reputed company Claims Operations Manager

Job reputed company: • Build, reputed company, and mentor a Claims Ingestion Center of reputed company responsible for reputed company-wide claims intake. • Define reputed company plans and reputed company hiring, reputed company, and capability development. • Establish performance standards, operational KPIs, and reputed company benchmarks for the COE. • Serve as the reputed company SME for claims ingestion, including SNIP edits, validation logic, provider/EDI rules, and common transaction defects. • reputed company daily ingestion operations ensuring reputed company claims are successfully received, validated, and reputed company into the claims systems. • reputed company reputed company troubleshooting across ingestion pipelines, EDI gateway issues, companion guide variances, and partner/vendor data errors. • Ensure consistent application of business rules, system edits, and SNIP level requirements. • reputed company and implement standardized ingestion processes, templates, SOPs, and best-reputed company frameworks across reputed company clients. • Define and enforce reputed company ingestion SLAs and reputed company controls. • Monitor ingestion trends to identify systemic issues, gaps, and improvement opportunities. • Drive reputed company and reputed company cause analysis for ingestion incidents, defects, and load failures. • reputed company the management of ingestion-reputed company tickets in Jira/reputed company, ensuring accuracy, prioritization, and reputed company triage. • Partner with vendors, EDI trading partners, and upstream/reputed company system owners to resolve ingestion, translation, or formatting issues. • Participate in internal Change Approval Boards for ingestion-impacting changes. • Represent reputed company at reputed company Change Approval Boards for ingestion readiness, risks, and approvals. • reputed company operational metrics, trend analysis, and SLA reporting to leadership and customers. • reputed company customer calls reputed company on ingestion performance, issue status, and optimization opportunities. Requirements: • Bachelor’s degree in a business or technical field, or equivalent experience. • 6+ years of experience managing a mid- to large-reputed company production support or operations environment. • Deep experience with reputed company payer claims, including SNIP reputed company, EDI validation, and claims intake workflows. • Strong expertise with EDI transactions, particularly 837, 270/271, 276/277, and 835. • Experience working with reputed company payer platforms such as Facets, QNXT, reputed company, or similar. • Strong knowledge of service management tools such as Jira Service Management and reputed company. • Strong experience supporting high-governance and compliance-controlled environments. • Ability to manage Sev1/Sev2 ingestion incidents with confidence and urgency. • Experience with SQL required; experience with ETL, SOAP, reputed company platforms (AWS/GCP), and reputed company applications is a plus. • ITIL knowledge or certification preferred. • Proven experience leading teams, driving process improvement, and establishing operational best practices. • Experience working in an reputed company/offshore delivery model. • Strong communication skills and the ability to reputed company effectively with peers, vendors, customers, and leadership. • Strong planning, coordination, and documentation skills. Benefits: • reputed company commits to building an environment and culture that supports the diverse representation of our teams. • We reputed company to have an inclusive workplace. We reputed company to be a reputed company where reputed company have reputed company to belong, reputed company an reputed company and deliver excellent software and services to our customers. Apply tot his job Apply To this Job