Manager, Insurance Operations

Position Overview

Manager of Insurance Operations is responsible for overseeing all activities related to contracted payer denials, underpaid claims, and insurance follow-up processes prior to any formal appeal process. This role ensures timely resolution of reimbursement issues, manages and distributes work queues, and drives operational efficiency in handling claims and agreements. The manager will also lead efforts related to Letters of Agreement (LOA) and Single Case Agreements (SCA) with non-contracted payers to secure appropriate reimbursement.

Leaders at Adaptive demonstrate behaviors consistent with Adaptive’s Core Values and Leadership Principles. Critical functions of your role include helping establish individual team member goals, aligning those individual goals with broader team objectives, and ensuring those objectives drive the achievement of company goals. Providing thoughtful coaching and consistent feedback to your team members will drive performance excellence and accountability, as well as support your team members’ growth and development. Leaders at Adaptive create an environment of belonging, respect, and open and honest communication every day.

Key Responsibilities and Essential Functions

Denials & Underpayments Management

• Oversee workflows for contracted payer denials and underpaid claims.
• Develop and implement strategies to reduce denials and recover underpayments.
• Monitor denial trends and collaborate with internal teams to address root causes.
• Collaborate with payer relations and contracting teams for denial trends.

Insurance Follow-Up Oversight

• Manage insurance follow-up queues to ensure timely and accurate responses to payer requests.
• Establish performance metrics and monitor team productivity for follow-up activities.
• Serve as an escalation point for complex payer issues.

Non-Contracted Payer Agreements

• Oversee negotiation and execution of Letters of Agreement and Single Case Agreements with non-contracted payers.
• Ensure agreements are documented, compliant, and aligned with organizational reimbursement goals.

Leadership & Team Development

• Manage and mentor team responsible for denials, underpayments, and payer follow-up.
• Provide training and guidance to ensure adherence to policies and best practices.
• Foster a culture of accountability, collaboration, and continuous improvement.

Reporting & Analytics

• Prepare and analyze reports on denial rates, recovery performance, and payer trends.
• Present findings and recommendations to senior leadership for process optimization.

All other duties as assigned

Position Requirements (Education, Experience, Other)

Required

• Bachelor's degree in Healthcare Administration, Business, or related field (or equivalent experience).
• 8+ years of experience in reimbursement operations, revenue cycle management, or payer relations.
• Strong knowledge of insurance billing, payer contracts, and reimbursement methodologies.
• Proven leadership experience with the ability to manage teams and drive performance.
• Excellent communication, negotiation, and problem-solving skills.
• Proficiency in revenue cycle systems (Quadax preferred) and Microsoft Office Suite.

Preferred

• Experience with LOA/SCA negotiations.
• Familiarity with denial management tools and payer portals.
• Analytical mindset with the ability to interpret complex data and trends.

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Compensation

Salary Range: $101,600 - $152,400

Other compensation elements include:

• equity grant
• bonus eligible