Director of Claims Management

Job Summary

Responsible for the strategy, performance, and compliance of claims ancillary functions, the full-time remote Director of Claims Management will manage the Plan Documents Manager and CMAS Manager, ensuring accuracy and regulatory compliance of plan documents while overseeing claims audit, appeals, and subrogation processes.

Key responsibilities:

• Own the strategy and compliance of plan document functions, ensuring adherence to relevant regulations
• Direct the performance of CMAS functions, establishing operational and quality KPIs to monitor effectiveness
• Manage and develop teams, fostering a culture of accountability and collaboration across departments

Required qualifications:

• 7 years of experience in employee benefits compliance, plan document administration, or healthcare claims operations
• 5 years of leadership experience managing teams in plan document or claims ancillary functions
• Deep knowledge of ERISA, HIPAA, and other relevant regulations related to employer-sponsored welfare benefit plans
• Experience in overseeing plan document drafting and claims audit functions in a regulated environment
• Bachelor's degree required; paralegal certification or advanced degree preferred