Director of Claim Operations & Transformation - Remote

Overview

This leadership role is pivotal in overseeing the entire claims processing operation, ensuring accuracy, efficiency, and compliance with prompt pay regulations.

In Short

• Manage claim processing inventory and queue oversight, ensuring timely completion within prompt pay timelines.
• Investigate prompt pay misses and develop systems to prevent future occurrences.
• Build and enhance quality management processes using team feedback and claims data.
• Develop capacity models to forecast volume, identify hiring needs, and ensure training adequacy.
• Track and report impacts of operational and technical changes on efficiency and accuracy.
• Translate organizational goals into actionable programs and team initiatives.
• Identify opportunities to leverage automation, AI, and modern tools to reduce manual tasks.
• Collaborate with product and engineering teams to develop tools that mitigate operational risks.
• Promote transparency and teamwork while cultivating a culture of accountability and professional growth.

Requirements

• Proven leadership experience in claims operations or related fields.
• Strong analytical skills and ability to manage data-driven decision-making.
• Experience with automation and AI technologies in operational settings.
• Excellent communication and collaboration skills.
• Ability to foster a culture of quality and accountability.

Benefits

• Opportunity to drive transformation in healthcare operations.
• Collaborative and innovative work environment.
• Professional growth and development opportunities.