Senior Claims Operations Leader

DETROIT WAYNE Integrated HEALTH Network; Detroit (MI); On-site; USD 110,000 - 160,000; Full time

Job summary

DETROIT WAY Integrated HEALTH Network seeks a Senior Administrator of Claims to provide strategic leadership and administrative oversight of the claims unit. You will assure accurate, timely adjudication and payment of provider claims in line with Medicaid/Medicare guidelines, MDHHS requirements, and contractual obligations.

In collaboration with executive leadership and cross-functional teams, you will develop policies, strengthen internal controls, monitor performance, and drive data-driven

Responsibilities

• Provide strategic direction and administrative oversight of the Claims Unit.
• Develop and evaluate goals, plans, and performance standards for claims processing.
• Direct daily claims intake, adjudication, payment processing, and reconciliation.
• Establish controls to ensure accuracy, timeliness, and compliance.
• Monitor KPIs, prepare management reports, and drive improvement initiatives.
• Coordinate with Finance and Compliance to resolve discrepancies.

Skills

Strategic leadership

Claims administration

Regulatory compliance

Audit readiness

Staff leadership

Financial oversight

Job description

DETROIT WAY Integrated HEALTH Network seeks a Senior Administrator of Claims to provide strategic leadership and administrative oversight of the claims unit. You will assure accurate, timely adjudication and payment of provider claims in line with Medicaid/Medicare guidelines, MDHHS requirements, and contractual obligations.

In collaboration with executive leadership and cross-functional teams, you will develop policies, strengthen internal controls, monitor performance, and drive data-driven