Manager, IT Applications & Operations Support

Description

GRS Claims Business Services is a specialized operations and technology support team that safeguards day‑to‑day claims processing for Global Risk Solutions (GRS). The team owns the health and stability of the medical bill review ecosystem and a set of critical workers compensation claims platforms, including ExPRS (ECM), Strataware, BOComp/GOComp, and related billing and reporting workflows.

This group acts as the connective tissue between business operations, vendor platforms, and IT teams. It monitors and reconciles high‑volume bill and claims flows (e.g., finalized bill files, claim downloads, post‑payment files, provider and trading‑partner data), manages onboarding and “takeovers” for new customers/programs, and drives rapid incident response for outages, delays, and data quality issues affecting adjusters and downstream reporting.

Working in an agile, high‑volume environment, this role leads a team that combines production support, process engineering, and deep domain expertise to protect business continuity, reduce operational friction for claims teams, and improve the accuracy and timeliness of medical bill and claims outcomes across GRS. A critical expectation for this leader is to elevate the team by thoughtfully embedding AI and automation into core processes—using AI as a force multiplier and amplifier so that people can focus their time and talent on the most complex, high‑judgment problems.

Responsibilities

• Provide end‑to‑end leadership for the health, stability, and performance of key claims and bill review applications (e.g., ExPRS, Strataware, BOComp/GOComp) and associated workflows.
• Oversee monitoring and reconciliation of high‑volume bill and claims flows, ensuring timely and accurate processing of finalized bill files, claim downloads, post‑payment files, provider and trading‑partner data, and related feeds.
• Lead incident management for this ecosystem, including detection, triage, communication, and coordination of resolution for issues impacting claim intake, bill review, archive, and regulatory/financial reporting.
• Manage onboarding and “takeovers” for new customers, programs, and fronting arrangements, including configuration, validation, and transition to steady‑state support.
• Own and govern core configuration and reference data (e.g., fronting carrier tables, max comp rates, trading partner profiles, provider and TIN data, message codes, pathways, pricing contracts).
• Drive stability and resiliency initiatives across the ecosystem (e.g., ExPRS stability, Strataware/FBF reliability, MQ error reduction, improved monitoring and reporting).
• Partner closely with Claims, Billing, SMO L1/L2, vendor partners, and technology teams to prioritize work, align on roadmaps, and ensure high‑quality, compliant operations.
• Provide business consulting and SME guidance on complex billing rules, regulatory requirements (e.g., NY Ebill, NYHCRA, state reporting), PPO/fee logic, and vendor fee tracking.

AI & Process Innovation

• Identify and prioritize use cases where AI and automation can improve incident detection, triage, knowledge reuse, and operational efficiency while maintaining strong controls and compliance.
• Champion AI as a force multiplier and amplifier for the team—standardizing patterns, integrating AI into day‑to‑day workflows, and enabling team members to focus on the most challenging, high‑impact problems.
• Partner with enterprise AI, data, and technology teams to pilot, scale, and continuously refine AI‑enabled solutions (e.g., intelligent monitoring, summarization of incidents, automated reporting, knowledge base generation).

• Experience leading operations, production support, or platform management teams in a complex, high‑volume environment; claims, medical bill review, or insurance domain experience strongly preferred.
• Proven track record managing business‑critical systems with multiple upstream/downstream dependencies and vendor‑hosted platforms.
• Demonstrated experience with incident management, problem management, and stability/resiliency initiatives.
• Strong ability to translate business needs and regulatory requirements into operational processes, configurations, and controls.
• Experience collaborating with cross‑functional partners (operations, technology, vendors, and finance/compliance) to prioritize work and drive outcomes.
• Exposure to AI, automation, or analytics tools in an operational context, with a demonstrated interest in using technology to improve how teams work.
• Excellent communication, stakeholder management, and change‑management skills.

Leadership Expectations

• AI‑Forward Mindset: Actively look for opportunities to embed AI and automation into team workflows as a force multiplier—simplifying routine work, improving quality and speed, and freeing people to focus on the most complex, judgment‑driven issues.
• Customer & Outcomes Focus: Anchor decisions in the needs of claims professionals, policyholders, and business stakeholders; balance speed, quality, cost, and risk thoughtfully.
• Operational Excellence: Set clear expectations, metrics, and routines for availability,
• stability, and incident performance; foster a culture of continuous improvement and learning from incidents
• People Development: Invest in building domain, technical, and AI fluency within the team; coach team members to adopt new tools and ways of working confidently and safely.
• Collaboration & Influence: Build strong partnerships across Claims, Billing, SMO, technology, and vendor organizations; influence without authority and align diverse stakeholders during high‑pressure situations
• Change Leadership: Lead the team through process, technology, and AI‑driven change with clarity and transparency, ensuring adoption and measurable impact.
•  
• Competencies typically acquired through a Bachelor`s or Master`s Degree in technical or business discipline or equivalent experience, Master`s Degree preferred
• Generally a minimum of 8 years related experience with 3 years in leadership role desirable