Job Description

The Company

This health system is a nonprofit healthcare organization committed to serving people with complex healthcare needs in the mid-Atlantic region. The system combines the resources of a health plan, pediatric specialty hospital, home health agency and parent foundation to provide the best care possible for its patients. 


The Position

Reporting to the VP of Process Reengineering & Chief of Staff, the Director of Claims Operations is responsible for the day to day oversight of the Claims Operations department.  The position will identify process improvements and implement short and long range goals, coordinate claims operations staff, enhance claims business development efforts, and continually focus on optimization in the areas of compliance, quality and reporting.  The Director, Claims Operations is responsible for ensuring compliance with company policies, procedures, State and Federal regulatory requirements for all claims operations under their management.  This position works closely with other plan leadership to identify opportunities for innovation.


The Successful Candidate

The successful Director of Claims Operations will minimally possess:

  • Seven (7) or more years’ experience in health care managed care operations required.
  • In-depth knowledge of ICD-10 and CPT coding.
  • Must be a high-energy, dynamic leader who enjoys mentoring and managing people.
  • Excellent verbal and written communication skills and the ability to effectively collaborate with other departments in the successful resolution of operational issues.
  • Strong leadership skills in the areas of staff development, performance improvement with demonstrated results.  Ability to foster a cohesive working environment.
  • Bachelor’s degree in healthcare, business, or related field.
  • Proficiency with MS Office and common web-based applications.
  • Track record of success and achievement in high-accountability environments.



The successful candidate will be a highly skilled member of the organization’s leadership team. Included in the compensation package is:

  • Highly competitive salary.
  • Medical, Dental, and Vision insurance.
  • 401-K match.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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