Director, Claims Support
$144,368–$238,207 year
Remote · California, United States or Arizona, United States
Job Summary
Director, Claims Support responsible for strategic and operational leadership of CareMore Health's claims administration, including intake, adjudication, payment, adjustment, and provider reimbursement across multiple markets. Leads compliance with CMS/Medicare Advantage/Medicaid and state regulations, establishes operational metrics and continuous improvement initiatives (automation, efficiency, payment accuracy), partners with providers and internal stakeholders to resolve issues, and coaches managers across locations. Requires extensive healthcare claims operations experience, strong leadership, and collaboration with cross-functional teams and external organizations to ensure timely, accurate, and compliant claims processing.
Required Qualifications
- Bachelor's degree in Business Administration, Healthcare Administration, Finance, Public Health, or related field, or equivalent experience
- Minimum 9 years of progressive healthcare claims operations experience
- Minimum 5 years of leadership experience managing managers and/or large operational teams
- Experience within Medicare Advantage, Medicaid, Managed Care, Health Plan, or Payer environments
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