Claims Operations Manager
Description
The Claims Operations Manager is responsible for overseeing the end-to-end claims processing function within a healthcare payer environment. This role ensures accurate, timely adjudication of claims, drives process improvements, and manages vendor relationships to optimize operational efficiency and service quality. The ideal candidate brings strong knowledge of healthcare claims workflows, a continuous improvement mindset, and experience working in fast-paced operations environments.
Claims Operations & Oversight
Manage daily claims operations, including intake, adjudication, adjustments, and issue resolution
Ensure claims are processed accurately, efficiently, and in compliance with regulatory and internal guidelines
Monitor key performance indicators (KPIs) such as turnaround time, accuracy, and backlog
Process Improvement & Optimization
Identify inefficiencies and implement process improvements to enhance productivity, quality, and cost-effectiveness
Partner with internal stakeholders to streamline workflows and reduce manual intervention
Support automation, system enhancements, and operational transformation initiatives
Vendor Management
Oversee third-party vendors and business partners supporting claims processing
Track vendor performance against SLAs and KPIs
Collaborate with vendors to resolve escalations and improve service delivery
Team Leadership (Preferred)
Provide guidance, coaching, and support to claims staff (if applicable)
Foster a high-performance, collaborative team environment
Support workforce planning, training, and talent development initiatives
Cross-Functional Collaboration
Work closely with Provider Relations, Customer Service, Compliance, and IT teams
Assist in resolving complex claims issues and escalations
Participate in audits, compliance reviews, and reporting activities
Qualifications
Experience in healthcare claims operations within a payer organization
Strong understanding of claims processing workflows and adjudication concepts
Knowledge of healthcare regulations, coding basics (ICD, CPT, HCPCS), and reimbursement methodologies
Demonstrated ability to analyze processes and implement improvements
Experience managing operational metrics and performance targets
Preferred
Prior supervisory or team leadership experience
Hands-on experience with claims adjudication systems (e.g., QNXT, Facets, or similar platforms)
Experience working with third-party vendors or outsourced operations
Lean, Six Sigma, or process improvement certifications (a plus)
Skills & Competencies
Strong analytical and problem-solving skills
Excellent communication and stakeholder management abilities
Ability to manage multiple priorities in a fast-paced environment
Detail-oriented with a focus on accuracy and quality
Results-driven with a continuous improvement mindset
Additional Skills & Qualifications:
Previous experience working/managing offshore teams and familiarity with claims adjudication systems (QNXT, Facets, Epic Tapestry, HealthEdge, etc.,)
Job Type & Location
This is a Contract position based out of Honolulu, HI.
Pay and Benefits
The pay range for this position is $30.00 - $32.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a hybrid position in Honolulu,HI.
Application Deadline
This position is anticipated to close on May 29, 2026.
About TEKsystems
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
About TEKsystems and TEKsystems Global Services
We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.
