Claims Operations Manager – US Healthcare

Claims Operations Manager (US Healthcare)

Location: Makati, Valero

Position Summary

Step into a client-facing leadership position where your skills matter. We’re scaling US healthcare operations and need a seasoned Claims Operations Manager to lead end-to-end claims adjudication delivery. This role owns performance, quality, and client confidence—end of story.

If you’ve been running claims teams, managing SLAs, and translating data into action, this role gives you real authority and visibility, not just responsibility.

Work Arrangement: Onsite initially, with the opportunity for remote flexibility contingent upon performance.

What You’ll Do

Claims Operations • Oversee daily medical claims adjudication activities to meet quality, productivity, and SLA targets • Support end-to-end claims processing including intake, adjudication, reprocessing, and resolution • Review claims for accuracy and compliance with client and regulatory requirements • Monitor operational metrics such as TAT, pend rates, and error trends
Team Supervision & Coaching • Conduct daily huddles, coaching sessions, and performance check-ins • Support onboarding and training of new claims processors • Identify skill gaps and recommend refresher or remediation training
Quality & Process Support • Assist with QA audits, reviews, and calibration sessions • Analyze error trends and help implement corrective actions • Ensure adherence to SOPs and client-specific workflows
Client Support • Support client inquiries and assist in resolving escalations • Participate in client calls, meetings, or reporting as needed • Communicate clearly and professionally with challenging US clients
Collaboration & Compliance • Coordinate with QA, Training, WFM, and Operations teams • Ensure compliance with healthcare regulations, SLAs, and internal policies

What Success Looks Like

SLAs consistently met or exceeded

Reduced error rates and rework

Strong bench strength through structured training

Clients trust your numbers—and your narrative

What We’re Looking For Required • 3–5 years of experience in US healthcare medical claims adjudication • Experience as a Claims Supervisor, Team Lead, or Junior Manager • Strong knowledge of ICD, CPT, HCPCS, medical terminology, and benefit interpretation • Experience supporting client-facing communication or escalations • Background in a healthcare BPO or shared services environment • Comfortable in a hands-on, production-focused role •Data-driven, solutions-oriented leader
Preferred • Experience supporting US health plans or TPAs • Exposure to QA, training, or process improvement • Familiarity with claims automation or AI-assisted adjudication tools

Other Requirements

• Amenable to work nightshift/ US Hours, holidays and weekends.

• Willing to report onsite -Makati as required by business needs.

• This is an urgent hiring - Can start ASAP

What we Offer

• Comprehensive HMO Coverage (Medical/Dental)

• Coverage on Day1 + 1 Free Dependent

• Competitive Salary

 Apply now and fast-track your career! 

COMPANY OVERVIEW:

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers. 

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers.  The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.  The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.