Director, Claims

Altais

Base: $129,000 - $154,800pyr; bonus/equity: eligib...
10+ years related experience
7+ years in a leadership role
5+ years bpo/bpaas solutions experience
The Director will provide strategic leadership for claims processing, appeals, and recovery while ensuring adherence to CMS and Knox Keene requirements

Job Summary

  • The Director will provide strategic leadership for claims processing, appeals, and recovery while ensuring adherence to CMS and Knox Keene requirements.
  • This role focuses on driving continuous improvement through automation initiatives to reduce administrative costs and improve turnaround times.
  • Candidates will lead high-performing teams, manage vendor relationships, and present performance dashboards to executive leadership.

Matching Summary

The Director will provide strategic leadership for claims processing, appeals, and recovery while ensuring adherence to CMS and Knox Keene requirements.

Salary

Base: $129,000 - $154,800/yr; Bonus/Equity: Eligible for annual bonus program; Benefits: Medical, vision, dental, 401k match, flexible time off, 9 paid holidays

Skills & Requirements

Must-have

  • 10+ years related experience
  • 7+ years in a leadership role
  • 5+ years BPO/BPaaS solutions experience
  • ICD-10 CPT HCPCS coding conventions
  • Commercial Medicare Advantage claims rules
  • Knox Keene regulatory compliance

Nice-to-have

  • Epic Tapestry system experience
  • HealthRules Payor system experience
  • System integration and replacement skills
  • Strong analytical and project management skills
  • Experience scaling operational teams

Key Requirements

  • Bachelor's Degree or equivalent experience
  • Experience developing and managing department budgets
  • Proven ability to build and lead high-performing operational teams

Work Rights

Not specified

Tailored Resume

Cover Letter