Director, Claims & Payment Integrity (Hybrid)

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

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