Director of Claims Improvement

Job Summary

Leading the enterprise claims process improvement strategy, the full-time Director of Claims Improvement will drive initiatives to enhance claims performance, reduce costs, and ensure regulatory compliance while working remotely.

Key responsibilities

• Establish and oversee the long-term vision and operational roadmap for claims process improvement across the organization
• Collaborate with cross-functional teams to identify and prioritize process improvement opportunities that deliver measurable business outcomes
• Leverage technology and automation to enhance operational scalability and support continued membership growth

Required qualifications

• 8+ years of experience in health plan claims operations or related healthcare operations functions
• 3+ years of leadership experience in team or enterprise program management
• Proven track record of leading complex initiatives that improve claims performance and reduce manual efforts
• Deep understanding of end-to-end claims processing workflows and claims lifecycle management
• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Operations, Information Systems, or a related field