalable and adaptable to meet the demands of the business as it continues to grow.
• Monitor industry trends and regulatory changes to proactively adapt claims processes, ensuring compliance and best practices are maintained.
  
  
• Data-Driven Performance Management:
  
• Leverage key performance metrics to monitor team performance and drive accountability.
• Utilize data to make informed decisions, improve claims handling processes, and communicate progress to senior leadership.
• Track trends and key metrics to continuously evolve the Member Claims operation and optimize the member experience.
  
  
• Cultural Leadership & Team Engagement:
  
• Serve as a key member of the Member Services Leadership team, fostering a collaborative culture that emphasizes transparency, accountability, and excellence.
• Promote a positive, inclusive, and high-performing office culture that aligns with [Company Name]'s values and mission.
  
  

To be successful in this role, you'll need:

• Experience:
  
• 8+ years of experience in operations management, with a focus on customer service, claims adjudication, or similar process-oriented environme