---
title: 'Senior Manager, Claims Systems at Collective Health'
canonical: 'https://feeny.ai/job/senior-manager-claims-systems-collective-health-san-francisco-p3bc5rmb5s02'
type: 'job'
last_seen: '2026-11-03'
---

# Senior Manager, Claims Systems at Collective Health

- **Company:** Collective Health
- **Location:** San Francisco, CA / Lehi, UT / Plano, TX
- **Compensation:** $110k–$172k
- **Posted:** 2026-10-28
- **Last confirmed live:** 2026-11-03
- **Apply:** https://jobs.collectivehealth.com/apply/?gh_jid=8319002

## Job description

At Collective Health, we’re transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design.

Collective Health is reimagining health benefits through technology-driven, member-focused healthcare administration. We are seeking an experienced Senior Manager, Claims Systems to lead the specialized teams responsible for Accumulator Operations, EDI 837 Ingestion & File Resolution, and Claims Performance & Resolution (CPR).

This role requires deep technical knowledge of end-to-end claims adjudication, EDI transactions, benefit hierarchy, health plan configuration, and claims system logic. The ideal candidate can independently identify systemic gaps, translate complex operational issues into actionable technical requirements, and partner with Product and Engineering to drive sustainable solutions.

## Key Responsibilities

Claims Systems & Technical Oversight

- EDI 837 Ingestion & File Resolution: Oversee institutional and professional claims transactions (837I/837P), investigate ingestion rejections, resolve return file errors, and maintain data integrity across claims processing workflows.
- Accumulator Operations: Lead accumulator research, reconciliation, transfers, and over-accumulation remediation across medical and pharmacy benefit integrations.
- Claims Performance & Resolution (CPR): Oversee system defect triage, Run-The-Business (RTB) gap identification, and adjudication pend rule configuration and maintenance.
- Adjudication & Configuration Expertise: Evaluate end-to-end claims adjudication, benefit hierarchy, plan configuration, and system logic to identify processing gaps, configuration defects, and opportunities to improve automated adjudication.
- Root-Cause Analysis: Independently investigate complex claims processing failures, distinguish between operational, configuration, EDI, and system defects, and drive appropriate resolution.

Cross-Functional Partnership & Operational Excellence

- Serve as a technical operational subject matter expert for Product and Engineering, translating system gaps into actionable requirements, prioritized fixes, and automation opportunities.
- Partner with medical networks, PBMs, and clearinghouses to ensure accurate data exchanges, timely issue resolution, and SLA adherence.
- Establish and monitor operational KPIs, defect trends, processing timelines, and SLA performance to drive accountability and continuous improvement.
- Identify opportunities to reduce manual intervention, eliminate recurring defects, and improve claims processing accuracy and scalability.
- Maintain documentation supporting adjudication logic, system workflows, compliance, and operational consistency.

People Leadership & Accountability

- Lead, coach, and develop specialized claims systems teams and team leads, building technical expertise and operational ownership.
- Establish clear performance expectations, delegate effectively, and hold leaders and teams accountable for results.
- Demonstrate sound judgment, address performance concerns directly, navigate difficult conversations, and make decisions that balance operational priorities and organizational needs.

## Skills & Qualifications

## Minimum Qualifications

- 10+ years of experience in health insurance operations, third-party administration (TPA), or health plan claims systems, including direct management experience or equivalent practical experience.
- EDI & Claims Systems Expertise: Strong technical understanding of EDI 837 transactions, clearinghouse exchanges, file ingestion, system coding and logic, and error resolution.
- End-to-End Adjudication Knowledge: Demonstrated expertise in claims adjudication workflows, benefit hierarchy, health plan configuration, pend rules, and identifying systemic processing gaps.
- Accumulator Operations: Experience with accumulator reconciliation, cross-benefit transfers, over-accumulation research, and synchronization.
- Technical Problem-Solving: Ability to independently diagnose complex system defects, identify root causes, and translate findings into actionable solutions for Product and Engineering.
- Cross-Functional Collaboration: Experience partnering with technical and operational stakeholders to prioritize system improvements, resolve defects, and reduce manual processing.
- People Leadership: Proven ability to develop technical teams, delegate responsibilities, establish accountability, make difficult decisions, and lead through organizational change.

