The role serves as a critical interface between client relationships, external stakeholders, and internal teams to align transformation efforts with industry standards
Job Summary
The role serves as a critical interface between client relationships, external stakeholders, and internal teams to align transformation efforts with industry standards.
Candidates will drive initiatives to increase straight-through processing, reduce manual effort, and enhance adjudication accuracy using advanced analytics and AI.
This position requires a leader who can foster a culture of innovation while ensuring seamless collaboration across underwriting, actuarial, and technology teams.
Matching Summary
The role serves as a critical interface between client relationships, external stakeholders, and internal teams to align transformation efforts with industry standards.
Skills & Requirements
Must-have
7+ years healthcare insurance experience
Claims transformation leadership
AI and automation in claims workflows
Provider risk management expertise
Regulatory compliance knowledge
Nice-to-have
Consulting background preferred
Medical degree or MBA advantageous
Strong stakeholder influence skills
Data-driven decision making
Resilient operator mindset
Key Requirements
Over 7 years of experience in provider management or medical claims
Demonstrated experience leading claims transformation initiatives
Prior consulting experience in strategy or health systems preferred