Director, Provider Operations & Claims Excellence

SOS International; San Antonio (TX); On-site; USD 150,000 - 190,000; Full time

Job summary

A global health service organization is seeking a Head of Provider Operations to lead the operational delivery and performance of TRICARE services in San Antonio, Texas. This role is crucial for managing claims operations, ensuring quality control, and facilitating effective provider support. Ideal candidates will have a strong background in healthcare claims processing, exceptional leadership skills, and the ability to drive continuous improvement and vendor management. The position requires travel up to 40% of the time and offers an opportunity to make a significant impact in the healthcare field.

Qualifications

• Deep expertise in medical and healthcare claims processing with hands-on experience.
• Ability to interpret performance data and drive data-driven decisions.
• Knowledge of credentialing controls and data governance processes.

Responsibilities

• Lead operational delivery and performance of provider-facing services for TRICARE.
• Define operational structure and maintain performance metrics.
• Ensure audit readiness through robust process controls.

Skills

Provider operations understanding

Claims processing expertise

Analytical skills

Vendor management expertise

Leadership in matrix environments

Excellent communication

Education

Bachelor’s degree in business or related field

Master’s degree preferred

Job description

A global health service organization is seeking a Head of Provider Operations to lead the operational delivery and performance of TRICARE services in San Antonio, Texas. This role is crucial for managing claims operations, ensuring quality control, and facilitating effective provider support. Ideal candidates will have a strong background in healthcare claims processing, exceptional leadership skills, and the ability to drive continuous improvement and vendor management. The position requires travel up to 40% of the time and offers an opportunity to make a significant impact in the healthcare field.