Director of Claims, Enrollment

Denver Health

. Lead daily operational management of claims, enrollment, and credentialing .

Posted 11/10/2026full-timeDenver • Colorado • United StatesLead💰 $140,000 - $231,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive leadership in claims and enrollment management, with a strong focus on regulatory compliance, vendor oversight, and process improvement. Proficient in managing claims processing for Medicare and Medicaid, with a solid understanding of industry regulations and coding standards.

Highest-signal resume keywords

Claims Processing ManagementVendor OversightRegulatory ComplianceData AnalyticsLeadership Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationBenefit ConfigurationProcess Flow ImplementationSystem DevelopmentClaims CodingData ReportingFraud DetectionPolicy DevelopmentContinuous ImprovementRisk Assessment

Soft Skills

Effective CommunicationLeadershipTeam ManagementProblem SolvingTraining and Development

Tools & Technologies

Trizetto QNXTMicrosoft WordMicrosoft ExcelMicrosoft AccessMicrosoft PowerPoint

Industry Keywords

MedicareMedicaidCMS RegulationsColorado Department of Health Care Policy & FinancingHEDISNCQABundled PaymentsRisk-SharingProvider CapitationClaims Forms

About the role

Key responsibilities & impact

Lead daily operational management of claims, enrollment, and credentialing
Provide strategic oversight of encounters and system configuration functions
Enforce CMS, Colorado Medicaid, Colorado Division of Insurance, and contractual requirements
Oversee weekly and monthly encounters submission processes and improve rejection rates and acceptance outcomes
Drive improved claims-processing configuration and manage seasonal and annual benefits configuration changes
Oversee four internal teams and vendor partners
Manage vendor oversight, audits, risk assessments, continuous monitoring, KPIs, metrics, and remediation
Lead audit planning and execution to assess vendor performance, compliance, and contractual service levels
Use data analytics, automation, and reporting to improve vendor auditing
Lead issue resolution and corrective and preventive actions
Communicate audit findings, performance metrics, and risk assessments to senior leadership and stakeholders
Facilitate dialogue with vendors and drive continuous improvement
Implement operational changes to maintain regulatory compliance
Update system configuration and team operating procedures to align claims processing and payment with Utilization Management policies
Collaborate with Contracting and Provider Relations teams on contract compliance and inconsistencies
Develop, modify, review, and implement policies and procedures for pricing changes, contractual modifications, and adjustments
Monitor and detect potential fraud and abuse and share findings with Payment Integrity and Compliance teams
Hire, train, supervise, evaluate, and develop Claims and Enrollment Managers
Develop, review, and present productivity and accuracy reports
Develop comprehensive training programs and ensure adherence to claims policies and procedures

Requirements

What you’ll need

Bachelor's Degree required
Seven to ten years in a leadership role within claims and enrollment management and oversight, including overseeing benefit configuration, effective process flow implementation, and maintenance for commercial and government product lines required
Experienced in managing claims processing for Medicare and Medicaid required
Experience with CHP+, Large Group Commercial, or Healthcare Exchange preferred
Experience in credentialing operations preferred
Demonstrated track record in creating approaches, policies, and procedures to ensure effectiveness of the claims payment and adjudication process at a health plan
Solid system development and evaluation abilities
Effective leadership and management skills
Outstanding written and oral communication skills
Experience and proficiency with Trizetto QNXT highly desired
Knowledge of Medicare, Medicaid, and commercial fee-for-service schedules
Knowledge of CMS and Colorado Department of Health Care Policy & Financing (HCPF) industry regulations
Knowledge of claims forms and coding types, including UB-04, CMS 1500, ICD-9, ICD-10, HCPC, Revenue Codes, and NDC coding
Knowledge of HIPPA, HEDIS, and NCQA
Knowledge of bundled payments, risk-sharing, and provider capitation
Proficient with Microsoft Word, Excel, Access, PowerPoint, and claims adjudication systems
Able to perform effectively in a leadership role and evaluate processes for efficiency
Experienced in supervising staff and ensuring key tasks and goals are met on a timely basis
All job applicants for safety-sensitive positions must pass a pre-employment drug test after a conditional offer

Benefits

Comp & perks

Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans
Employer-paid disability and life insurance
Comprehensive well-being programs including on-site employee fitness center and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs and exclusive perks on large brands, travel, and more
Tuition reimbursement and assistance
Education, coaching, and professional development opportunities through the Workforce Development Center
Professional clinical advancement program and shared governance
Public Service Loan Forgiveness (PSLF) eligible employer
Free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer