Director, Claims Operations
$113,400–$170,100 year
On-siteMadison, Wisconsin, United States or Minnetonka, Minnesota, United States
Job Summary
Director, Claims Operations responsible for end-to-end claims functions including processing, payment recovery, analysis, and provider appeals; lead a high-performing organization to ensure high-quality, timely, and accurate service across all lines of business; drive operational excellence, budgeting, and strategic initiatives; partner cross-functionally with Payment Integrity, Customer Service, EDI, Configuration, Finance, IT, Compliance/SIU, and Markets; oversee performance management of KPIs and stakeholder reporting; guide workforce strategy and potential BPO partnerships to achieve scalability and cost efficiency; onsite office role with locations in Minnetonka, MN and Madison, WI.
Required Qualifications
- Bachelor's degree or equivalent experience in related field
- 10+ years of work experience beyond degree in healthcare, health plans and/or claims operations
- 5+ years of people leadership experience
- Experience partnering cross-functionally (e.g., Payment Integrity, Finance, IT, Compliance) to deliver end-to-end claims outcomes
- Strong track record of driving operational performance across service, cost, productivity, and quality metrics
- Strong analytical and problem-solving capabilities with a focus on root cause analysis and continuous improvement
Additional Requirements
- Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application.
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.