Director, Claims Support

How Will You Make An Impact & Requirements

• Hours & Location: Full Time: Monday-Friday, Pacific Time Remote work Essential
• Direct all aspects of claims intake, adjudication, payment, adjustment, and provider reimbursement activities.
• Ensure claims are processed accurately, timely, and in compliance with contractual, regulatory, and organizational requirements.
• Provide leadership and guidance on highly complex claims and provider disputes.
• Establish and monitor operational metrics, SLAs, productivity standards, and quality indicators.
• Lead continuous improvement initiatives focused on automation, efficiency, payment accuracy, and provider experience.
• Serve as a key leader within Health Plan Operations, partnering closely with Provider Network Management, Finance, Compliance, Configuration, Delegation Oversight, Appeals & Grievances, Clinical Operations, and external provider organizations to ensure optimal claims performance and regulatory compliance.

Required Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, Public Health, or related field, or equivalent experience.
• Minimum 9 years of progressive healthcare claims operations experience.
• Minimum 5 years of leadership experience managing managers and/or large operational teams.
• Experience within Medicare Advantage, Medicaid, Managed Care, Health Plan, or Payer environments.

Preferred Qualifications

• Master's degree (MBA, MHA, MPH, or related field).
• Experience supporting delegated provider organizations, value-based care models, payment integrity programs, and provider dispute resolution.

Benefits

• 3 weeks PTO & 8 paid holidays
• Medical, Dental, Vision
• Employer Paid Basic Life & Short Term Disability coverage (goes into effect after 1 year of full-time employment)
• 401(k) with match
• Employee Wellness
• Other Employee Discount programs like Tickets at Work and cell phone discounts
• Other benefits: Dependent Care FSA, Voluntary Life, Long Term Disability, Critical Illness, Pet Insurance, and more

Compensation

$144,368.00 to $238,207.00