Senior Director, Claims Operations & Strategy

Prominence Health; Reno (NV); Sur place; USD 140 000 - 190 000; Plein temps

Avantages offerts par ce poste

Loan Forgiveness Program

Competitive Compensation

Excellent Medical, Dental, Vision and

401(K) with company match and stock

SoFi Student Loan Refinancing Program

Career development opportunities

Résumé du poste

Prominence Health is seeking a Director of Claims to lead strategic direction, planning, and execution of all claims operations. You will oversee leadership, ensure compliance with federal, state, and payer regulations, and drive innovation through technology and process optimization.

The ideal candidate has extensive Commercial, ASO, Medicare and Medicaid claims experience, expertise in claims adjudication systems (QNXT preferred), and a strong record of strategic leadership in healthcare

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, budgeting, forecasting and collaboration with executive leadership.

Responsabilités

• Lead strategic direction, planning, and execution of all claims operations.
• Ensure compliance with federal, state, and payer regulations.
• Drive innovation through technology and process optimization.

Connaissances

Claims management

Leadership

Budgeting

Forecasting

Regulatory compliance

HIPAA knowledge

Project management

QNXT experience

Medical terminology

Communication

Formation

Bachelor’s degree in health care administration or business management

Outils

QNXT system

Description du poste

Prominence Health is seeking a Director of Claims to lead strategic direction, planning, and execution of all claims operations. You will oversee leadership, ensure compliance with federal, state, and payer regulations, and drive innovation through technology and process optimization.

The ideal candidate has extensive Commercial, ASO, Medicare and Medicaid claims experience, expertise in claims adjudication systems (QNXT preferred), and a strong record of strategic leadership in healthcare