Senior Director Network and File Operations - LH

Health Care Service Corporation

2d•$102,900 - $193,200•Remote

About The Position

At Luminare Health, our people are what set us apart. Their expertise, dedication, and passion for service excellence are the foundation of our success. We're committed to helping our employees grow through thoughtful development opportunities, meaningful work, and a culture that values collaboration and continuous improvement. When you join Luminare Health, you join a purpose-driven team focused on making healthcare simpler, better, and more affordable. Job Summary The Senior Director of Network and File Integration is a strategic and operational leader responsible for overseeing all aspects of hospital and provider network integration as well as the design, delivery, and governance of outbound data integrations to point-solution vendors, strategic partners, and third-party organizations. Provide leadership for the modernization, standardization, and governance of provider network integration, ensuring alignment with long-term corporate and operational strategy. This role ensures that provider networks are accurately, efficiently, and compliantly integrated into the organization’s systems, while also managing outbound file exchange processes that support clinical programs, care navigation, cost-containment solutions, benefits administration, and operational partners. The Senior Director will lead cross-functional teams, establish enterprise integration standards, and collaborate closely with IT, operations, compliance, and network contracting to ensure seamless execution across all integration workflows.

Requirements

Bachelor’s Degree and 12 years of related business experience in TPA/Payer operations
5 years leadership experience
Ability to develop business strategy and convert into action-oriented objectives and measurable results in partnership with product, other operational and IT partners.

Nice To Haves

Broad understanding of and experience in the health care/insurance industry.
Advanced degree/education preferred.
Experience applying Lean process methodologies to improve operational efficiency.
Experience with network integration, provider maintenance, outbound file integration
Hands-on experience supporting business operations leveraging the HealthEdge platform, including claims administration, provider configuration, network management, enrollment, benefits, payment integrity, and related operational workflows.
Proven success partnering with business stakeholders to optimize HealthEdge-enabled processes, drive operational efficiency, and improve service delivery.
Understanding of healthcare data interchange formats, including X12 EDI transactions (834, 835, 837, 820, 270/271, 276/277, 999, and related companion guides).
Ability to interpret vendor file specs and guide teams through mapping, validation, balancing, and certification processes.

Responsibilities

Direct the end-to-end integration of hospital, physician, ancillary, and specialty networks into enterprise systems.
Ensure accurate and timely processing of provider demographics, contracts, fee schedules, reimbursement methodologies, participating status, and network tiering.
Partner with the EDI and Network operations teams to ensure data file flows and standards are maintained; failure points are identified and improved, and automated monitoring alerts are reviewed and resolved quickly.
Develop and maintain standardized workflows for network onboarding, mapping, quality assurance, and validation.
Partner with operational units and client managers to ensure that client needs are clearly understood, and setups are executed to support those needs.
Partner with hospital system clients to develop scalable, sustainable processes
Provide leadership for the modernization, standardization, and governance of provider network integration, ensuring alignment with long-term corporate and operational strategy.
Establish and oversee frameworks for accuracy, quality, automation, and compliance in all provider and file integration activities.
Shape and drive multi-year roadmaps for digital transformation and integration scalability, guiding cross-functional teams
Lead high-performing teams through a culture of innovation, accountability, and continuous improvement that supports enterprise performance objectives.
Overall accountability for setting, communicating and delivering on team and individual goals that are aligned with company and client interests.
Handle personnel matters including mentoring, coaching, motivating, performance management and feedback, recognition, performance evaluation and time tracking of direct reports.
Responsible for staff decisions; onboard, offboard, promote.
Provide input into compensation and promotional increases.
Regularly communicate with staff via management meetings and one-on-one meetings with team members.
Mentor and develop leaders within team.
Interview and recommend viable candidates for job openings.
Oversee outbound file integration teams to ensure successful implementation of files to new and existing point solution vendors
Ensure organization is adhering to all data sharing and security protocols when sending data to outside vendors
Overall accountability for maintaining relationships with key vendors and partners
Responsibility for collaborating with IT to manage and troubleshoot day to day file integration issues
Metric tracking and adherence to applicable outbound file KPIs and client SLAs, including, but not limited to file quality and delivery schedule.
Oversee the execution, maintenance, and adherence to outbound file-related process documentation, ensuring that all material is digestible and comprehensive
Own the lifecycle of file integrations, including requirements gathering, file layout design, mapping, validation rules, scheduling, and monitoring.
Establish SLAs for file delivery, error resolution, and quality control.
Evaluate new technologies, automation tools, and integration platforms to enhance operational performance.