Director of Health Economics leading HEOR strategy for Integra’s medical technologies. Providing economic insights to support market access and competitive differentiation.
About the role
- Director of Claims Cost Management leading innovative strategies to optimize reimbursement and reduce medical spending. Collaborating across functional teams to enhance claims cost management initiatives.
Responsibilities
- Build and lead a comprehensive CCM strategy, leveraging internal tools and external vendors.
- Oversee programs for claim editing, coding validation, anomaly detection, and payment accuracy.
- Collaborate with network partners to ensure reimbursement integrity and address emerging billing trends.
- Integrate claims insights into prior authorization and early intervention strategies.
- Develop dashboards, cost-savings reports, predictive analyses, and financial impact assessments for leadership and Trustees.
- Identify inappropriate claim submissions and translate findings into actionable recommendations.
- Drive initiatives that improve billing accuracy, reduce rework, and promote high-value care.
- Lead cost-management pilots, system enhancements, and vendor-supported programs.
- Ensure compliance with national standards, audit expectations, and Fund policies.
- Manage CCM vendor relationships and performance in partnership with MCVA.
- Foster a culture of continuous improvement, accountability, and innovation.
Requirements
- 10+ years in claims operations, payment integrity, or cost management with measurable financial impact
- 5–7 years in leadership roles
- Claims adjudication
- Reimbursement methodologies
- Payment accuracy programs
- Bachelor’s degree or equivalent experience; coding certification preferred
- Strategic and financial acumen
- Data-driven decision-making
- Program/project management
- Advanced Excel and claims editing systems
- Developing and coordinating policies and procedures
Benefits
- Medical
- Dental
- Vision
- Paid Time-Off (PTO)
- Paid Holidays
- 401(k)
- Short- & Long-term Disability
- Pension
- Life
- AD&D
- Flexible Spending Accounts (healthcare & dependent care)
- Commuter Transit
- Tuition Assistance
- Employee Assistance Program (EAP)
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