Senior Director, Claims & Payment Integrity - Remote

Responsibilities

• Drive quality and timely claims processing for regulatory compliance and financial management
• Enhance inventory management processes and auto adjudication
• Optimize vendor oversight and seek new vendor opportunities through RFI/RFP
• Collaborate with business and IT for system readiness on claims processing impacts
• Ensure operational readiness, testing, and training for claims processing updates
• Act as business owner for claims processing vendors, managing day-to-day operations
• Develop and maintain claims process documentation with quality assurance controls

Qualifications

• Bachelor's degree required; Master’s 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