Position Summary:The Director of Payment Operations provides strategic and operational leadership across the end-to-end revenue and claims life cycle, including Enrollment, Appeals & Grievances, Claims, Encounters, Configuration, and Payment Integrity. This role is accountable for the accuracy, timeliness, compliance, and financial integrity of McLaren's payment operations functions, ensuring seamless coordination from member/provider enrollment through claims adjudication, encounter submission, and payment recovery. This role serves as a critical cross-functional partner to Compliance, Finance, IT, Provider Network, and Clinical leadership, and represents Payment Operations in regulatory audits, executive reporting, and enterprise strategic planning.
Qualifications:Required:
- Bachelor's degree in business administration, healthcare administration, or related field.
- Eight (8) years of progressively more responsible health plan operations experience including claims processing, enrollment, appeals & grievances, or system configuration to ensure payment integrity, including five (5) years in a leadership role managing multiple functions and multi-disciplinary teams
Preferred:
- Master's degree in business administration, healthcare administration, or related field.
- Five (5) years' experience driving measurable operational and financial improvement through process redesign, automation, and payment integrity programs.
- Strong vendor management and contract negotiation experience.
