The Supervisor, Claims Systems is a hybrid leadership and hands-on role responsible for the day-to-day operation, support, and continuous improvement of claims administration systems. This position combines direct oversight of a team with active involvement in system configuration, issue resolution, and implementation activities. The role ensures claims systems operate accurately, efficiently, and in compliance with business and regulatory requirements, while also contributing directly to key system initiatives and operational deliverables.
Responsibilities:Claims Systems Oversight & Hands-On Support
- Oversee daily operation and performance of claims administration systems, including Actisure and related platforms
- Perform hands-on system configuration and maintenance, including benefit plans, provider setup, code sets, user roles, permissions, and claims correspondence
- Monitor system functionality and directly address issues impacting claims processing accuracy, timeliness, and compliance
- Maintain system controls and ensure adherence to operational standards
Operational Change & Product Enablement
- Translate business and operational changes (e.g., new products, benefit updates, enrollment changes, regulatory requirements) into system requirements
- Configure, review, and validate system updates to ensure accuracy prior to release
- Participate directly in system build, testing, and validation activities
- Ensure alignment between Enrollment and Claims for eligibility, benefits, and adjudication logic
- Collaborate with IT, Product, Enrollment, Finance, Compliance, and vendors on system enhancements, upgrades, integrations, and defect resolution
- Lead and execute user acceptance testing (UAT), including test planning, scripting, execution, and defect resolution and support implementation readiness and perform post-release validation activities
- Serve as a primary point of contact for Claims Systems-related questions, issues, and initiatives.
Risk Management, Compliance & Controls
- Ensure claims systems and configurations comply with regulatory requirements, contractual obligations, and internal policies
- Participate in and support audits (e.g., SOC and other internal/external audits), including documentation, testing, and remediation
- Monitor system performance and operational trends; take direct action to resolve risks and control gaps.
People Leadership & Work Execution
- Supervise and support a team of claims system analysts while also carrying an individual workload
- Assign and prioritize teamwork alongside personal responsibilities to ensure timely delivery of system updates and issue resolution
- Provide coaching, guidance, and feedback while reinforcing accountability and quality of work
- Step in to perform analyst-level work as needed to support team capacity and critical initiatives
Requirements:- 1+ years of leadership experience
- 2+ years of experience in claims operations, claims systems, or business systems analysis within healthcare or insurance
- Experience working with claims administration platforms (e.g., Actisure, Guidewire, or similar systems)
- Experience supporting system implementations, enhancements, and testing activities
- Strong understanding of claims processing workflows and system configurations
- Experience translating business requirements into system specifications
- Proficiency in data analysis and reporting (e.g., Excel, SQL, or similar tools preferred)
- Familiarity with system testing methodologies (UAT, regression testing)
- Ability to translate business and product requirements into operational system solutions.
- Knowledge of claims lifecycle, benefit structures, and eligibility processes
- Understanding of regulatory and compliance requirements impacting claims processing
- Exposure to payment integrity and reconciliation processes preferred
What you'll get in return:- Competitive base pay + annual bonus
- Competitive medical plans
- Telemedicine available
- Paid parental leave
- Employee assistance and wellness support 24/7
- Free international healthcare coverage
Other Great Perks: - Work abroad arrangements available
- Generous PTO accrual program with carry-over option
- 9 paid holidays in addition to one floating holiday and one volunteer day
- Tuition reimbursement
- Career/Learning and development opportunities
- 401(k) with generous company match
- Pet insurance offerings
- Identity theft and legal coverages available
- Emphasis on well-being (Virtual well-being platform, monthly mindfulness events, and giveaways)
