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.

This role oversees the Member Claims General Processing Teams, responsible for the day-to-day processing and adjudication of medical claims. These teams play a vital role in ensuring the accuracy, timeliness, and efficiency of claims processing for our employer-sponsored medical plans while addressing complex claims scenarios and maintaining compliance with regulatory and operational requirements.

What You'll Do

• Leadership & People Development
• Lead, coach, and develop a team of early-career Team Leaders who manage Member Claims Associates.
• Build leadership capability through structured coaching, performance feedback, and targeted professional development plans.
• Model high-quality leadership behaviors that reinforce accountability, ownership, curiosity, and member-first thinking.
• Foster a positive, collaborative, and inclusive team culture aligned with Collective Health values.
• Operational Ownership & Performance Management
• Fully own the Member Claims function; including strategy, process development, execution, and KPI achievement.
• Ensure accurate, timely, and compliant medical claims processing across all work streams, maintaining high performance standards in accuracy, timeliness, and efficiency.
• Oversee day-to-day operational execution including staffing, workload distribution, quality assurance, up-training, and issue resolution.
• Monitor key operational, quality, and productivity metrics; leverage performance insights to drive continuous improvement, accountability and execute operational excellence.
• Process Improvement & Scaling
• Identify, prioritize, and lead strategic initiatives that improve scalability, reduce complexity, and enhance the member experience.
• Champion process improvement efforts that streamline workflows, reduce variation, and support long-term efficiency.
• Collaborate closely with cross-functional partners (Network, Regulatory, Compliance Engineering, Member Advocacy, Quality Assurance, etc.) to resolve escalations, address root causes, and build scalable solutions.
• Cross-Functional Leadership
• Represent Member Claims as a key leader within the larger health plan operations team partnering with internal and external business partners.
• Participate in, and at times, lead cross-functional initiatives that improve system capabilities, support new products, or evolve our operating model.
• Influence stakeholders to ensure buy-in for operational changes and broader claims-related initiatives.
• Quality & Compliance
• Maintain rigorous quality assurance standards to ensure claims are processed accurately, compliantly, and consistently.
• Lead investigation of complex and escalated claims issues, identifying root causes, trends, and emerging risks.
• Own end-to-end correction and resolution, including claim rework, remediation, and implementation of corrective actions.
• Drive timely escalation resolution in partnership with cross-functional teams and ensure fixes are durable and prevent recurrence.

• 8+ years experience in healthcare operations, preferably within medical claims, health plan operations, or a related payer environment.
• To be a strong people leader with 3+ years of direct people management experience, including coaching early-career leaders and helping them grow.
• Experience managing quantitative, process-oriented teams and thrive in back-office environments that require high accuracy and analytical rigor.
• To have led teams through scaling, change, and operational transformation.
• To be passionate about simplifying healthcare and delivering exceptional experiences for members and clients.
• To be highly analytical, use data to drive decisions, and can translate insights into clear, actionable plans.
• To be energized by developing others, strengthening leadership pipelines, and building high-performance teams.
• To communicate with clarity, empathy, and influence across all levels of the organization.
• Bachelor's degree or equivalent experience preferred.