Director, Strategic Claims Research & Resolution

Jefferson Health; Philadelphia (Philadelphia County); Hybrid; USD 130,000 - 190,000; Full time

Benefits offered by this job

Medical insurance

Tuition discounts

Retirement plans

Job summary

Jefferson Health in Philadelphia seeks a Director to lead strategy, governance, and execution for complex claims issues. You will oversee an analytical team and collaborate across Operations, Healthcare Economics, Configuration, Pricing, and Provider Network to improve payment accuracy and regulatory compliance.

The role requires extensive leadership experience, strong analytical skills, and a track record of developing high-performing teams while ensuring SLAs and regulatory alignment across

Qualifications

• Deep operational experience handling complex disputes and contract terms.
• Experience with medical coding reconsiderations and data quality issues.
• Proven ability to lead large teams of analysts.

Responsibilities

• Provide leadership for intake, investigation, prioritization and resolution of complex claims issues.
• Direct root cause analysis across cross-functional teams to identify systemic flaws.
• Establish monitoring, tracking and reporting of denial trends and risks.
• Mentor a high-performing team and ensure accountability for corrective actions.
• Oversee daily provider call center operations to meet SLAs and CMS/state regulations.

Skills

Operations leadership

Root cause analysis

Regulatory compliance

Team leadership

Education

High School Diploma/GED

Job description

Jefferson Health in Philadelphia seeks a Director to lead strategy, governance, and execution for complex claims issues. You will oversee an analytical team and collaborate across Operations, Healthcare Economics, Configuration, Pricing, and Provider Network to improve payment accuracy and regulatory compliance.

The role requires extensive leadership experience, strong analytical skills, and a track record of developing high-performing teams while ensuring SLAs and regulatory alignment across