AVP, Medical Claims Operations & Client Leadership

Davies Group; Northern (KY); Hybrid; USD 180,000 - 240,000; Full time

Job summary

Davies Group is seeking an Assistant Vice President of Medical Claims Operations in the United States to lead the medical claims management team, oversee medical excess and reinsurance claims, and ensure payment integrity for client programs.

You will direct staff, manage client relationships, review complex claims, and drive quality, efficiency, and compliance with CMS and payer requirements.

Qualifications

• Seasoned experience (10 years +) in medical claims management and related operations.

Responsibilities

• Lead claims staff including Claims Directors, Examiners, and Assistants; coach and manage performance.

Skills

Medical claims

Managed care

Payment integrity

Provider risk

Employer stop loss

Leadership

Client service

Analytical

Problem solving

MS Word/Excel

Tools

Claims Adjudication System

Job description

Davies Group is seeking an Assistant Vice President of Medical Claims Operations in the United States to lead the medical claims management team, oversee medical excess and reinsurance claims, and ensure payment integrity for client programs.

You will direct staff, manage client relationships, review complex claims, and drive quality, efficiency, and compliance with CMS and payer requirements.