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Senior Manager, Member Claims ID-12423

April 22, 2025

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.

As the Sr. Manager of Member Claims, you will oversee the entire Member Claims function, ensuring operational excellence, continuous process improvement, and alignment with the broader organizational goals. This leadership position will require a focus on optimizing performance across teams, building and evolving processes to support significant growth, and mentoring the next generation of leaders within the organization. You will be a key driver in shaping the future of our Member Claims operations, contributing to strategic initiatives that enhance the overall member experience and help us scale efficiently.

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What you'll do:

Strategic Leadership & Operational Excellence:

Own the Member Claims function, including strategic planning, process development, and overall performance management.
Lead the design, execution, and optimization of key claims adjudication processes that meet evolving business needs.
Ensure the team meets and exceeds performance targets related to claims accuracy, timeliness, and efficiency.
Identify long-term strategic initiatives to scale the Member Claims function, supporting company growth and operational excellence.
Provide thought leadership and solutions to solve complex problems that arise from the rapid growth and complexity of the business.

Team Management & Development:

Lead and mentor a team of 5+ Team Leaders, ensuring that they have the resources and skills needed to drive team performance.
Focus on leadership development, coaching, and performance management to ensure Team Leaders are equipped to support and develop their teams.
Champion a culture of continuous improvement, ensuring all team members contribute to and benefit from opportunities for professional growth.
Foster a collaborative, high-performance environment that aligns with company values and contributes to organizational success.

Cross-Functional Collaboration & Strategic Initiatives:

Collaborate closely with other departments (e.g., IT, Operations, Product, and Regulatory) to drive cross-functional projects that impact the broader organization.
Work with senior leadership and stakeholders to prioritize initiatives and resolve issues that affect Member Claims’ performance and capabilities.
Lead efforts to integrate innovative solutions, improving both member satisfaction and operational efficiency.

Process Improvement & Scalability:

Continuously analyze claims processes, identifying bottlenecks and inefficiencies, and champion process improvements to streamline workflows.
Ensure that claims processes are scalable and adaptable to meet the demands of the business as it continues to grow.
Monitor industry trends and regulatory changes to proactively adapt claims processes, ensuring compliance and best practices are maintained.

Data-Driven Performance Management:

Leverage key performance metrics to monitor team performance and drive accountability.
Utilize data to make informed decisions, improve claims handling processes, and communicate progress to senior leadership.
Track trends and key metrics to continuously evolve the Member Claims operation and optimize the member experience.

Cultural Leadership & Team Engagement:

Serve as a key member of the Member Services Leadership team, fostering a collaborative culture that emphasizes transparency, accountability, and excellence.
Promote a positive, inclusive, and high-performing office culture that aligns with Collective Health's values and mission.

To be successful in this role, you'll need:

Experience:

8+ years of experience in operations management, with a focus on customer service, claims adjudication, and similar process-oriented environments.
At least 5 years of leadership experience, including managing teams through periods of growth, change, and increased complexity.
Proven track record in scaling operations, managing large teams, and optimizing complex processes.

Skills & Competencies:

Strong leadership skills with experience managing multiple teams and developing senior leaders.
Strategic thinker with the ability to balance day-to-day operations with long-term planning.
Excellent problem-solving skills and the ability to navigate complex challenges in a fast-paced environment.
Analytical mindset with the ability to use data to drive decisions and monitor team performance.
Strong communication and interpersonal skills, with the ability to influence and collaborate across departments.

Education:

Bachelor’s degree or equivalent experience in a leadership capacity.

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

DISCLAIMER

Other Jobs You May Be Interested In

What you'll do:

To be successful in this role, you'll need:

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

5. HOW DO YOU PROCESS INFORMATION?

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

8. HOW TO PRIORITIZE WORK?

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?