Senior Director of Claims Delegation
About The Position
The Senior Director Claims Delegation provides strategic oversight of claims delegation and claims operations projects to ensure timely, accurate adjudication and strong regulatory alignment. This senior leader drives cross-functional execution, strengthens controls, and elevates performance against service expectations. 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
- Leading claims-related initiatives end to end
- Setting project priorities across internal and external workstreams
- Expanding claims reviews and audits in line with VillageCare policy, NYS Prompt Pay, DOH, and CMS
- Delivering monthly status reporting to Finance leadership and updates to senior leaders
- Partnering with Utilization Management on authorization-driven changes impacting claims
- Monitoring claims metrics against SLAs
- Directing root-cause analysis for processing risks
- Serving as claims data steward during migration efforts
- Recruiting, coaching, and developing a team of managers, specialists, and analysts
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What This Job Offers
Job Type
Full-time
Career Level
Senior
