Claims Operations Director - Fully remote (US)

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Claims Operations Director in the United States.

This role offers a unique opportunity to lead and transform the claims operations function for a large-scale health benefits organization. You will be responsible for driving operational efficiency, system optimization, and compliance across all claims processes, including hospital, physician, disability, and supplementary claims. The position requires strategic leadership, cross-functional collaboration, and a data-driven approach to improve member experience, manage costs, and ensure regulatory adherence. You will oversee teams, mentor managers, and influence organizational decisions while implementing scalable operational strategies. This is a senior leadership role ideal for a seasoned professional ready to deliver measurable improvements in a dynamic, remote-enabled environment.

• Establish and execute short- and long-term strategic goals to enhance claims processing efficiency and effectiveness.
• Lead all claims-related operations, including electronic claim intake, adjudication, provider maintenance, quality assurance, and training.
• Oversee Short-Term Disability claims and medical appeals to ensure accuracy, compliance, and transparency.
• Drive system and process optimization for benefit plan design, claims editing, and vendor management, ensuring scalable operational strategies.
• Define, monitor, and report on KPIs and metrics to support data-driven decision-making and operational improvements.
• Implement compliance, governance, and risk management practices, including HIPAA and regulatory adherence.
• Coach and develop managers and supervisors, lead HR functions, and foster a culture of inclusion, accountability, and high performance.

• Minimum 15 years of progressive leadership experience in automated group health claims environments.
• At least 10 years managing teams, including 5+ years in senior leadership roles.
• 5+ years of experience with system configuration and benefit plan design.
• Bachelor’s degree in business administration, healthcare, or related field preferred (or equivalent experience).
• Deep knowledge of group health benefits, claims processing systems, and regulatory requirements (DOL, ERISA, ACA).
• Experience with Taft-Hartley plan administration strongly preferred.
• Strong strategic, analytical, and problem-solving skills with a focus on operational efficiency.
• Ability to travel 15+% as needed.

• Competitive salary range: $137,200–$174,900 annually
• Medical, dental, and vision insurance
• Paid time off and holidays
• 401(k) plan with employer match
• Short- and long-term disability coverage
• Life and AD&D insurance
• Flexible spending accounts for healthcare and dependent care
• Commuter transit reimbursement
• Tuition assistance and employee assistance programs
• Remote work with occasional travel

Why Apply Through Jobgether?

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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