Director of Claims — Strategy & Innovation in Value-Based Care

UHS; Reno (NV); On-site; USD 140,000 - 220,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Challenging and rewarding work环境

Competitive Compensation & Generous PT

Excellent Medical, Dental, Vision and药

401(K) with company match and stock

SoFi Student Loan Refinancing Program

Career development opportunities

Benefits details at benefits.uhsguest

Job summary

Prominence Health, part of Universal Health Services, seeks a Director of Claims to lead the strategic direction and execution of all claims operations. You will oversee leadership, ensure regulatory compliance, and drive innovation through technology and process optimization, aligning with organizational goals and budgets.

The ideal candidate has extensive Commercial, ASO, Medicare and Medicaid claims experience, expertise in claims adjudication systems (QNXT preferred), and a proven track

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 budgets, forecasting and collaboration with executive leadership.
• Strong leadership skills with an ability to influence and persuade internally and externally while driving cross-functional collaboration.
• Deep understanding of medical terminology, coding systems (CPT, ICD-10), and insurance billing practices.
• Comprehensive knowledge of healthcare regulations, including HIPAA, CMS guidelines, state laws and experience in information preparation for required regulatory audits.
• Ability to promote data driven decision making throughout the organization.
• Knowledge of benefits, pricing and inventory management and reporting.
• Experience with software implementation and technology adoption; familiarity with claims systems (QNXT preferred).
• Outstanding interpersonal skills and communication abilities.

Responsibilities

• Lead strategic direction and execution of all claims operations.
• Ensure compliance with federal, state, and payer regulations.
• Drive innovation through technology and process optimization.
• Collaborate with executive leadership to align claims operations with organizational goals.
• Manage departmental budgets and lead cross-functional initiatives to improve service delivery, quality, and efficiency.

Skills

Leadership

Medicare claims

Claims management

Data driven decisions

Regulatory knowledge

Regulatory audits

Education

Bachelor’s degree in health care administration or business management

Tools

QNXT system

MS Office

Job description

Prominence Health, part of Universal Health Services, seeks a Director of Claims to lead the strategic direction and execution of all claims operations. You will oversee leadership, ensure regulatory compliance, and drive innovation through technology and process optimization, aligning with organizational goals and budgets.

The ideal candidate has extensive Commercial, ASO, Medicare and Medicaid claims experience, expertise in claims adjudication systems (QNXT preferred), and a proven track