Manager, Claims Operations

with us.

We’re currently seeking a Claims Operations Manager who will lead our claims processing team and drive operational excellence in claims adjudication, appeals, compliance and reporting, dispute resolution, and member support. This role is critical to ensuring accurate, timely claims processing while building scalable processes and developing team members.

We are building a distributed team and encourage all applicants to apply, regardless of location.

What you will do:

Manage and develop a team of Claims and Appeals Processors, providing training, feedback, and performance management to ensure SLA and quality targets are consistently met

Own end-to-end claims operations, including adjudication, appeals, QA, IDR negotiations, and compliance with plan policies and regulatory requirements

Develop and strengthen scalable processes by documenting SOPs, identifying workflow improvements, and leading automation or tooling initiatives that reduce friction and improve accuracy

Manage customer support and provider escalations, partnering closely with CX, Network Operations, Sales, and Broker teams to resolve issues efficiently and represent Claims Operations with professionalism and clarity

Oversee rule-based payment logic, collaborating with Product and Engineering to maintain and enhance our claims rules engine and operational systems (Jira, internal platforms, reporting tools, etc.)

Build and maintain plan document infrastructure ensuring operational accuracy,alignment with claims logic and network rules, and regulatory compliance

Serve as claims subject-matter expert for internal teams, manage vendor relationships, and ensure timely support for Stop Loss reporting and required documentation.

Develop KPIs and reporting dashboards to monitor performance, uncover trends, and drive continuous operational improvement

Partner on payment integrity and cost containment programs, leveraging data and vendor partnerships to reduce waste, ensure appropriate reimbursement, and protect plan assets

Drive cross-functional projects, coordinating requirements, timelines, and stakeholders for system changes, rule updates, plan documents, and process improvements

About you:

4+ years of experience in health insurance claims processing, with strong familiarity across institutional and professional claims, coding standards (ICD, CPT/HCPCS, revenue codes), and regulatory requirements

2+ years managing and developing teams in fast-paced, metrics-driven environments, with a track record of building high-performing, accountable teams

Exceptionally organized with strong time-management skills, able to prioritize competing deadlines, manage escalations, and keep multiple workflows moving in parallel

Process-builder with a startup mindset and who is comfortable creating structure from ambiguity, documenting SOPs, and improving systems while adapting quickly to change

Gritty problem-solver who’s willing to dive into the details, ask foundational questions, and work through complex or ambiguous scenarios to get to clarity

Excellent verbal and written communication skills, with the ability to synthesize data from disparate sources, tell a clear story, and communicate effectively to both technical and non-technical audiences

Analytical and data-driven, with experience in spreadsheets and (ideally) SQL to support operational reporting, trend analysis, and KPI development

Stop Loss and Independent Dispute Resolution (IDR) experience is a plus, but not required.

Benefits:

Remote company with a fully distributed team – no return-to-office mandates

Flexible vacation policy (and a culture of using it)

Medical, dental, and vision insurance with 100% company-paid employee coverage

401k w/ company match

FSA, and HSA plans

Paid parental leave

Short and long-term disability, as well as life insurance

Competitive stock options are offered to all employees

Transparent compensation & formal career development programs

Paid one-month sabbatical after 5 years

Stipends for setting up your home office and an ongoing learning budget

Direct positive impact on members’ lives – wait until you see the positive feedback members share every day

$93,000 – $126,000 a year

Our cash compensation amount for this role is targeted at $93,000 – $126,000 per year for all US-based remote locations. Final offer amounts are determined by multiple factors including candidate experience and expertise and may vary from the amounts listed above.

About Sana

Founded in 2017, Sana is a health plan solution built for small and midsize businesses — designed around our integrated primary care service, Sana Care. It’s the foundation of everything we build: ensuring members can easily access high-quality, affordable care while employers and brokers have the tools they need to manage company benefits with confidence.

We’ve been remote-first since day one, with a fully distributed team across the U. S. We value curiosity, ownership, and speed — and we build in the open, together. If you’re energized by solving complex, meaningful problems and want to help reshape how healthcare works from the inside out, we’d love to meet you