Head of Claims

Company: Angle Health Inc.
Location: San Francisco
Posted on: May 29, 2025

Job Description:

Changing Healthcare For Good
At Angle Health, we believe the healthcare system should be accessible, transparent, and easy to navigate. As a digital-first, data-driven health plan, we are replacing legacy systems with modern infrastructure to deliver our members the care they need when they need it. If you want to build the future of healthcare, we'd love for you to join us.The Role
We're seeking a senior-level leader to serve as our Head of Claims-someone with deep experience in the TPA space who thrives in fast-changing environments and is eager to build from the ground up. Reporting to our President and GM of Angle Health's TPA (Adrem), this individual will oversee the full "claims universe" at Angle Health-including claims processing, appeals, audits, training, and cost containment. This is a high-impact leadership role focused on stabilizing and scaling our claims operation as we grow.We're looking for someone who isn't afraid of broken processes, unanswered questions, or startup ambiguity. The ideal candidate can confidently own strategic projects from end to end, adapt quickly, and help build a claims organization that's efficient, compliant, and built to scale.Core Responsibilities:

• Lead and oversee all core functions related to health insurance claims: processing, auditing, appeals, training and network/vendor coordination.
• Supervise and mentor a team of -28 claim processors, adjusters, auditors, and appeal coordinators, working closely with our team lead(s), managers, etc..
• Lead and manage the claims team with a strong sense of urgency, providing clear direction and decisive guidance to ensure timely, accurate, and efficient resolution of claims.
• Build and refine SOPs and operational workflows across the claims lifecycle
• Conduct performance evaluations and provide training and coaching when necessary
• Foster a positive and productive work environment with the ability to motivate and guide team members, resolve conflicts, and address performance issues in a constructive manner
• Oversee the processing of health insurance claims and appeals to ensure accuracy and adherence to company policies and procedures, as well as state and federal regulations
• Own critical metrics related to accuracy, timeliness, and compliance
• Review and audit high dollar and complex claims and resolve escalated issues
• Help refine and scale our claims systems in collaboration with plan building as the company grows
• Monitor claim trends, utilizing data to target and implement process improvements to enhance efficiencies and reduce errors
• Develop and implement a comprehensive claims auditing and quality assurance program
• Stay updated on changes in health insurance laws and regulations to ensure ongoing compliance
• Work closely with the Care Team to ensure routed service tickets and escalations are handled timely and with a high level of satisfaction, addressing and resolving customer complaints
• Prepare, track, and analyze reports on claim performance, including but not limited to daily inventory; monitoring metrics related to processing times, accuracy, financial impact, etc.
• Collaborate with other departments to integrate best practices and enhance overall operational efficiency
• Identify areas of risk or inefficiency and lead corrective action initiatives
• Play a key role in future strategic planning and team expansion as needed
• Maintain and report on staffing analytics
• Other duties as assigned
  Qualifications:
  • Minimum of 5+ years of experience in health insurance claims management, with a preference of 10+ years of health insurance experience
  • Senior leadership experience at a Third Party Administrator (TPA) - large carrier only experience/backgrounds will not be considered
  • Deep knowledge of health insurance claims processing, procedures, and regulatory requirements
  • Excellent leadership and interpersonal skills with a proven track record of effective communication and relationship-building with team members, stakeholders, and clients
  • Nimble, adaptable, and able to thrive in ambiguity
  • Experience managing and developing high-performing teamsBonus Points
    • Experienced in building plans within the VBA Software claims processing system
    • Experience working for a healthcare startup
    • Experience building and implementing claims auditing protocols
    • Understanding of electronic claim exchanges and network routing
    • Bachelor's degree, or equivalent work experienceTitles You May Have Held
      • Head of Claims
      • Director of Claims
      • Director of Claims Auditing
      • Senior Claims Manager
      • Assistant VP of Claims
        The salary range for this job opportunity is $110,000 to $140,000 per year, which is the amount Angle Health anticipates paying for this position at the time of this job posting. The actual base salary offered may differ and will depend on various factors such as geographic location, skills, qualifications, and experience.
        Because We Value You:
        • Competitive annual salary
        • 100% company-paid comprehensive health, vision & dental insurance for you and your dependents
        • Supplemental Life, AD&D and Short-Term Disability coverage options
        • Discretionary time off
        • Opportunity for rapid career progression
        • Relocation assistance (if relocation is required)
        • 3 months of paid parental leave and flexible return to work policy (after 12 months of employment)
        • Work-from-home stipend for remote employees
        • 401(k) account
        • Other benefits are coming soon!About Us
          Backed by a team of world class investors, we are a healthcare startup on a mission to make our health system more effective, accessible, and affordable to everyone. From running large hospitals and health plans to serving on federal healthcare advisory boards to solving the world's hardest problems at Palantir, our team has done it all. As part of this core group at Angle Health, you will have the right balance of support and autonomy to grow both personally and professionally and the opportunity to own large parts of the business and scale with the company.Angle Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Angle Health is committed to working with and providing reasonable accommodations to applicants with physical and mental disabilities.
          
          --- A Note on Recruiting Outreach
          We've been made aware of individuals falsely claiming to represent Angle Health using lookalike email addresses (like @anglehealthcareers.com). Please note that all legitimate emails from our team come from @. We will never ask for sensitive information or conduct interviews via messaging apps.
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Keywords: Angle Health Inc., Woodland , Head of Claims, Other , San Francisco, California