Claims Director

Peyton Resource Group; San Antonio (TX); On-site; USD 95,000 - 115,000; Full time

Job summary

A healthcare organization is seeking a Director of Claims Operations in San Antonio, Texas. This role involves leading the Claims department, ensuring compliance with regulations, and improving operational efficiency. The ideal candidate has over 10 years of experience in healthcare claims and a strong understanding of Medicare guidelines. Leadership skills and familiarity with claims systems are essential. The position offers a competitive salary and full-time employment.

Qualifications

• Minimum of 10 years of experience in healthcare claims or revenue cycle management.
• Strong understanding of Medicare and managed care regulations.
• Demonstrated analytical and problem-solving skills.

Responsibilities

• Lead and manage the Claims department, ensuring compliance.
• Develop and execute strategic goals to improve claims accuracy.
• Supervise, mentor, and evaluate staff performance.

Skills

Leadership

Analytical skills

Communication

Problem-solving

Collaboration

Education

Bachelor’s Degree in Business or Healthcare Administration

Tools

EZCap

EZEDI

Microsoft Excel

Electronic medical record (EMR) software

Job description

Base pay range

$95,000.00/yr - $115,000.00/yr

Overview

The Director of Claims Operations is responsible for overseeing all functions of the Claims department, ensuring compliance with Medicare Advantage, managed care delegation, and regulatory requirements. This leadership role focuses on driving accuracy, timeliness, and operational efficiency while fostering collaboration across departments and maintaining strong relationships with internal and external partners.

Responsibilities

• Lead and manage the Claims department, ensuring all activities comply with organizational policies, payer requirements, and regulatory standards.
• Develop and execute strategic goals to improve claims accuracy, processing efficiency, and departmental performance.
• Supervise, mentor, and evaluate staff performance; provide coaching, feedback, and professional development opportunities.
• Establish and maintain policies, procedures, and productivity standards to guide daily operations.
• Monitor key performance metrics such as claims accuracy, turnaround time, and audit results; identify issues and implement corrective measures.
• Prepare for and support audits by maintaining documentation, ensuring data integrity, and responding to findings promptly.
• Collaborate with departments such as Contracting, Clinical, Finance, and IT to align processes and system updates.
• Communicate effectively with providers, delegated entities, and payers to resolve issues and ensure service excellence.
• Stay current with regulatory and payer updates, incorporating new requirements into department practices.
• Participate in budget planning, resource allocation, and process improvement initiatives.
• Foster a culture of accountability, teamwork, and continuous learning within the department.
• Perform other related duties as assigned.

Qualifications & Experience

• Minimum of 10 years of experience in healthcare claims or revenue cycle management, including at least 5 years in a leadership or managerial role.
• Strong understanding of Medicare and managed care regulations, including Medicare Advantage guidelines.
• Experience with delegated claims operations, audits, and payer compliance.
• Demonstrated analytical and problem-solving skills with the ability to interpret and validate complex data sets and reports.
• Excellent communication, leadership, and interpersonal skills with a focus on collaboration and team development.
• Proficiency in claims systems such as EZCap, EZEDI, or similar platforms, and advanced knowledge of Microsoft Excel.
• Experience with electronic medical record (EMR) software is required.

Education

• Bachelor’s Degree in Business, Healthcare Administration, or a related field preferred.
• In lieu of degree, a minimum of 10 years of relevant experience will be considered.

Employment type

• Full-time

Job function

• Finance

Industries

• Hospitals and Health Care