Director – Claims Operations
Posted on 2/13/2024
Small business employee benefits platform
Sana's mission is to make quality healthcare understandable, accessible and affordable for all. Sana helps small businesses offer high-quality benefits, save on healthcare costs, and avoid expensive employee turnover.
Growth & Insights
6 month growth↓ -2%
1 year growth↓ -5%
2 year growth↑ 30%
Operations & Logistics
- 6+ years of relevant medical claims operations experience
- Working knowledge of healthcare billing regulations, compliance requirements, and industry trends
- Experience with SQL, Excel/Sheets, and business intelligence tools such as Tableau or Mode
- Experience with software like Jira, Zendesk, Visium, etc.
- Strong written and verbal communication skills
- Ability to multitask and prioritize business requirements in a dynamic, fast-paced environment
- Lead and grow a team of Claims Processors, Claims Analysts, and Managers
- Ensure accurate and timely payment of medical claims and balance bill settlements
- Develop plans for team members’ career growth through coaching and feedback sessions
- Collaborate with Product leadership and engineers to support system development
- Ensure compliance with state and federal regulations
- Own partner relationships including claims intake, pricing, payment disbursements, and dispute resolution
- Create and monitor key performance indicators using SQL-backed business intelligence tools
- Be accountable for quarterly and annual goals aligned with company targets
- Act as the Claims Operations cross-functional leader and partner to other teams
- Experience with vendors in the provider payment space (e.g. ECHO), third-party claims clearinghouses, FAIR Health, etc.
- Values-oriented and cares deeply about making the healthcare system work better for people and businesses
- Willingness to jump into any of the team’s work and support
- Comfortable in challenging the processes and approaches taken by legacy carriers
- Appreciation and respect for the diversity of thoughts and skills within the team
Our health system is broken, and it’s a huge problem. Costs are rising out of control while the patient experience gets worse. At Sana, we’re passionate about fixing this problem by bringing accessible and affordable health plans to small and medium businesses. We’ve built an innovative team with top talent from across the health insurance and tech industries to create engaging, modern plans for our clients. This allows our customers to offer competitive benefits packages while paying an average of 20% less than traditional plans.
We are looking for a passionate, analytical, process-oriented, people manager to join our team as Director of Claims Operations. In this role, you will be responsible for ensuring the smooth functioning of our first dollar and stop loss claims processing, balance bill settlements, and plan compliance. You’ll be leading a talented, experienced team and will continue to build something special from the ground up.
What you will do
- Lead and grow a team of incredible Claims Processors, Claims Analysts, and Managers to ensure the accurate and timely payment of first dollar and stop loss medical claims, and balance bill settlements.
- Develop and foster plans for team members’ continued career growth through regular coaching, consistent 1:1s, feedback sessions, problem solving, and Q&A during normal business hours.
- Collaborate with Product leadership and engineers to determine the system development roadmap and support its execution as the Operations stakeholder.
- Ensure the on-going compliance of our health plans by adhering to state and federal regulations such as Section 111 reporting, No Surprises Act requirements, Gag Clause Attestations, New York State Healthcare Reform Act requirements, Non-Quantitative Treatment Limitations (NQTL) analysis, etc.
- Own SPD plan document templates and work cross-functionally to evolve the design of our health plans including medical and prescription drug coverage, cost-sharing, and member and provider policies to ensure we meet the needs of our clients and maintain compliance.
- Own partner relationships including claims intake, claims pricing, payment disbursements, dispute resolution, and payment integrity.
- Create, monitor, and internally report on key performance indicators using SQL-backed business intelligence tools.
- Create and be accountable for quarterly and annual goals aligned with company targets.
- Act as the Claims Operations cross-functional leader and partner to other teams such as Finance, Pricing and Underwriting, Customer Support, Strategic Partnership, and more.
- 6+ years of relevant medical claims operations experience, preferably in a fast-growth company environment, with working knowledge of healthcare billing regulations, compliance requirements, and industry trends.
- Excellent people manager and strong team player with a track record of working cross-functionally and delivering results. You know how to identify, recruit, and maximize your team’s talent. People love working with and for you.
- Exceptional analytical skills with a demonstrated ability to look at data on a regular basis to find trends, drill-down into cases as needed, and to take data-informed action accordingly. Experience with SQL, Excel/Sheets, and business intelligence tools such as Tableau or Mode is required.
- Adaptable. Eager to learn and master new skills and platforms in order to effectively drive success and foster a culture of continuous improvement. Experience with software like Jira, Zendesk, Visium, etc. as well as vendors in the provider payment space (e.g. ECHO), third-party claims clearinghouses, FAIR Health, etc. is a plus.
- Creative problem solving skills with the ability to multitask and prioritize business requirements aligned with company goals in a dynamic, fast paced environment.
- Effective communicator. You possess strong written and verbal communication skills in order to drive alignment, set vision, and guide team members
- Outstanding communication skills in-person, over the phone, in writing, via email, chat, carrier pigeon, etc. to drive alignment, share vision, and guide team members.
- Values-oriented. You care deeply about making our healthcare system work better for people and businesses.
- Gritty. You’re willing to jump into any of the team’s work and support. We’re a small team and sometimes when a few of us are out, we all need to help fill in for each other.
- Unphased by change. We are a startup and need people who are ok doing things outside of their traditional job description. We need someone comfortable in challenging the processes and approaches taken by legacy carriers, as we aren’t here to simply improve on what’s been done incrementally.
- Team player. You appreciate and respect the diversity of thoughts and skills within the team and contribute to an inclusive and positive team culture.
- Stock options in rapidly scaling startup
- Flexible vacation
- Medical, dental, and vision Insurance
- 401(k) and HSA plans
- Parental leave
- Remote worker stipend
- Wellness program
- Opportunity for career growth
- Dynamic start-up environment
Sana is a modern health plan solution for small and medium businesses. We use a more efficient financing structure and integrated technology solutions to cut out wasteful spending and get members access to better quality care at lower cost. Founded in 2017, we are an experienced team of engineers, designers and health system operators. We have the financial backing of Silicon Valley venture firms and innovative reinsurance partners. If you are excited about building something new and being a part of fixing our broken healthcare system from the inside, please reach out!