Operations Support Director, Claims
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Job Description
Operational Support Director responsible for managing project implementations and process improvements in Medical Claims Operations. Leading teams and driving innovation while ensuring regulatory alignment.
Responsibilities:
- Lead and manage cross-functional project implementation within Provider Operations
- Drive continuous process improvement and foster a culture of innovation
- Serve as the primary escalation point for production support needs
- Develop, manage, and mentor teams of subject matter experts
- Proactively communicate with a diverse range of stakeholders
- Define and lead the multi-year automation roadmap
- Oversee Auto Adjudication (AA) performance and enhancement efforts
- Partner and define requirements, develop automations, and own post-implementation controls
- Ensure compliant implementation and operational oversight for systems
- Lead system release cycles and testing processes
- Identify potential operational risks and implement mitigation strategies
- Identify opportunities for cost savings while maintaining service delivery standards.
Requirements:
- High School Diploma or GED required
- Bachelor’s degree in Business, Operations Management, or a related field preferred
- 8+ years progressive leadership experience within Medical Claims Operations
- Proven ability to operate at a director level, influencing senior and executive leaders
- Deep experience in operational transformation, automation strategy, system modernization, and scaling innovation
- Strong track record of delivering complex initiatives with measurable business impact
- Demonstrated success working within highly matrixed organizations
- Strategic thinker with the ability to translate vision into executable plans
- Exceptional stakeholder management, communication, and executive presence
- Strong risk management mindset
- Excellent written, verbal, and active listening skills.
Benefits:
- Health insurance
- Vision insurance
- Dental insurance
- Well-being and behavioral health programs
- 401(k)
- Company paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
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