Claims Process Optimization Director
virtual vocationsDenver, CO
Claims Process Optimization Director
L7
virtual vocationsDenver, CO4 days ago
Occupations
Medical and Health Services ManagersClaims Adjusters, Examiners, and InvestigatorsGeneral and Operations ManagersIndustries
Claims AdjustingAll Other Insurance Related ActivitiesPharmacy Benefit Management and Other Third Party Administration of Insurance and Pension FundsLeading the design and implementation of automation and AI capabilities in claims operations, the full-time remote Claims Process Optimization Director will manage process oversight, vendor performance, and a team of specialists while driving operational efficiency and performance improvements.
Key responsibilities:
Maintain oversight of claims adjudication workflows and manage the operating budget and vendor performance
Build and prioritize the claims automation and AI roadmap, ensuring measurable benefits and regulatory compliance
Conduct end-to-end analysis of claims workflows to identify constraints and drive process improvements
Required qualifications:
Bachelor's degree in business, health administration, data analytics, or a related field
Seven years of health plan claims or healthcare operations experience
Five years of leadership experience
Practical understanding of automation and AI capabilities in claims work
Working knowledge of claims adjudication platforms and standard code sets including CPT, HCPCS, and ICD-10
Apply now (opens in a new tab)
Level
ManagerL7
Location
Denver, CO
Occupation
Medical and Health Services Managers
Industry
Claims Adjusting
Posted
4 days ago
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