Associate Director – Claims Disputes

Associate Director – Claims Disputes

Requirements

• 7+ years of experience in claims operations including, communication or other Technical writing
• 5+ years of experience in people management and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once
• 3+ years of experience with benefit and contract interpretation or coding in professional/ institutional billing requirements
• 3+ years of experience managing claims across multiple product types (i.e. Medicare or Commercial)
• 3+ years of experience analyzing and improving processes and workflows
• 5+ years of experience working with technical teams (e.g. engineering and product) in translating business requirement specifications

Responsibilities

• Develop and maintain detailed process documentation, including standard operating procedures (SOPs), work instructions, and guidelines related to healthcare claims processing specifically
• Ensure accuracy, clarity, and compliance with industry standards and regulatory requirements
• Analyze current claims processing workflows to identify inefficiencies and areas for improvement
• Work closely with internal claims department stakeholders and audit teams and tech partners to understand existing processes and recommend best practices
• Stay updated on healthcare regulations, including HIPAA, CMS guidelines, and insurance policies, to ensure compliance in documentation and processes
• Work with cross-functional teams, including Tech, quality assurance, and compliance teams, to gather information and improve process efficiency
• Translate technical or complex information into clear, user-friendly documentation
• Assist in developing training materials, FAQs, and user manuals for new hires and existing staff
• Manage open provider claim dispute inventory and mitigation of interest bearing claims payment
• Responsible for ongoing career development of the team by maintaining culture, employee satisfaction and team performance management
• Develop annual and ad-hoc training program for team members and managers
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• Bachelor’s degree in communications, or 4 years commensurate experience
• Experience in making data-driven decisions in a fast paced environment
• Excellent leadership and communication skills to drive decision-making and results across multiple partners