Manager of Claims Technical Operations

Regency Plaza, 4643 S Ulster Street, Suite 700, Denver, Colorado, United States of America

Posted Thursday, January 22, 2026 at 9:00 AM

Thevision of Colorado Accessis to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care.

Why should you consider a career with Colorado Access?

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). O ur focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion.

• Find work/life balance:
  We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
• Be a part of something bigger and make an impact :
  We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
• Sharpen your skills, learn, and grow :
  We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

We are looking for a MANAGER OF CLAIMS TECHNICAL OPERATIONS who can help shape our vision and support our mission. Here is what the position will look like.

• Provides oversight into the execution of claim processing/appeals/encounter/research related business/technical operations.
• Conducts routine, actionable claims monitoring.
• Develops and monitors dashboards for claims, appeals and encounters to identify volumes, benchmarks, comparative data and continuously improve proactive delivery of information for providers, provider facing teams, and other departments that benefit from early knowledge of changes.
• LOB Benefit Review and escalates contract configuration Issues when identified.
• Responsible for actionable monitoring and reporting for both internal staff and external vendor.
• Manages daily activities with our outsourced claims and audit vendor for compliance with policies, procedures, and performance SLAs.
• Participates in Vendor configuration discussions, provides insight and recommendations related to claims configuration.
• Maintains external claims editing product and serves as internal SME to build rules. Updates configuration, as necessary.
• Attends vendor claims team meetings, tracks issues to resolution, ensures vendor documentation is updated, and claims teams trained on policy or process changes.
• Monitors for aging claims, or claims trends identified in research/monitoring that might require claims policy/process changes and monitors all internal claim workbaskets.
• Encounters
• Manages the oversight of the encounter monitoring process which includes, but not limited to tracking of submissions, trending, dashboard tracking and monthly reporting to providers and HCPF liaison with Rates Team
• Interfaces with the Encounter Data Manager for monthly QA as well as on issues or trends that are seen in monitoring, provides recommendations and solutions.
• Serves as a Colorado Access Business Information Owner for claims, encounters and appeals related data.
• Serve as a Subject Matter Expert in various committees or meetings as needed.
• Represents Sr. Director of Claims Operations and Provider Reimbursement in various meetings as needed.
• Stays informed of and aligned with regulatory and compliance requirements, data governance, and company strategy/future alignment of functions and services.
• Attends meetings and supports company-wide activities as a Subject Matter Expert on behavioral health, claims, encounters, and appeals for JOC, HCPF, internal/external audits and other meetings as needed.
• Supports knowledge transfer of behavioral health with HCPF and…