Director of Operations :: 100% Remote
Posted 1 day ago by JS Consulting Solutions
Negotiable
Undetermined
Remote
Remote or California
Summary: The Director of Operations will provide strategic leadership for technology-enabled claims operations, focusing on accuracy, compliance, and efficiency. This role requires extensive experience in Medicare Advantage and claims operations, including system migration and optimization. The position is fully remote and involves collaboration with IT and vendors to enhance claims platforms. The contract duration is 6+ months with potential for extension.
Key Responsibilities:
- Direct and oversee end-to-end claims processing, including system configuration, adjudication logic, integrations, and performance monitoring.
- Develop, implement, and optimize technology-enabled policies, workflows, automation, and quality assurance standards across claims systems.
- Lead, mentor, and develop managers and technical/operational staff, fostering excellence, collaboration, and scalable processes.
- Partner with IT, Data, Compliance, Finance, and external vendors to resolve complex system issues, enhance capabilities, and drive continuous improvement.
- Ensure adherence to regulatory requirements (CMS, state, Medicaid, Medicare Advantage, SNP) and support technology and operational readiness for audits.
- Drive automation, system enhancements, and process optimization initiatives to improve accuracy, reduce manual work, and increase throughput.
- Oversee upgrades, testing, and change management for claims platforms and related technologies.
Key Skills:
- 8+ years of experience in claims operations with significant involvement in claims systems, technology, or systems optimization; at least 3 years in leadership roles.
- Strong knowledge of claims platforms (e.g., Facets, QNXT, HealthRules, Javelina, Amisys), configuration, compliance standards, and operational best practices.
- Proven ability to lead cross-functional technology initiatives and translate business needs into system requirements.
- Excellent leadership, analytical, and communication skills.
- Health Plan, Medicare Advantage, and SNP experience required.
- Bachelor's degree required; advanced degree or relevant certifications (e.g., PMP, Lean/Six Sigma, AHIP) preferred.
Salary (Rate): undetermined
City: undetermined
Country: undetermined
Working Arrangements: remote
IR35 Status: undetermined
Seniority Level: undetermined
Industry: Other
Title: Director of Operations
Location: 100% Remote
Duration: 6+ Months Contract with possible extension
Must have -
- Medicare Advantage experience
- Background in claims operations side
- Claims systems platform experience
- Experience migrating to new claims system
Purpose:
Provide strategic leadership and oversight for all technology-enabled claims operations, ensuring accuracy, compliance, system integrity, and efficiency across adjudication, audits, automation, and related IT and business functions. This role will partner closely with IT, vendors, and operations leadership to optimize claims platforms and drive digital transformation.
Key Responsibilities:
- Direct and oversee end-to-end claims processing, including system configuration, adjudication logic, integrations, and performance monitoring.
- Develop, implement, and optimize technology-enabled policies, workflows, automation, and quality assurance standards across claims systems.
- Lead, mentor, and develop managers and technical/operational staff, fostering excellence, collaboration, and scalable processes.
- Partner with IT, Data, Compliance, Finance, and external vendors to resolve complex system issues, enhance capabilities, and drive continuous improvement.
- Ensure adherence to regulatory requirements (CMS, state, Medicaid, Medicare Advantage, SNP) and support technology and operational readiness for audits.
- Drive automation, system enhancements, and process optimization initiatives to improve accuracy, reduce manual work, and increase throughput.
- Oversee upgrades, testing, and change management for claims platforms and related technologies.
Qualifications:
- 8+ years of experience in claims operations with significant involvement in claims systems, technology, or systems optimization; at least 3 years in leadership roles.
- Strong knowledge of claims platforms (e.g., Facets, QNXT, HealthRules, Javelina, Amisys), configuration, compliance standards, and operational best practices.
- Proven ability to lead cross-functional technology initiatives and translate business needs into system requirements.
- Excellent leadership, analytical, and communication skills.
- Health Plan, Medicare Advantage, and SNP experience required.
- Bachelor's degree required; advanced degree or relevant certifications (e.g., PMP, Lean/Six Sigma, AHIP) preferred.