Director of Claims Operations & Strategy

Providers; Reno (NV); On-site; USD 150,000 - 190,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Competitive Compensation & Generous PT

Excellent Medical, Dental, Vision, Rx

401(K) with company match

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

Prominence Health is seeking a Director of Claims to lead the strategic direction, planning, and execution of all claims operations. The role requires ensuring compliance with federal, state, and payer regulations while driving innovation through technology and process optimization.

The Director will collaborate with executive leadership to align claims with organizational goals, manage departmental budgets, and lead cross-functional initiatives to improve service delivery, quality, and

Qualifications

• Bachelor’s degree in health care administration or business management, or equivalent work experience.
• 5+ years’ experience in claims management with direct Medicare claims experience.
• 5+ years’ experience managing, budgeting, forecasting and collaboration with executive leadership.
• Strong leadership with cross-functional collaboration and influence.
• Deep understanding of CPT/ICD-10 and insurance billing practices.
• Knowledge of HIPAA, CMS guidelines, and regulatory audits.

Responsibilities

• Lead strategic direction for claims operations and ensure regulatory compliance.
• Oversee departmental leadership and budgets; drive cross-functional initiatives.
• Collaborate with executive leadership to align claims with organizational goals.
• Drive innovation through technology and process optimization.
• Promote data-driven decision making across the organization.
• Manage large-scale projects and claims adjudication improvements (QNXT preferred).

Skills

Leadership

Regulatory compliance

Stakeholder management

Healthcare claims knowledge

Data-driven decision making

Project management

Education

Bachelor’s degree in health care administration or business management, or equivalent work experience

Tools

QNXT

MS Office

Regulatory audit preparation tools

Job description

Prominence Health is seeking a Director of Claims to lead the strategic direction, planning, and execution of all claims operations. The role requires ensuring compliance with federal, state, and payer regulations while driving innovation through technology and process optimization.

The Director will collaborate with executive leadership to align claims with organizational goals, manage departmental budgets, and lead cross-functional initiatives to improve service delivery, quality, and