Claims Operations Director

Job Summary

A company is looking for a Director of Claims to provide strategic leadership and oversee day-to-day operations in claims processing and related functions.

Key Responsibilities

• Lead and scale end-to-end claims operations, including intake, adjudication, and appeals coordination
• Optimize performance standards and drive operational excellence across various metrics
• Oversee BPO/BPaaS relationships and monitor performance against operational KPIs and service level agreements

Required Qualifications

• 10+ years of related experience
• Bachelor's Degree or equivalent experience required
• 7+ years in a leadership role
• 5+ years of experience with BPO/BPaaS solutions
• Advanced knowledge of healthcare coding conventions such as ICD-10, CPT, and HCPCS