Position: Senior Director of Claims Delegation
Location: Hybrid (Must Reside in NY/NJ/CT)
Work Schedule: Monday - Friday, 9:00am - 5:00pm
Compensation: $153,978.55 - $173,225.87
Role Summary
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.
Key responsibilities include 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; and recruiting, coaching, and developing a team of managers, specialists, and analysts.
Qualifications:
- Bachelor's degree
- 10+ years in claims operations (5+ in healthcare)
- 5+ years managing staff
If you're ready to lead complex claims delegation work with integrity and precision, apply today.
How Your Day Flows
Your day typically starts with a review of overnight claims dashboards and open action logs, followed by brief check-ins with managers to confirm priorities and remove blockers. You'll spend focused time validating audit findings, reconciling trends against SLAs, and preparing clear rollups for monthly Finance reporting.
Midday, you'll partner with Utilization Management leaders to align authorization changes with downstream claims outcomes, then join working sessions with Business Intelligence and Compliance to confirm definitions, controls, and reporting logic. Afternoons often include reviewing project timelines, escalating risks with practical options, and guiding data-migration decisions as the claims data steward.
Throughout the day, you'll maintain steady communication across Network Management and Member Services to ensure issues are triaged, documented, and resolved with speed and accuracy.
