Director of Claims and Encounters
HJ Staffing
full-time
Posted on:
Location Type: Office
Location: Albuquerque • California, Illinois, New Mexico, New York, North Dakota, Ohio, Washington, Wyoming • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- Provide strategic leadership and operational excellence for Claims Operations
- Direct the Encounters Resolution team for Medicaid rate setting
- Monitor budgets and manage variance reporting
- Ensure regulatory compliance across areas, particularly NM Medicaid compliance
- Support resolution of complex benefit and provider process issues
- Partner with technical SMEs to enhance automation and process simplification
Requirements
- Bachelor’s degree in Finance, Business, Healthcare, or a related field (MBA preferred)
- 10+ years of healthcare-specific operational leadership with a focus on Health Plan Claims Operations
- 5+ years of experience leading within a complex, highly matrixed function
- Deep understanding of Health Care industry operations, delivery models, and revenue models
- Experience with Jiva and HRP is highly preferred.
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Professional development
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
budget managementvariance reportingregulatory complianceprocess automationprocess simplificationhealthcare operationsclaims operationsMedicaid rate settinghealthcare delivery modelsrevenue models
Soft skills
strategic leadershipoperational excellenceproblem resolutioncollaborationcommunication
Certifications
Bachelor’s degreeMBA