Director of Claims and Provider Services

Job Summary

A company is looking for a Director of Claims and Provider Services.

Key Responsibilities:

• Implement strategies to streamline operations, reduce processing times, improve quality, satisfaction and enhance overall effectiveness
• Ensure compliance with regulatory requirements, industry standards, and internal policies
• Own and improve key performance indicators (KPIs) for performance of internal and offshore operations

Required Qualifications:

• Bachelor's degree in Health Administration, Business, or equivalent combination of experience and education
• 8+ years of experience in operations, with a focus on leadership and strategy
• Strong analytical and problem-solving skills, with proficiency in data analytics tools
• Proven leadership competencies in designing, developing and implementing process structure, tools and measurement indicators that drive operational results
• Extensive knowledge of managed care reimbursement process, regulations, and compliance requirements