Claims Operations Supervisor (U.S. Healthcare Claims)

About this role

Claims Operations Supervisor (U.S. Healthcare Claims)

Work Set-Up: Office-based (Onsite)

Location: Insular Life Building, Makati

Work Schedule: May vary depending on business needs

Pay Rate: Php 60,000 to Php 80,000 per month depending on experience

We are looking for a Claims Supervisor to lead U.S. healthcare claims operations, with a strong focus on team performance, quality, service levels, stakeholder communication, and continuous improvement. This role is ideal for a people leader with solid experience in healthcare claims, adjudication, or revenue cycle operations who can drive results in a fast-paced, metrics-driven environment.

Key Responsibilities

• Lead daily claims operations to meet accuracy, productivity, quality, and service level goals.
• Manage team performance through coaching, performance monitoring, and issue resolution.
• Partner with training and QA teams to strengthen onboarding, refresher training, accuracy, and consistency.
• Handle client or stakeholder communication, escalations, and operational updates in a timely and professional manner.
• Provide regular business updates on team performance, quality, service levels, and improvement actions.
• Drive continuous improvement initiatives to reduce errors, delays, and rework.
• Ensure adherence to operational processes, controls, and compliance requirements.
• Collaborate with cross-functional teams such as QA, training, workforce management, HR, and client services to support execution.

Must-Have Qualifications

• 5+ years of experience in U.S. healthcare claims adjudication, with deep end-to-end process knowledge.
• 2–3 years of leadership experience managing claims adjudication teams (35-50 FTEs).
• Strong understanding of medical terminology, coding (ICD, CPT, HCPCS), plan structures, and benefit rules.
• Excellent verbal and written communication skills; highly responsive and professional with clients.
• Demonstrated ability to create training programs, curriculum, modules, and certification paths.
• Experience managing KPIs and SLAs in a BPO or healthcare operations environment.
• Strong analytical and problem-solving abilities; comfortable with data-driven decision-making.
• Ability to work in a fast-paced environment and manage multiple priorities.
• Experience supporting U.S. health plans or TPAs.
• Exposure to AI-assisted adjudication tools or digital transformation initiatives.
• Background in quality assurance or instructional design.
• Work Setup
• Office-based position
• Key Competencies
• Operational leadership
• People coaching and performance management
• Quality and service level management
• Client and stakeholder communication
• Analytical thinking and problem-solving
• Continuous improvement and cross-functional collaboration

About Imagenet

Imagenet is a technology-forward healthcare operations partner with more than 25 years of experience helping healthcare payers manage critical administrative and operational processes. Founded in 2000 and headquartered in Tampa, Florida, Imagenet supports 150+ health plans through its payer clients.

Our teams help improve efficiency, accuracy, visibility, and service across complex healthcare operations, including digital mailroom, claims adjudication, contact center, member communications, and related administrative functions. By combining experienced operational teams, proven processes, and purpose-built workflow technology, Imagenet helps payers keep essential processes moving for the members, providers, and communities they serve.

Imagenet operates 10 secure facilities across the U.S. and one secure facility in Manila, Philippines.

Joining Imagenet means contributing to work that supports the healthcare operations members and providers rely on every day.