Lead and develop a high-performing Insurance and Claims Advocacy team
Own program strategy, service delivery standards, and key performance indicators across insurance navigation and claims resolution.
Oversee resolution of complex medical billing and insurance issues (denials and appeals, billing errors/coding discrepancies, out-of-network disputes)
Guide proactive insurance navigation, including benefits education, coverage guidance, and pre-service support to remove barriers and improve member outcomes.
Build and optimize scalable workflows, leveraging data, technology platforms, and responsible AI-enabled tools to improve quality, efficiency, and turnaround time.
Ensure accurate, audit-ready documentation and adherence to SOPs, regulations, and quality standards.
Partner cross-functionally (Sales, Client Service, Member Services, Analytics, and clinical teams) to implement improvements, support growth, and elevate the member experience.

7+ years of experience in medical billing/claims advocacy, complex claims resolution, appeals, coordination of benefits, and insurance plan analysis
Bachelor’s degree in healthcare administration, business, or related field required; advanced degree and/or relevant certification preferred
3+ years of progressive people leadership experience, with demonstrated success managing teams and service operations
Deep knowledge of payer claims adjudication, CPT/ICD coding, and provider billing practices
Strong negotiation and escalation management skills
Proven ability to drive process improvement using data/analytics, technology platforms (e.g., Salesforce, MS Office), and responsible AI-enabled tools
Excellent communication skills and ability to influence cross-functional stakeholders in a fast-paced environment.

Senior Manager, Insurance and Claims Advocacy

Key skills