Hybrid Claims Administration Director

Posted 3 months ago

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About the role

  • Claims Administration Director leading claims management activities and ensuring quality control. Responsible for operations and collaboration with various departments to achieve strategic goals.

Responsibilities

  • Provides leadership and direction for the Claims Administration team
  • Ensures claims are processed for payment accurately and timely
  • Identifies and resolves operational issues using documented processes
  • Serves as expert in provider billing, reimbursement, and encounter reconciliation
  • Collaborates with Vaya business teams to support operational improvement
  • Reviews and provides leadership for handling unusual claims or eligibility issues
  • Monitors claims activities and ensures compliance with policies

Requirements

  • Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, Human Services or related field required
  • 10 years of claims processing experience; supervisory role with increased responsibilities over time
  • Extensive knowledge of claims management, Medicaid, and State funding rules and regulations, third-party payer, and coordination of benefits
  • Knowledge of a capitated managed care environment
  • Strong focus on the people side of change
  • Proficiency in Microsoft products to include Excel and Outlook

Benefits

  • Health insurance
  • 401(k) matching
  • Paid time off
  • Flexible work arrangements
  • Professional development opportunities

Job title

Claims Administration Director

Job type

Experience level

Lead

Salary

$107,960 - $140,348 per year

Degree requirement

Bachelor's Degree

Location requirements

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