Director of Claims Transformation

Job Summary

Leading strategic modernization initiatives, the full-time remote Director of Claims Transformation will assess current capabilities, identify operational gaps, and design future-state operating models to enhance claims and stop-loss platforms.

Key responsibilities

• Evaluate current-state claims and stop-loss capabilities and develop transformation strategies and implementation roadmaps
• Lead enterprise process redesign initiatives to improve operational scalability and service performance
• Partner with Technology teams to translate business opportunities into system enhancements and automation solutions

Required qualifications

• Significant leadership experience within a third-party administrator (TPA) or self-funded health plan
• Demonstrated success in leading healthcare transformation initiatives and business process redesign
• Experience partnering with Technology teams for workflow automation and operational enablement
• Understanding of claims operations and stop-loss administration processes
• Strong analytical and strategic thinking capabilities with excellent communication skills