Senior Director of Claims Management

Job Summary

Overseeing health plan claims administration and payment integrity functions, the full-time Senior Director of Claims Management will develop and optimize processes to ensure claims payment accuracy while working remotely.

Key responsibilities

• Drive quality and timely claims processing to achieve regulatory compliance and financial management outcomes
• Manage vendor relationships to enhance system processing efficiency and accuracy, including overseeing RFI/RFP processes
• Collaborate with business and IT teams to ensure operational readiness for claims processing updates and system fixes

Required qualifications

• Bachelor's degree required; Master's in business administration or comparable advanced degree strongly preferred
• CPC certification preferred
• 10+ years of health plan management experience required
• Experience managing vended system applications
• Experience with test plan development, strategy, and execution