Health Insurance Operations Director

New

Skills

Microsoft Office Regulatory Compliance Verbal communication Written Communication

Job Overview

Sets vision and governance for Part C authorizations and claims processing. Manages end-to-end encounter data operations and regulatory compliance. Oversees day-to-day adjudication operations to ensure timely, accurate outcomes. Builds scalable processes for accurate authorizations, adjudication, and data quality. Partners with cross-functional teams to resolve data discrepancies and production issues. Provides leadership with actionable insights to drive continuous improvement.

Responsibilities
  • Sets vision and governance for Part C authorizations and claims processing
  • Manages end-to-end encounter data operations and regulatory compliance
  • Oversees day-to-day adjudication operations to ensure timely, accurate outcomes
  • Builds scalable processes for accurate authorizations, adjudication, and data quality
  • Partners with cross-functional teams to resolve data discrepancies and production issues
Requirements & Qualifications
  • Bachelor's degree required; Master's preferred
  • 8+ years in health insurance operations with leadership
  • Deep expertise in claims processing and utilization management
  • Experience with encounter data processing, reporting KPIs, and data quality
  • Ability to lead cross-functional teams and present insights to senior leadership
  • Proficient in Microsoft Office; excellent verbal and written communication

Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: 12 Months

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