Senior Director of Claims Delegation

Village Care•New York, NY

8d•$153,979 - $173,226•Hybrid

About The Position

VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.

Requirements

Bachelor's degree
10+ years in claims operations
5+ years in healthcare claims operations
5+ years managing staff

Responsibilities

Provides strategic oversight of claims delegation and claims operations projects to ensure timely, accurate adjudication and strong regulatory alignment.
Drives cross-functional execution, strengthens controls, and elevates performance against service expectations.
Leads claims-related initiatives end to end.
Sets project priorities across internal and external workstreams.
Expands claims reviews and audits in line with VillageCare policy, NYS Prompt Pay, DOH, and CMS.
Delivers monthly status reporting to Finance leadership and updates to senior leaders.
Partners with Utilization Management on authorization-driven changes impacting claims.
Monitors claims metrics against SLAs.
Directs root-cause analysis for processing risks.
Serves as claims data steward during migration efforts.
Recruits, coaches, and develops a team of managers, specialists, and analysts.
Reviews overnight claims dashboards and open action logs.
Conducts brief check-ins with managers to confirm priorities and remove blockers.
Validates audit findings.
Reconciles trends against SLAs.
Prepares clear rollups for monthly Finance reporting.
Partners with Utilization Management leaders to align authorization changes with downstream claims outcomes.
Joins working sessions with Business Intelligence and Compliance to confirm definitions, controls, and reporting logic.
Reviews project timelines.
Escalates risks with practical options.
Guides data-migration decisions as the claims data steward.
Maintains steady communication across Network Management and Member Services to ensure issues are triaged, documented, and resolved with speed and accuracy.