Medical Claims Operations Vice President

Job Summary

Leading a team of claims professionals, the full-time salaried Medical Claims Operations Vice President will oversee medical excess and reinsurance claims operations, ensuring quality assurance, client service, and workflow management in a fully remote environment.

Key Responsibilities

• Manage and develop claims staff, ensuring accurate and timely completion of assignments
• Oversee client accounts, acting as a senior contact for communication regarding claims status and issue resolution
• Provide technical oversight on complex claims and reinsurance matters, including payment integrity and claims investigations

Required Qualifications

• Minimum of 10 years of experience in medical claims management and managed care operations
• Proven leadership experience in managing claims professionals and client deliverables
• Strong knowledge of self-insured plans, medical and pharmacy claims, and risk-sharing arrangements
• Familiarity with CMS regulations, Medicare and Medicaid programs, and medical coding
• Proficiency in Microsoft Word and Excel, with the ability to manage multiple priorities in a fast-paced environment