Senior Lead Claims Operations (m/f/x)

Working closely with the VP Member Experience, Legal, Clinical Operations, and Finance, you’ll help maintain a fair, consistent, and compliant claims framework across our markets. You’ll bring practical judgement to reviewing contracts, invoices, and claims documentation, recognising country-specific requirements and knowing when specialist input is needed.

You’ll also drive the continuous development of our internal claims processing tool, member-facing claims submission experience, and wallet in partnership with Product and Engineering. You’ll translate operational and member needs into clear requirements, help prioritise improvements, and ensure new features meet those requirements before launch.

We’re looking for a collaborative, pragmatic leader who combines strong analytical skills with precision and attention to detail. You’ll enjoy being close to the work, use data to guide decisions, take ownership of improvements, and understand the impact every claim can have on a member’s journey.

What you will do

Team leadership and daily operations

• Lead and develop our claims team through coaching, feedback, and regular quality reviews.
• Coordinate workloads, priorities, and coverage to meet service levels and maintain a sustainable workload.
• Handle complex or escalated cases, review selected claims, and support processing during periods of increased demand.
• Define clear targets and SLAs for the team, such as turnaround times, processing accuracy, and member satisfaction. Track them continuously, report on progress to the VP Member Experience, and drive measurable improvements quarter over quarter.

Process improvement and member experience

• Use operational data and team insights to identify recurring issues and improve workflows across markets and product lines.
• Maintain consistent claims decisions, clear documentation, and effective escalation and quality-assurance processes.
• Ensure members receive accurate, timely, and empathetic communication throughout the claims journey.

Claims products, wallet, automation and AI

• Drive improvements to our internal claims processing tool, member-facing claims submission experience, and wallet with Product and Engineering, and identify where AI can make claims work faster and more accurate.
• Define product requirements and acceptance criteria, including where AI may support a decision and where human review remains mandatory, and help prioritise enhancements based on member needs, operational impact, data protection, and risk.
• Coordinate user acceptance testing, validate features before launch, and prepare the team through updated workflows and training.
• Monitor results after launch, including the quality and accuracy of AI outputs, and drive further improvements.

Claims framework, regulatory requirements, and controls

• Review provider contracts, invoices, and claims documentation for market-specific contractual and regulatory requirements, involving Legal, Clinical Operations, or Finance where needed.
• Maintain the claims framework and translate agreed requirements into practical workflows, controls, and guidance.
• Partner with Finance on payment accuracy and reconciliation, support audits, and address control or compliance gaps.

Requirements

• At least 5 years of experience in claims, healthcare benefits, reimbursement, insurance operations, or a related field, including three years coordinating or leading a team.
• Hands-on expertise in complex claims, quality assurance, operational controls, and financial reconciliation.
• Hands-on experience using AI tools in your daily work, ideally in operational workflows such as document processing or case handling, with a clear sense of where human judgement and data protection require oversight.
• Experience reviewing contracts, invoices, and claims documentation against market-specific contractual and regulatory requirements, recognising when specialist input is needed.
• Experience defining product requirements with Product and Engineering, testing new features, and supporting operational rollouts.
• Experience improving processes and managing competing priorities in a fast-paced environment, ideally within a technology company or scale-up.
• Strong analytical skills, precision, and attention to detail, using operational KPIs to guide decisions and improvements.
• Clear communication, sound judgement, and a collaborative, empathetic leadership style focused on the member experience.
• Professional fluency in English.

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Quelle: Statistisches Bundesamt (Destatis), Tabelle; dl-de/by-2-0; eigene Berechnung

Auf Jobportal gelistet am 09. Nov. 2026

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