Senior Director Network and File Operations - LH

About the role

The Senior Director of Network and File Integration is a strategic and operational leader responsible for overseeing all aspects of hospital and provider network integration as well as the design, delivery, and governance of outbound data integrations to point-solution vendors, strategic partners, and third-party organizations. This role ensures provider networks are accurately, efficiently, and compliantly integrated into the organization’s systems while managing outbound file exchange processes that support clinical programs, care navigation, cost-containment solutions, benefits administration, and operational partners.

The Senior Director will lead cross-functional teams, establish enterprise integration standards, and collaborate closely with IT, operations, compliance, and network contracting to ensure seamless execution across all integration workflows.

Responsibilities

Network Integration and Provider Maintenance Leadership

• Direct the end-to-end integration of hospital, physician, ancillary, and specialty networks into enterprise systems.
• Ensure accurate and timely processing of provider demographics, contracts, fee schedules, reimbursement methodologies, participating status, and network tiering.
• Partner with the EDI and Network operations teams to maintain data file flows and standards, identify and improve failure points, and ensure automated monitoring alerts are reviewed and resolved quickly.
• Develop and maintain standardized workflows for network onboarding, mapping, quality assurance, and validation.
• Partner with operational units and client managers to ensure client needs are clearly understood and setups are executed to support those needs.
• Collaborate with hospital system clients to develop scalable, sustainable processes.
• Provide leadership for the modernization, standardization, and governance of provider network integration, ensuring alignment with long-term corporate and operational strategy.
• Establish and oversee frameworks for accuracy, quality, automation, and compliance in all provider and file integration activities.
• Shape and drive multi-year roadmaps for digital transformation and integration scalability, guiding cross-functional teams.

People Leadership and Development

• Lead high-performing teams through a culture of innovation, accountability, and continuous improvement that supports enterprise performance objectives.
• Set, communicate, and deliver on team and individual goals aligned with company and client interests.
• Handle personnel matters including mentoring, coaching, motivating, performance management, feedback, recognition, performance evaluation, and time tracking of direct reports.
• Responsible for staff decisions: onboard, offboard, promote.
• Provide input into compensation and promotional increases.
• Regularly communicate with staff via management meetings and one-on-one meetings with team members.
• Mentor and develop leaders within the team.
• Interview and recommend viable candidates for job openings.

Outbound File Integration

• Oversee outbound file integration teams to ensure successful implementation of files to new and existing point-solution vendors.
• Ensure the organization adheres to all data sharing and security protocols when sending data to outside vendors.
• Maintain relationships with key vendors and partners.
• Collaborate with IT to manage and troubleshoot day-to-day file integration issues.
• Track metrics and adhere to applicable outbound file KPIs and client SLAs, including file quality and delivery schedule.
• Oversee the execution, maintenance, and adherence to outbound file-related process documentation, ensuring all material is digestible and comprehensive.
• Own the lifecycle of file integrations, including requirements gathering, file layout design, mapping, validation rules, scheduling, and monitoring.
• Establish SLAs for file delivery, error resolution, and quality control.
• Evaluate new technologies, automation tools, and integration platforms to enhance operational performance.

Requirements

• Bachelor’s Degree and 12 years of related business experience in TPA/Payer operations.
• 5 years of leadership experience.
• Ability to develop business strategy and convert it into action-oriented objectives and measurable results in partnership with product, operational, and IT partners.

Preferred Qualifications

• Broad understanding of and experience in the healthcare/insurance industry.
• Advanced degree/education preferred.
• Experience applying Lean process methodologies to improve operational efficiency.
• Experience with network integration, provider maintenance, outbound file integration.
• Hands-on experience supporting business operations leveraging the HealthEdge platform, including claims administration, provider configuration, network management, enrollment, benefits, payment integrity, and related operational workflows.
• Proven success partnering with business stakeholders to optimize HealthEdge-enabled processes, drive operational efficiency, and improve service delivery.
• Understanding of healthcare data interchange formats, including X12 EDI transactions (834, 835, 837, 820, 270/271, 276/277, 999, and related companion guides).
• Ability to interpret vendor file specs and guide teams through mapping, validation, balancing, and certification processes.

Schedule

This is a telecommute (remote) role. Remote employees must live within the continental United States, excluding Alaska, California, Hawaii, or New York.

Benefits

• Health and wellness benefits.
• 401(k) savings plan.
• Pension plan.
• Paid time off.
• Paid parental leave.
• Disability insurance.
• Supplemental life insurance.
• Employee assistance program.
• Paid holidays.
• Tuition reimbursement.
• Other incentives.

Pay

The compensation offered will vary depending on job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and conditions of the plan.

Min to Max Range: $102,900.00 - $193,200.00. Exact compensation may vary based on skills, experience, and location.