Operations Manager

3 days ago

Quezon City, National Capital Region, Philippines Conifer Health Solutions Full time

Position Summary:

Provides direction to the Claims Unit team while monitoring daily workflows, examiner assignments and production, and ensuring compliance with health plan and regulatory requirements.

Job Duties and Essential Functions:

  1. Responsible for compliance of all claims regardless of department where the claim is pending.
  2. Monitors inventory reports and assigns work queues based on staffing and/or volume re-assess, identifies and distributes unprocessed work to staff on a first-in first-out basis or other established priorities.
  3. Works collectively with all levels of management and staff to ensure compliance with inventory production and timeliness standards including but not limited to QC, T&C, Eligibility, UM, Compliance, and Operations Departments.
  4. Reviews daily operational reports throughout the day to assure compliance.
  5. Maintains controls to insure that all claims are processed within regulatory requirements.
  6. Reviews daily production reports to monitor and counsel staff not meeting the established production requirements.
  7. Reviews monthly report cards to train and counsel staff that is consistently not meeting quality standards.
  8. Identifies training for staff failing to meet established minimum production and quality objectives.
  9. Updates and implements department training materials, approved policies and procedures, and such other approved reference materials as may be required for performance of the examiner's job functions.
  10. Holds regular unit meetings to review new policies and procedures and training issues.
  11. Completes Corrective Action Plans for the Claims department by the requested due dates.
  12. Maintains and keeps in total confidence, all files, documents and records that pertain to the operation of the business.
  13. Attends internal and external meetings/trainings as necessary.
  14. Manages staff hours and attendance
  15. Assesses inventory vs. resources and provides overtime and inventory reduction plans when necessary
  16. Available to work extended hours and weekends.

Experience/Skills Requirements:

Over 5 years experience in processing managed care health claims. Must have good understanding of various coding concepts (ICD9 CM, HCPCS, CPT, ASC, etc.). Requires a working knowledge of managed care concepts and regulatory requirements, particularly as relates to timeliness. Must have keyboarding skills and ability to read and write English. Must be able to assess work volumes versus resources. Needs to be able to communicate in a clear and concise manner. Needs basic understanding of word processing and spreadsheet applications; Microsoft Office experience is preferred. Must have keyboarding skills. Must have strong written and verbal communication skills. Must possess problem solving abilities and the ability to multi-task in a demanding environment.

  • Team Manager, B2B Operations

    2 weeks ago

    Mandaluyong City, National Capital Region, Philippines REMITLY PHL OPERATIONS INC Full time ₱300,000 - ₱600,000 per year

    Job Description:At Remitly, we believe everyone deserves the freedom to access, move, and manage their money wherever life takes them. Since 2011, we've tirelessly delivered on our promise to customers sending money globally, providing secure, simple, and reliable ways to manage their money, ensuring true peace of mind. Whether it's supporting loved ones...

  • Operations Manager

    4 days ago

    Quezon City, National Capital Region, Philippines Japan Home Inc Full time

    Japan Home Centre is looking for a Operations ManagerJob Description:Develops and implements operational strategies, systems, and policies to improve efficiency, sales, and overall performance across all stores.Oversees nationwide store operations, supervises key operational staff, and ensures alignment with company goals and performance targets.Analyzes...

  • Operations Manager

    20 hours ago

    Quezon City, National Capital Region, Philippines KER Systems & Solutions Corp. Full time

    Operations ManagerThe company's Operations Manager is tasked with maintaining and increasing the efficiency of a business.They consult executives on decisions impacting all facets of company operations.ResponsibilitiesOverall management of different teams directly related to company operations; (Warehouse & Yard, Production, Logistics)Lead, motivate, and...

  • operation manager

    3 days ago

    Quezon City, National Capital Region, Philippines Caferoo Full time

    Willing to undergo a one-week training period at Café Roo Taal Branch as required by management.Job Summary:The Operations Manager is responsible for overseeing daily business operations to ensure efficiency, productivity, and compliance with company policies. This role ensures that all departments operate smoothly, meet performance standards, and support...

  • Operations Manager

    1 week ago

    Quezon City, National Capital Region, Philippines Southstar Drug Full time

    Drive Excellence as our Operations ManagerPosition: Operations ManagerLocation: On-Site (Office at Brgy. Manresa, Quezon City)Company: MODERNBRANDS INCDo you thrive in dynamic environments where every decision makes an impact? At Modernbrands Inc, were seeking an Operations Manager to lead our operations to optimize work flows and ensure our business runs...

  • Operations Manager

    2 weeks ago

    Quezon City, National Capital Region, Philippines PESO Resources Development Corp. Full time ₱2,000,000 - ₱2,500,000 per year

    Company DescriptionPESO Resources Development Corp. (PRDC) is an HR Management Solutions company with expertise in all lines of business. We have provided a fast-growing workforce solutions throughout the Philippines for over 30 years.About the Role:PRDC is looking for anOperations Managerwho will lead overall service delivery, strengthen client...

  • Operations Manager

    4 days ago

    Quezon City, National Capital Region, Philippines AURA RUZ MEDICAL GROUP Full time

    AURA RUZ is a rapidly AESTHETIC AND skincare brand known for its innovative products and precision AESTHETICS We are expanding globally and looking for an experienced Operations Manager to help streamline and optimize our processes.Job Overview: As the Operations Manager, you will play a critical role in ensuring efficient business operations. You'll oversee...

  • Operations Manager

    6 days ago

    Quezon City, National Capital Region, Philippines HAROLDS HOTEL QUEZON CITY Full time

    We are seeking a dynamic and experienced Operation Manager with a strong background in hotel operations and hospitality management. The ideal candidate will be a hands-on leader, committed to delivering exceptional guest experiences while driving operational excellence, team performance, and financial results.This position requires a proven track record in...

  • operations manager

    1 week ago

    Quezon City, National Capital Region, Philippines AQUADYS INC Full time

    About the Role:We are looking for an experienced Operations Manager to oversee day-to-day construction operations specializing in painting and waterproofing works. The ideal candidate can manage multiple project sites simultaneously, ensure timely and quality completion, and lead teams effectively in a fast-paced environment.Key Responsibilities:Oversee and...

  • Operations Manager

    1 week ago

    Quezon City, National Capital Region, Philippines Hi-Deas Expedient Solutions Limited Full time

    Job Title: Operations Manager for Utilization Management - USRNShift: Night shiftWork Set-up: On-site in Bridgetowne, Quezon CitySalary range: 150K to 180KHC: 1Start date: Dec 31, 2025/ ASAPRecruitment Process: 2 interviews with Ops/virtual, Assessment depends on the recommendations after the interviewsLOB DESCRIPTION: Utilization Management - medical...