Director of Claims Operations

Job Description:

• Build & Lead a High-Performance Claims Operation
• Lead and scale a multidisciplinary Claims Operations team — spanning claims adjudication, quality, operations, and clinical — to drive accurate, timely claims processing and an exceptional member experience
• Foster a culture of metrics-driven continuous improvement, accountability, and high performance across all Claims functions
• Develop future leaders within the team and build the bench for a growing, complex operation
• Drive AI, Automation, and Operational Transformation
• Identify, prioritize, and lead automation that meaningfully increases end-to-end auto-adjudication rate, reduces claims processing time, and improves quality / accuracy
• Partner with Product and Engineering to shape the roadmap for claims technology — acting as a strategic voice, not just an operator
• Lead change management efforts as the team adopts new tools, workflows, and ways of working
• Build and maintain governance structures that support scalable, compliant, and data-informed operations
• Own Claims Strategy & Business Outcomes
• Align claims operations with Sidecar Health's broader business objectives — including continued growth, sustainable MLR, and an obsessive focus on member experience
• Drive payment accuracy, fraud prevention, and claims spend optimization through proactive stakeholder management and cross-functional initiatives
• Translate operational data into strategic insights and recommendations for senior leadership
• Mitigate operational and regulatory risk while maintaining full compliance with healthcare regulations
• Own budget development and resource allocation, ensuring alignment with organizational priorities

Requirements:

• 15+ years of operations experience, including 5+ years in healthcare
• 8+ years in senior leadership roles, leading large teams in complex environments
• Experience operating in a high-growth, tech-enabled health insurance or benefits company preferred
• Comfort with data — able to build and interpret operational dashboards and hold teams to metric-based goals
• Proven ability to lead through ambiguity, manage cross-functional stakeholders, and drive change in fast-moving environments
• Strong financial acumen — experience owning budget, headcount planning, and cost-per-claim targets
• Demonstrated results deploying AI or automation in a claims or complex operations environment

Benefits:

• Competitive salary, bonus opportunity, and equity package
• Comprehensive Medical, Dental, and Vision benefits
• A 401k retirement plan
• Paid vacation and company holidays
• Opportunity to make an impact at a rapidly growing mission-driven company transforming healthcare in the U.S.

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