Senior Claims Operations Director

Dwihn; Detroit (MI); On-site; USD 120,000 - 180,000; Full time

Job summary

Detroit Wayne Integrated Health Network (DWIHN) seeks a Senior Administrator of Claims to provide strategic leadership and administrative oversight for the Detroit claims function. The role ensures accurate, timely adjudication and payment of provider claims in accordance with Medicaid/Medicare, MDHHS, and internal policies.

Collaboration with finance, operations, compliance, IT, and network management is essential to optimize performance and manage risk.

Qualifications

• Requires a bachelor’s degree in a related field such as healthcare administration, public health, or social services.
• 5+ years of professional experience in claims administration or healthcare management.
• Experience in executive/administrative leadership within healthcare or behavioral health.

Responsibilities

• Provide strategic leadership and administration of the claims unit to align with organizational goals.
• Oversee adjudication, payment integrity, and regulatory compliance for provider claims.
• Develop policies, procedures, and internal controls to ensure accuracy and efficiency.
• Monitor KPIs, manage staff performance, and ensure audit readiness.
• Collaborate with Finance, Compliance, IT, and Provider Network teams to optimize operations.

Skills

Strategic leadership

Claims operations management

Policy development

Regulatory compliance

Data analysis

Project management

Education

Bachelor's degree in Healthcare Administration

Bachelor's degree in Public Health

Tools

Claims management systems

Microsoft Excel

Job description

Detroit Wayne Integrated Health Network (DWIHN) seeks a Senior Administrator of Claims to provide strategic leadership and administrative oversight for the Detroit claims function. The role ensures accurate, timely adjudication and payment of provider claims in accordance with Medicaid/Medicare, MDHHS, and internal policies.

Collaboration with finance, operations, compliance, IT, and network management is essential to optimize performance and manage risk.