Director, Claims Solutions
RemoteDubuque, Iowa, United States
Job Summary
Lead strategy, performance, and growth for CBCS's ancillary claim solutions portfolio by overseeing vendor partnerships, solution design, and go-to-market execution. Select, negotiate, and manage relationships with solution providers while monitoring performance against KPIs and service standards. Develop pricing strategies, ROI analyses, and cost-benefit models to oversee profitability across all solution lines. Drive increased utilization and penetration by partnering with claims operations to embed solutions into workflows and lead change management efforts. Serve as subject matter expert, delivering training to claims, account management, and client service teams while fostering cross-functional collaboration. Travel approximately 25–30% for vendor visits, conferences, and internal training.
Required Qualifications
- Bachelor's degree in Business, Risk Management, Insurance, Healthcare Administration, or related field
- 10+ years of progressive experience in Property & Casualty claims
- Deep knowledge of managed care, litigation support, investigation, and Medicare compliance solutions
- Proven vendor management and contract negotiation experience
- Experience driving solution utilization and financial performance
- Strong financial analysis and P&L experience
- Travel approximately 25–30% for vendor visits, conferences, client engagements, and internal training
Desired Qualifications
- Master's degree or designations (ARM, CPCU, AIC, CCM, etc.)
- Experience in a TPA environment
- Advanced knowledge of Medicare compliance
- Background in program implementation or change management
- Familiarity with claims technology platforms
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