Claims Process Optimization Director

Job Summary

Leading the design and implementation of automation and AI capabilities in claims operations, the full-time remote Claims Process Optimization Director will manage process oversight, vendor performance, and a team of specialists while driving operational efficiency and performance improvements.

Key responsibilities:

• Maintain oversight of claims adjudication workflows and manage the operating budget and vendor performance
• Build and prioritize the claims automation and AI roadmap, ensuring measurable benefits and regulatory compliance
• Conduct end-to-end analysis of claims workflows to identify constraints and drive process improvements

Required qualifications:

• Bachelor's degree in business, health administration, data analytics, or a related field
• Seven years of health plan claims or healthcare operations experience
• Five years of leadership experience
• Practical understanding of automation and AI capabilities in claims work
• Working knowledge of claims adjudication platforms and standard code sets including CPT, HCPCS, and ICD-10