Director, Claims Operations - Remote

Overview

The Director of Claims Operations at Guidehealth will oversee various operational departments related to claims, ensuring efficiency and compliance while driving improvements.

In Short

• Provide operational oversight for claims departments.
• Supervise department managers and evaluate performance.
• Monitor system performance and resolve operational issues.
• Compile and analyze data to inform leadership decisions.
• Maintain up-to-date desktop procedures within departments.
• Identify workflow improvements to enhance efficiency.
• Conduct regular staff meetings and policy committee participation.
• Manage vendor relationships and financial budgets.
• Ensure compliance with regulations and company policies.
• Present operational metrics at leadership meetings.

Requirements

• 3-5 years of management experience in claims operations.
• Certifications like CPB or CPC are preferred.
• Advanced knowledge of claim processing and data analysis.
• Proficient in Microsoft Excel, Word, Access, and PowerPoint.
• Experience with EDI transactions.
• Strong understanding of healthcare regulations and reimbursement.
• Ability to work independently with good judgment.
• Exceptional communication skills for team leadership.
• Comfortable with public speaking.

Benefits

• Fully remote work environment.
• Comprehensive medical, dental, and vision plans.
• 401(k) plan with employer match.
• Life and disability insurance options.
• Employee assistance program for support.
• Paid time off for work-life balance.
• Paid parental leave for new family members.
• Resources for professional growth and development.