Strategic Director, Claims Operations & Payment Integrity

VNS Health; New York (NY); On-site; USD 138,000 - 184,000; Full time

Job summary

VNS Health seeks a strategic leader to oversee Claims Operations Support, Claims Service Operations, and Claims Payment Integrity across managed care lines. You will drive performance standards, executive reporting, and cross-functional collaboration to ensure timely payments and high-quality claims processing.

Ideal candidates have extensive healthcare management experience, deep knowledge of Medicare/Medicaid reimbursement, and proven leadership in high-volume environments.

Qualifications

• Bachelor's Degree in Business Administration, Healthcare Administration, related field, or equivalent work experience required.
• Master's Degree in Business Administration, Healthcare Administration, related field, or equivalent work experience preferred.

Responsibilities

• Provide strategic leadership and direct oversight for Claims Operations Support, Claims Service Operations, and Claims Payment Integrity across managed care lines.
• Establish performance standards, executive reporting, and cross-functional accountability for claims quality, turnaround, auto-adjudication, and payment accuracy.
• Direct provider disputes and service escalation oversight, DOH/DFS complaint investigation support, and audits.
• Lead data-driven workflow redesign, controls, automation opportunities, and root-cause remediation to reduce payment defects.
• Own and improve the provider claims experience, ensuring timely, accurate, and transparent communications.

Skills

Data analytics

Leadership

Healthcare management

Claims processing

Regulatory compliance

Education

Bachelor's degree in Business Administration/Healthcare Administration/related field

Master's degree in Business Administration/Healthcare Administration/related field (preferred)

Job description

VNS Health seeks a strategic leader to oversee Claims Operations Support, Claims Service Operations, and Claims Payment Integrity across managed care lines. You will drive performance standards, executive reporting, and cross-functional collaboration to ensure timely payments and high-quality claims processing.

Ideal candidates have extensive healthcare management experience, deep knowledge of Medicare/Medicaid reimbursement, and proven leadership in high-volume environments.