Claims Operations Manager

About this Role:

We're building a digital claims and rebate processing platform for the veterinary industry in partnership with a leading global animal health manufacturer. The platform operates on a good-faith reimbursement model where clinics apply discounts at checkout and submit claims that are validated post-transaction, similar to health insurance claims processing.

We're hiring a Claims Operations Manager to build this operational function from scratch. You'll design processes, lead daily claim validation, and partner with engineering to transition from manual review (pilot) to scalable automation. This is a foundational, hands-on leadership role with high visibility and significant ownership.

Apply if you’re excited to::
• Hire, onboard, and manage a small team of Operations Analysts: building workflows, SOPs, escalation paths, and QA frameworks from a blank slate.
• Own end-to-end claim validation: daily intake, review, approval, denial, and reconciliation, including hands-on management of the Manual Review Queue for claims flagged by logic deviations, data quality issues, or edge cases.
• Partner with Engineering and Product to translate operational workflows into system requirements and drive the transition from manual processing to scalable automation.
• Serve as the operational point of contact for veterinary clinics and pharmaceutical manufacturer stakeholders by handling escalations, guiding denial remediation, and reporting on claims trends and program performance.
• Define and own operational KPIs such as turnaround time, approval/denial rates, accuracy, backlog volume, and build recurring reports, SLAs, and benchmarks for internal leadership and external partners.

About You::
• Bachelor's degree in Business Administration, Information Technology, Computer Science, or a related field.
• 5+ years in claims processing, payment reconciliation, or operations (healthcare, insurance, fintech, or SaaS).
• 3+ years of people management, which includes hiring, coaching, and performance accountability.
• Strong grasp of claims adjudication, approval/denial workflows, exception handling, and remediation processes.
• Experience with Jira Service Management (JSM) for queue management, claims workflows, and SLA tracking.
• Proven ability to build operational processes from scratch, including SOPs, SLAs, queue management, escalation paths, and QA with no existing playbook.
• Cross-functional experience working with engineering/product teams to translate ops needs into system requirements.
• Excellent written and verbal communication across technical and non-technical stakeholders.
• Serve as a professional point of contact for veterinary clinics and pharmaceutical partners, clearly communicating claim decisions, resolving inquiries, and ensuring a positive and trusted customer experience.