Director, Claims - Health Plan

Summa Health; Cleveland (OH); Hybrid; USD 75,000 - 113,000; Full time

Benefits offered by this job

Health insurance

Retirement Savings Plan

Paid time off

Employee Assistance Program

Job summary

SummaCare in Akron, OH seeks a Director of Claims to lead a team responsible for processing claims, recoveries, document management, and mail services across Medicare Advantage, Fully Insured, MEWA, and Self-Funded lines. You will strengthen payment integrity and drive automation to improve performance and the customer experience.

The role requires a Bachelor degree, 5 years of management experience in claims operations, knowledge of Medicare and ERISA, and strong leadership and analytical

Qualifications

• Bachelor degree or equivalent combination of education and/or experience.
• Five years of progressively responsible claims management and leadership.
• Experience across Medicare Advantage, Fully Insured, MEWA, and Self-Funded lines.
• Knowledge of Medicare, ERISA, and health care regulations.
• Ability to lead, train, and develop staff; communicate effectively.

Responsibilities

• Lead a team processing claims, recoveries, document management and mail services across multiple lines of business.
• Establish policies and procedures to meet production and regulatory performance measures.
• Provide guidance to department managers to achieve objectives and improve performance.
• Demonstrate strong leadership, analytical, and problem-solving skills.
• Maintain knowledge of regulatory requirements and ensure confidentiality and compliance.

Skills

Leadership

Analytical thinking

Communication skills

Problem solving

Regulatory knowledge

Education

Bachelor degree or equivalent

Job description

Hybrid

Behind every claim is a member who got care, a provider who delivered it, and a promise SummaCare made to both. As our Director, Claims, you’ll make sure we keep that promise accurately, quickly, and fairly. You’ll lead a talented team processing claims, recoveries, document management and mailroom activities across Medicare Advantage, Fully Insured, MEWA, and Self-Funded lines of business. You’ll strengthen payment integrity, push automation forward, and turn data into decisions that improve both performance and the experience of the people we serve.

SummaCare - 1200 E Market St, Akron, OH

Full-Time / 40 Hours / Days

Hybrid

Behind every claim is a member who got care, a provider who delivered it, and a promise SummaCare made to both. As our Director, Claims, you’ll make sure we keep that promise accurately, quickly, and fairly. You’ll lead a talented team processing claims, recoveries, document management and mailroom activities across Medicare Advantage, Fully Insured, MEWA, and Self-Funded lines of business. You’ll strengthen payment integrity, push automation forward, and turn data into decisions that improve both performance and the experience of the people we serve.

Provides direction and guidance to Claims, Document Management, Recovery and Mail Services areas. Establishes policies & procedures to ensure production staff achieve Corporate and Regulatory Performance Measures, while adhering to applicable legislative requirements.

• Formal Education Required: Bachelor Degree or equivalent combination of education and/or experience
• Experience and Training Required:
• Five (5) years of expanding scope of responsibilities performing same or similar functions. Relevant experience includes: Management of claims processing, customer service (including call center management), eligibility, and billing functions within a health insurance company, health plan or TPA, and across multiple lines of business (e.g. Medicare, Medicaid, Commercial, Self-funded Groups, Exchanges). Knowledge of Medicare, ERISA, and other health care regulations that impact health insurance operations also required.
• Other Skills, Competencies and Qualifications:
• Provides guidance and direction to department managers to accomplish departmental and company objectives.
• Directs and motivates managers to enhance personal and departmental performance.
• Provides guidance to resolve performance issues in timely and positive manner to achieve corrective action.
• Identifies and provides appropriate departmental training to keep staff skills and knowledge current. Demonstrate strong leadership and management skills.
• Demonstrate excellent analytical and problem-solving skills with ability to think outside the box and develop unique solutions to a variety of complex issues.
• Make sound decisions and recommendations based on consideration of facts, priorities, resources, and constraints
• Communicate effectively both internally and externally.
• Detail-oriented with well-developed financial management, analytical, and organizational skills.
• Organize and manage time to accurately complete tasks within designated time frames in fast paced environment.
• Maintain current knowledge of and comply with regulatory and company policies & procedures.
• Maintain confidentiality of member health and business information.
• Ability to adjust work hours to meet business demands
• Population Specific Competency: Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity
• Level of Physical Demands:
• Light: Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously.

Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

Equal Opportunity Employer/Veterans/Disabled

$54.76/hr - $82.14/hr

The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.

Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.

• Basic Life and Accidental Death & Dismemberment (AD&D)
• Supplemental Life and AD&D
• Dependent Life Insurance
• Short-Term and Long-Term Disability
• Accident Insurance, Hospital Indemnity, and Critical Illness
• Retirement Savings Plan
• Flexible Spending Accounts – Healthcare and Dependent Care
• Employee Assistance Program (EAP)
• Identity Theft Protection
• Pet Insurance
• Education Assistance
• Daily Pay