Job Details

A company is looking for a Director of Claims to provide strategic leadership and oversee day-to-day operations in claims processing and related functions.Key ResponsibilitiesLead and scale end-to-end claims operations, including intake, adjudication, and appeals coordinationOptimize performance standards and drive operational excellence across various metricsOversee BPO/BPaaS relationships and monitor performance against operational KPIs and service level agreementsRequired Qualifications10+ years of related experienceBachelor's Degree or equivalent experience required7+ years in a leadership role5+ years of experience with BPO/BPaaS solutionsAdvanced knowledge of healthcare coding conventions such as ICD-10, CPT, and HCPCS