Director of Claims

UHS•Reno, NV

About The Position

The Director of Claims is responsible for leading the strategic direction, planning, and execution of all claims operations. This role oversees departmental leadership, ensures compliance with federal, state, and payer regulations. This role drives innovation through technology and process optimization. The Director collaborates with executive leadership to align claims operations with organizational goals, manages departmental budgets, and leads cross-functional initiatives to improve service delivery, quality, and operational efficiency. The ideal Director candidate has extensive Commercial, ASO, Medicare and Medicaid claims experience, expertise in claims adjudication systems (QNXT preferred), and a proven track record of strategic leadership in healthcare claims management.

Requirements

Bachelor’s degree in health care administration or business management, or equivalent work experience.
5+ years’ experience in claims management with direct Medicare claims experience.
5+ years’ experience managing, budgeting, forecasting and collaboration with executive leadership.
Strong leadership skills with an ability to influence and persuade internally and externally while driving cross-functional collaboration.
Deep understanding of medical terminology, coding systems (CPT, ICD-10), and insurance billing practices.
Comprehensive knowledge of healthcare regulations, including HIPAA, CMS guidelines, state laws and experience in information preparation for required regulatory audits.
Ability to promote data driven decision making throughout the organization.
Knowledge of benefits, pricing and inventory management and reporting.
Expertise in software implementation, technology adoption and an understanding of which tools work best to meet the needs of organization.
Outstanding interpersonal skills
Excellent written, oral, and active listening communication skills.
Proficient in MS Office, contact center and training platforms, workforce management and project/team management software.
Strong project management skills and experience managing large scale projects.
Familiarity with claims systems and processes, QNXT system experience strongly preferred.

Nice To Haves

QNXT system experience

Responsibilities

Leading the strategic direction, planning, and execution of all claims operations.
Overseeing departmental leadership.
Ensuring compliance with federal, state, and payer regulations.
Driving innovation through technology and process optimization.
Collaborating with executive leadership to align claims operations with organizational goals.
Managing departmental budgets.
Leading cross-functional initiatives to improve service delivery, quality, and operational efficiency.