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Claims Operations Lead

Chicago, IllinoisTechnology & DevelopmentFull-Time

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About Nomi Healthcare

Nomi Health was founded in 2019 as a direct healthcare company with a simple yet bold mission: rewire how we pay for healthcare and how it is delivered to provide affordable and accessible healthcare experiences we all deserve as employers, patients and providers. We’re rebuilding healthcare from the ground up, simplifying how healthcare is understood, paid for and delivered through a real-time, direct infrastructure. 

We are looking for a talented Claims Operations Lead to join our team. You will be reporting to the Head of Connect Operations. You will manage day-to-day operations for the Nomi Connect solution. You will leverage a systematic approach that is repeatable, collaborative, resulting in a consistent high-performing team with a direct impact on a successful client experience, and product delivery.

How you will make an impact

  • Responsible for the strategic operational and service relationships with multiple clients
  • Ensuring service levels are met according to service level agreements
  • Develop and execute reconciliation processes for invoicing
  • Implement a TPA Healthcare Operations team, including but not limited to leveraging a Case Management tool (investigations), and client escalation
  • The leader must be both tactical and strategic in their day-to-day activities
  • Stays current on company and industry developments
  • Implementing appropriate Safeguards to prevent the use or disclosure of the protected health information other than permitted or required by the contract or as required by law
  • Ensure compliance with HIPPA regulations and requirements
  • Research compiles, and analyzes data to create reports, presentations, and other documents, including, but not limited to operations.  Ensures compliance with applicable policies and guidelines
  • Create KPIs that support growth while mitigating risk and maintaining internal and external compliance
  • Ensure operational risks associated with payment flows are properly documented, managed, and mitigated
  • Collaborating with our Product and our Technology teams to create ongoing solutions for Payments and Banking solutions for Operations
  • Drive the ongoing optimization of the servicing process by leveraging automation
  • Plan, manage and report on all aspects of TPA Operations
  • Create procedures, QA guidelines, and training programs to support the onboarding, training, and development of Operations Associates
  • Coach and develop a team to increase job satisfaction, minimize turnover and achieve goals
  • Please note due to the exposure of PHI-sensitive data - this role is a High-Risk Role

What we're looking for

  • 6+ years' experience in Third Party Administration operations
  • Solid understanding of risk, insurance, and claims
  • 3+ years of experience working within an Agile environment working in common tooling (Jira)
  • Proven track record of managing and developing high-performing teams
  • Extensive TPA background with a deep understanding of the infrastructure 
  • Experience executing TPA operations strategies with a track record of scaling and optimizing processes through automation
  • Highly action-oriented, strong organizational skills including critical thinking and problem solving with an attention to detail
  • Data-driven decisions and understanding the balance between business, system, and operational requirements
Apply now