Strategic Director, Claims Research & Resolution

Jefferson Health Plans; Pennsylvania; Sur place; USD 140 000 - 200 000; Plein temps

Résumé du poste

Health Partners Plans, Inc. is seeking a Director of Claims Research & Resolution to lead strategy, governance, and execution of complex claims issue remediation across multiple departments.

You will oversee a team of analysts, drive root-cause analysis, and implement corrective actions to improve payment accuracy and regulatory compliance. The role requires senior leadership, cross-functional collaboration, and accountability for preventing claims denials while enhancing operational performance

Qualifications

• 7 years progressive experience in insurance claims administration, medical billing, or denials and appeals management.
• 5 years experience in a supervisory or departmental management capacity, demonstrating the ability to lead large teams of analysts.

Responsabilités

• Provide leadership and oversight for intake, investigation, prioritization, and resolution of complex claims issues impacting payment accuracy, provider experience, and operational performance.
• Direct root cause analysis efforts to identify systemic issues and implement corrective actions.
• Establish and maintain monitoring, tracking, and reporting processes to identify payment/denial trends, risks, and improvement opportunities.
• Assist with financial impact assessments and remediation strategies.
• Partner with internal stakeholders to ensure timely issue resolution and accountability for corrective actions.
• Build, develop, and mentor a high-performing team with a culture of accountability and continuous improvement.
• Directs the daily operations of the provider call center to ensure adherence to SLAs and CMS/state requirements.

Connaissances

Leadership

Root cause analysis

Regulatory compliance

Formation

High School Diploma/GED

Description du poste

Health Partners Plans, Inc. is seeking a Director of Claims Research & Resolution to lead strategy, governance, and execution of complex claims issue remediation across multiple departments.

You will oversee a team of analysts, drive root-cause analysis, and implement corrective actions to improve payment accuracy and regulatory compliance. The role requires senior leadership, cross-functional collaboration, and accountability for preventing claims denials while enhancing operational performance