Director of Claims Operations

Job Summary

Leading the end-to-end claims operations remotely, the full-time salaried Director of Claims Operations will manage production processing, stop loss, support and appeals, and claims payments while driving process improvements and team performance.

Key responsibilities

• Own the full claims processing lifecycle, ensuring accountability for throughput, quality, and timeliness
• Directly manage a team of Claims Managers, fostering a culture of ownership and continuous improvement
• Champion automation within claims operations, identifying workflows for improvement and leading the adoption of new processes

Required qualifications

• Bachelor's degree or commensurate experience
• 8+ years of experience in healthcare claims operations, including production processing and claims payments
• 3+ years of experience leading teams and building accountability-driven cultures
• Strong knowledge of claims adjudication logic and stop loss mechanics
• Experience in driving automation and process improvement in manual-heavy environments