Sr. Manager of Claims Operations

The Sr. Manager of Claims Operations at Sandstone Care is primarily responsible for overseeing the entire billing cycle, ensuring timely processing of claims, and addressing payer denials. The role requires building strong relationships with insurance payors, managing complex claims, and ensuring compliance with healthcare billing standards.

To qualify for the Sr. Manager of Claims Operations position at Sandstone Care, you'll need at least a high school diploma, though a Bachelor's degree in a relevant field is preferred. Applicants should have 4+ years of experience in healthcare billing and claims, as well as 2+ years of leadership experience in the field.

Sandstone Care offers numerous professional growth opportunities for the Sr. Manager of Claims Operations, including competitive salary packages, merit-based pay increases, and access to continued training and development. We believe in fostering talent to improve our overall service.

As a remote position, the work environment for the Sr. Manager of Claims Operations at Sandstone Care is collaborative and supportive. Our remote employees enjoy flexibility while still receiving full support from a tight-knit team committed to excellence in healthcare billing.

Yes, the Sr. Manager of Claims Operations at Sandstone Care will work closely with various teams, including Billing Operations, Benefits Verification, and the Director of Revenue Operations. Effective collaboration with these departments is key for maintaining accurate billing processes and improving overall operational efficiencies.

When answering this question, highlight specific examples from your previous roles where you successfully managed claims processes. Emphasize your understanding of both standard and complex claim adjudications, and be prepared to discuss any challenges you faced and how you overcame them.

Focus on your proactive approach to managing denials. Discuss methodologies you use to identify root causes, your experience in communicating with both clients and payors, and specific strategies you implemented to reduce the rate of denials effectively.

Be sure to mention metrics that indicate both efficiency and effectiveness, such as claims processing time, denial rates, and employee performance metrics. Highlight how you use these metrics to coach your team and drive improvement.

Discuss your extensive understanding of healthcare regulations, sharing specific examples of how you kept your previous teams compliant and any auditing processes you have put in place to ensure standards were met.

Talk about common challenges, such as payer complexity and regulatory changes, and provide a thoughtful plan on how you would mitigate these issues through operational improvements and team training.

Describe a few methods you’ve used to build strong working relationships, such as regular meetings and open lines of communication, while emphasizing the importance of teamwork in achieving overall success.

Illustrate your leadership style with examples of how you've previously managed teams, mentored individuals, and led initiatives that improved team performance or morale within claims management.

Share your approach to onboarding new hires, including how you've structured training sessions and what key areas you focus on to get them up to speed quickly and effectively.

Provide specifics about how you've utilized data analysis to inform your decision-making, whether that's identifying trends in denials or assessing team performance, and how these insights helped streamline operations.

Share a detailed account of a challenging situation in claims management, focusing on the actions you took, the stakeholders involved, and the positive outcome achieved as a result of your intervention.