This is a hybrid position based out of our San Francisco, Lehi, or Plano office, with the expectation of being in office at least two to three weekdays per week. #LI-hybrid

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for 135,000 stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/. San Francisco, CA Pay Range $137,500—$171,875 USD

Lehi, UT Pay Range $110,000—$137,500 USD

Plano, TX Pay Range $121,000—$151,250 USD

Why Join Us?

- Mission-driven culture that values innovation, collaboration, and a commitment to excellence in healthcare
- Impactful projects that shape the future of our organization
- Opportunities for professional development through internal mobility opportunities, mentorship programs, and courses tailored to your interests
- Flexible work arrangements and a supportive work-life balance

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance, please contact recruiting-accommodations@collectivehealth.com.

Privacy Notice

For more information about why we need your data and how we use it, please see our privacy policy: [https://collectivehealth.com/privacy-policy/](https://www.google.com/url?q=https://collectivehealth.com/privacy-policy/&sa=D&source=calendar&ust=1673199018797635&usg=AOvVaw1JzrJxyoJc-0fOfzJZ8AMO).

## About Collective Health

## Company Overview
- **One-liner**: Collective Health is a technology-driven third-party administrator (TPA) that provides a unified platform for self-funded employers to manage health benefits, administration, and care navigation.
- **Entity Type**: Private
- **Headquarters**: San Francisco, California, USA (with major offices in Lehi, Utah, and Plano, Texas)
- **Founded**: 2013
- **Founders**: Ali Diab (Co-founder & CEO)

## Core Business
- **Primary industry**: Healthcare technology (Health benefits administration / Third-Party Administration)
- **Target customers**: B2B – Self-funded employers of all sizes, including enterprise clients like Red Bull, Uber, Zoom, Live Nation, Driscoll’s, and The Wonderful Company.
- **Mission statement**: "To make it easier to understand, navigate and pay for healthcare."

## Products & Services
- **Collective TPA™**: A modern, independent third-party administration platform that handles plan administration, claims processing, and cost management for self-funded employers. It offers a 99.91% claims process accuracy rate.
- **Navigation & Advocacy**: A high-touch, high-tech benefits front door that provides end-to-end care navigation, proactive care suggestions, and integrated access to all benefits. It boasts an industry-leading 70 NPS (vs. industry average of 30) and 86% member satisfaction.
- **Benefits Hub**: An integrated platform that brings together all benefits (including ancillary partners) into one place, featuring extensive network partnerships, a vetted Premier Partner Program™, and the Partner Collective® tool.
- **Collective AI (CAI™)**: An AI-powered layer across the platform that acts as a 24/7 AI companion (within My Collective®), supercharges Member Advocates, and brings efficiency to plan implementation and operational workflows. Built on a privacy-by-design framework.
- **Member Advocate Program**: A human support layer of Member Advocates (including bilingual Spanish speakers) who help members navigate their healthcare benefits, with no prior experience required for entry-level roles.

## Market Standing
- **Valuation**: Not publicly disclosed (private company).
- **Key Metric**: Over $25 billion in medical claims processed to date; serves over 800,000 members across all 50 states.
- **Notable Investors/Partners**: Not explicitly listed on the provided materials, but customers include Red Bull, The Wonderful Company, Boot Barn, Live Nation, Driscoll’s, Uber, and Zoom.
- **Growth Signals**: The company has processed over $25B in claims, serves over 800k members, and is actively hiring across engineering, product, and customer service roles, indicating strong growth. It has also received HITRUST r2 certification and NCQA accreditation, signaling trust and maturity.

