Director of Claims

E-Verify Program

. Set team priorities that align with the organization’s core values, strategic objectives, and key deliverables .

Posted 4/30/2026full-timeNorth Carolina • 🇺🇸 United StatesLead💰 $143,616 - $229,786 per yearWebsite

About the role

Key responsibilities & impact

Set team priorities that align with the organization’s core values, strategic objectives, and key deliverables
Direct end‑to‑end claims processing, adjustments, and financial recovery activities across commercial, government, and inter‑plan lines of business, leveraging data‑driven analytics to inform decisions and execution
Partner with operational leads and workforce management to supplement strategy with the development of budgets, staffing models, and operational performance standards
Lead claims process standardization and automation initiatives in partnership with the Continuous Improvement function
Collaborate with the Business Advisory team to identify and deliver claims process improvements, including Lean Six Sigma initiatives
Approve business and technical requirements, oversee initiatives, and prioritize decisions to effectively address evolving business needs
Partner with the Vendor Management Lead to identify and capture value through alternative staffing models and vendor solutions
Collaborate with providers and people leaders to develop and implement tailored customer strategies that improve performance and outcomes
Develop, coach, and motivate leaders and team members to reinforce core values and advance the target operating model
Leverage and advance analytical capabilities to support strategy execution and operational performance management
Resolve complex escalations and contribute to training development to maintain and improve service delivery
End to end inventory management to align with all regulatory, Internal, external and other applicable processing guidelines and timeliness expectations; includes evaluating and adjusting all processing guidelines as required to meet customer expectations
Report operational updates to the Claims AVP and Health Plan Operations VP; serve as a subject matter expert for Claims Operations

Requirements

What you’ll need

Bachelor's degree or advanced degree (where required)
10+ years’ experience in Health Care Delivery and Operations
In lieu of degree, 12+ years of experience in related field.
Deep health plan claims and service expertise
5+ years of progressive leadership experience
Strong analytical skills with the ability to drive transformational, consumer centric change while managing operations – highly preferred
Six Sigma/Continuous improvement experience - highly preferred

Benefits

Comp & perks

Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data-driven analyticsclaims processingfinancial recoverybudget developmentstaffing modelsoperational performance standardsclaims process standardizationautomation initiativesLean Six Sigmainventory management

Soft Skills

leadershipcoachingmotivationcollaborationproblem-solvingcommunicationstrategic thinkingdecision-makingtraining developmentcustomer strategy development

Certifications

Six Sigma