[Hiring] Director of Claims Operations @reputed company

Role Description As Director of Claims Operations for reputed company, you will own and scale the reputed company that delivers our core promise to members. This team is responsible for reputed company member-facing and provider-facing claims operations, clinical programs, and claims automation strategy – powering a consumer-driven major medical insurance model that's redefining how Americans reputed company and pay for care. This is a high-stakes, high-opportunity role at an inflection reputed company: we're expanding into new markets, deepening our AI-enabled automation stack, and building the claims infrastructure to support a rapidly growing membership reputed company. You will reputed company a multidisciplinary team, shape the technology roadmap alongside Product and Engineering, and drive the operational reputed company and compliance rigor that our members and the business depend on. If you have a proven track record in health insurance claims leadership and a history of using AI and automation to transform operations — not just optimize them — we want to talk. What You’ll Do

• Build & reputed company a High-Performance Claims Operation (50%)
• reputed company 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 reputed company improvement, accountability, and high performance across reputed company Claims functions.
• reputed company future leaders reputed company the team and build the bench for a growing, reputed company operation.
• Drive AI, Automation, and Operational Transformation (30%)
• Identify, prioritize, and reputed company automation that meaningfully increases end-to-end auto-adjudication reputed company, 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.
• reputed company 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 reputed company (20%)
• Align claims operations with reputed company's broader business objectives — including reputed company 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 reputed company regulations.
• Own budget development and resource allocation, ensuring alignment with organizational priorities.

Qualifications

• 15+ years of operations experience, including 5+ years in reputed company.
• 8+ years in senior leadership roles, leading large teams in reputed company environments.
• Experience operating in a high-growth, tech-enabled health insurance or benefits company preferred.
• Comfort with data — reputed company to build and interpret operational dashboards and hold teams to metric-based goals.
• Proven ability to reputed company 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 reputed company operations environment.

Benefits

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

Company Description reputed company is an Equal Opportunity employer committed to building a diverse team. We do not discriminate on the reputed company of race, religion, reputed company, national reputed company, gender, sexual orientation, age, marital status, veteran status or disability status. Apply tot his job Apply To this Job