Health Admins

Director

• Lead the assigned third-party administrator medical claims operation under client service level agreements
• Ensure claims are processed accurately and within required timeframes
• Run the two health share Needs teams, including intake, clinical review, processing, pay/deny/pend determinations, reimbursements, and runout
• Meet and sustain client SLAs, including processing timelines of roughly 21 to 45 days or within 30 days of clean receipt
• Own SLA tracking and responses when standards are at risk
• Build toward traditional medical claims administration for self-funded employer plans
• Lead Client Managers, Team Leads, and Coordinators across assigned teams
• Own workload distribution, escalations, performance management, hiring, and staff development
• Manage vendor relationships across clearinghouse, cost containment, medical review, staffing, and related functions
• Oversee vendor performance and resolve disputes and issues
• Develop hiring and staffing plans, fill approved headcount, and build bench depth
• Oversee operational projects, including system and reporting changes, vendor implementations, and go-lives
• Analyze claims data to identify trends, issues, and opportunities and implement data-driven improvements
• Prepare and present operational and performance reporting to senior leadership
• Maintain compliance with healthcare regulations, including ERISA, COBRA, HIPAA, and scope-of-practice requirements
• Maintain high-quality client service and resolve operational client issues
• Partner with Compliance, Benefits Administration, Client Services, and other internal stakeholders on audits, complex claims issues, regulatory changes, and operational excellence
• Report to the VP of Operations
• Travel occasionally as required

Director, Claims Management