Director Payment Operations - Michigan

McLaren Health Care • Flint, MI

6d

About The Position

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Director, Payment Operations, to join in leading the organization forward.
MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).
MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
Position Summary:
The Director of Payment Operations provides strategic and operational leadership across the end-to-end revenue and claims life cycle, including Enrollment, Appeals & Grievances, Claims, Encounters, Configuration, and Payment Integrity. This role is accountable for the accuracy, timeliness, compliance, and financial integrity of McLaren’s payment operations functions, ensuring seamless coordination from member/provider enrollment through claims adjudication, encounter submission, and payment recovery. This role serves as a critical cross-functional partner to Compliance, Finance, IT, Provider Network, and Clinical leadership, and represents Payment Operations in regulatory audits, executive reporting, and enterprise strategic planning.

Requirements

• Bachelor’s degree in business administration, healthcare administration, or related field.
• Eight (8) years of progressively more responsible health plan operations experience including claims processing, enrollment, appeals & grievances, or system configuration to ensure payment integrity.
• Five (5) years in a leadership role managing multiple functions and multi-disciplinary teams.

Nice To Haves

• Master’s degree in business administration, healthcare administration, or related field.
• Five (5) years’ experience driving measurable operational and financial improvement through process redesign, automation, and payment integrity programs.
• Strong vendor management and contract negotiation experience.

Responsibilities

• Provides strategic and operational leadership across the end-to-end revenue and claims life cycle, including Enrollment, Appeals & Grievances, Claims, Encounters, Configuration, and Payment Integrity.
• Accountable for the accuracy, timeliness, compliance, and financial integrity of McLaren’s payment operations functions, ensuring seamless coordination from member/provider enrollment through claims adjudication, encounter submission, and payment recovery.
• Serves as a critical cross-functional partner to Compliance, Finance, IT, Provider Network, and Clinical leadership.
• Represents Payment Operations in regulatory audits, executive reporting, and enterprise strategic planning.

What This Job Offers

• Job Type: Full-time
• Career Level: Director