Senior Manager, Commercial Insurance Verification Operations

Life Unlimited. At Smith+Nephew we design and manufacture technology that takes the limits off living.

What will you be doing?

As the Senior Manager of Commercial Insurance Verification Operations, you will lead a high-performing team responsible for executing insurance verification and prior authorization submissions for commercial customers. Supporting a $200M business, you will optimize operations and communications with both customers and internal sales teams. You will oversee a team of 50 individuals across various levels, providing coaching, guidance, and clear communication to foster an engaged, high-performing culture. Your daily responsibilities will include managing operations, supporting supervisors, and ensuring consistent delivery of training, development, performance feedback, and communication. You will maintain staffing plans aligned with production needs, monitor departmental KPIs, and address escalated payer issues or complex verification cases, including direct communication with insurance carriers.

In your financial management role, you will monitor and manage departmental budgets and contribute to budget setting and forecasting. You will continuously improve processes and technologies to enhance operational efficiency. You will ensure strict adherence to compliance and privacy policies, identify risks, implement mitigation strategies, and establish governance frameworks and internal controls. HIPAA compliance and patient confidentiality will be central to your oversight of insurance verification processes.

You will also drive continuous process improvement by developing and implementing plans that enhance efficiency and customer experience. Collaborating with IT, you will leverage industry technologies and stay informed of payer-specific policies and costing guidelines relevant to medical devices and DME billing. Cross-functional collaboration will be key, as you work closely with teams across Sales, Reimbursement, and Market Access to deliver optimal customer outcomes.

What will you need to be successful?

To succeed in this role, you will need a strong foundation in budget management, operational excellence, and business strategy. You should be skilled in developing and maintaining standard operating procedures (SOPs), optimizing processes, and driving continuous improvement. Your ability to lead change initiatives, analyze data for decision-making, and manage key performance indicators (KPIs) will be essential. You will also need to manage production workflows, resolve issues efficiently, escalate critical concerns when necessary, and maintain effective vendor relationships. Strong communication skills and responsiveness to information requests are key to supporting cross-functional collaboration and delivering results.

• Up to 10% domestic and international travel for meetings, conferences, and field work..
• A bachelor’s degree and a valid driver’s license.
• 7+ years of Commercial experience in healthcare operations related to insurance.
• Proven leadership in matrixed environments.
• A track record of managing production teams and driving process improvements.
• Experience in insurance verification and collaboration with commercial sales teams (preferred).

All field professionals that are required to gain entry into healthcare facilities to perform the basic remit of their role, must successfully compete our credentialing process, which often includes COVID 19 vaccine management.  

You. Unlimited.

We believe in creating the greatest good for society. Our strongest investments are in our people and the patients we serve.  

• Inclusion and Belonging- Committed to Welcoming, Celebrating and Thriving on Inclusion and Belonging, Learn more about Employee Inclusion Groups on our website (https://www.smith-nephew.com/).

• Your Future: 401k Matching Program, 401k Plus Program, Discounted Stock Options, Tuition Reimbursement

• Work/Life Balance: Flexible Personal/Vacation Time Off, Paid Holidays, Flex Holidays, Paid Community Service Day

• Your Wellbeing: Medical, Dental, Vision, Health Savings Account (Employer Contribution of $500+ annually), Employee Assistance Program, Parental Leave, Fertility and Adopt