Senior Director, Claims Ops & Strategy

MetroPlusHealth; New York (NY); Hybrid; USD 180,000 - 280,000; Full time

Job summary

MetroPlusHealth is seeking a Senior Director of Claims to provide strategic and operational leadership for the Claims Department. The role serves as the primary deputy to the Vice President of Claims, directing claims administration, processing, configuration testing, QA, auditing, and regulatory compliance.

The position is responsible for daily execution of claims operations, improving auto-adjudication rates, and delivering executive dashboards and scorecards to guide senior leadership

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Information Systems, or a related field required; Master's degree preferred.
• Eight or more years of progressive health plan claims operations experience.
• Seven or more years of leadership experience managing managers and senior leaders.
• Experience with Medicare, Medicaid, Commercial, Marketplace, and Special Needs products.
• Experience leading regulatory audits, operational transformation initiatives, and large-scale teams.
• Extensive knowledge of managed care claims administration and claims systems.
• Strong understanding of CMS and New York regulatory requirements.

Responsibilities

• Serve as second-in-command to the VP of Claims and act on behalf when designated.
• Direct all medical, behavioral health, and delegated BPaaS claims operations.
• Ensure timely, accurate, and compliant adjudication of claims across all product lines.
• Lead enterprise-wide projects involving claims operations, automation, and system modernization.
• Develop and execute short- and long-term strategic plans for the Claims organization.
• Provide executive reporting and recommendations to senior leadership.
• Oversee delegated entities and monitor vendor performance against SLAs.

Skills

Executive leadership

Claims operations

Regulatory compliance

Strategic planning

Data analysis

Vendor management

Cross-functional leadership

Education

Bachelor's degree in Healthcare Administration or related field

Master's degree preferred

Job description

MetroPlusHealth is seeking a Senior Director of Claims to provide strategic and operational leadership for the Claims Department. The role serves as the primary deputy to the Vice President of Claims, directing claims administration, processing, configuration testing, QA, auditing, and regulatory compliance.

The position is responsible for daily execution of claims operations, improving auto-adjudication rates, and delivering executive dashboards and scorecards to guide senior leadership