Job Description

Summary:

The Director of Claims Operations and Service Delivery is responsible for the overall strategy and effectiveness of Claims Operations. This role oversees claims adjudication, regulatory reporting functions, and all associated processes. The Director ensures timely and accurate claims processing, manages vendor relationships, and identifies opportunities for operational efficiencies. This position also involves hiring, training, and performance management of the Claims staff.

Education and Experience:

• Bachelor’s Degree in business, healthcare administration, or a related field (Master’s preferred).
• Minimum 7-10 years of claims and healthcare administration and/or managed care management experience.
• Strong knowledge of health insurance industry with all product lines (Medicare, Medicaid, Commercial, ASO, DSNP, ACA, etc.).
• Extensive knowledge of claims policies and procedures, including regulatory requirements and industry standards from AMA, CMS, and CCI edits.
• Experience managing geographically dispersed (onshore and offshore), hybrid, remote, onsite teams.
• Experience managing multinational operations is preferred

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