## Competitive Advantages
- **Independent and transparent**: Collective Health positions itself as an independent TPA, avoiding the conflicts of interest inherent in carrier-owned or vertically integrated solutions. They emphasize transparency in pricing and plan design.
- **High-tech + high-touch model**: Combines a modern, AI-powered platform with dedicated human Member Advocates, achieving a 70 NPS (far above the industry average of 30) and 86% member satisfaction.
- **Proven cost savings**: Claims to deliver up to $600 in potential savings per employee per year using its plans and programs.
- **Strong partner ecosystem**: Integrates with over 140 innovative partners across 30+ clinical categories, offering flexibility and choice to employers.
- **Data and analytics**: Leverages a modern tech stack (Java, Python, React, AWS, GCP, Databricks, Spark) to provide employers with data-driven insights to optimize outcomes.

## Strategic Focus
- **AI-first innovation**: The company is heavily investing in its "Collective AI" (CAI) platform, hiring for roles like Staff AI Engineer – Agentic AI and Automation and Lead Software Engineer, Agentic AI Systems, signaling a focus on agentic AI to automate and enhance member navigation and operational workflows.
- **Expanding member base and client acquisition**: With over 800k members and marquee clients, the focus is on scaling the platform to more self-funded employers.
- **Deepening the care navigation experience**: Continuing to build out the end-to-end care navigation and advocacy model to de-risk rising-cost claimants and improve health outcomes.
- **Maintaining high-quality service**: The company emphasizes its 99.91% claims accuracy and high NPS, suggesting a strategic focus on operational excellence and member satisfaction as a growth driver.

## Why Work Here
- **Mission-driven culture**: The company is deeply focused on transforming healthcare with technology, offering employees the chance to work on "some of the most challenging and interesting problems in AI, ML, distributed systems, data pipelines, analytics, user experience, system reliability, security, and privacy."
- **Strong benefits and ownership culture**: Collective Health offers up to 100% of employee premiums for medical, dental, and vision plans, equity packages for all employees, a $100 monthly wellness stipend, 12 paid holidays, parental leave, and a sabbatical program (4 weeks off for every 5 years of tenure).
- **Engineering excellence**: The engineering team works with a modern tech stack (AngularJS, React, Java, Python, Databricks, Postgres, AWS, GCP, Spark) and emphasizes good code, continuous learning, and knowledge sharing.
- **Career growth and mobility**: The Member Advocate program is designed for career starters with no prior experience, and high performers can move internally to other roles and teams within their first year.
- **Diversity and inclusion**: The company has Employee Resource Groups (ERGs), a focus on mitigating bias in hiring, and a commitment to providing equal opportunity. They also run a bilingual (Spanish) support program to serve a diverse member base.
- **Work locations**: Hybrid/office presence in San Francisco (CA), Lehi (UT), and Plano (TX), offering flexibility across major tech and business hubs.
- **Recognition**: Great Place to Work-Certified, HITRUST r2 certified, NCQA accredited, and recipient of Silver and Bronze Stevies and Training magazine’s APEX Awards.

## Sources
1. [collectivehealth.com - Company Overview](https://collectivehealth.com/company-overview/)
2. [collectivehealth.com - Main Site](https://collectivehealth.com/)
3. [jobs.collectivehealth.com - Careers Page](https://jobs.collectivehealth.com/)
4. [jobs.collectivehealth.com - Open Listings](https://jobs.collectivehealth.com/listings/)
5. [collectivehealth.com - Leadership](https://collectivehealth.com/company-overview/leadership/)

## Other roles at Collective Health

- [Marketing Operations Manager (Part-time Contract)](https://feeny.ai/job/marketing-operations-manager-part-time-contract-collective-health-san-francisco-e4jhf9etvaqr) — San Francisco, CA / Lehi, UT / Plano, TX
- [Spanish/English Bilingual Care Coordinator](https://feeny.ai/job/spanish-english-bilingual-care-coordinator-collective-health-lehi-b7cwj476khzb) — Lehi, UT