Director of Claims Operations

🕒 Maio 20

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🔴 Especialista

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Sidecar Health

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2018

⚕️ Seguro de Saúde

Healthcare Insurance

A Sidecar Health é uma empresa de seguros de saúde que oferece seguro médico abrangente com preços transparentes e sem restrições de rede ou exigências de encaminhamento. Seu objetivo é dar aos funcionários o controle de sua saúde, proporcionando um orçamento claro para cuidados e permitindo que escolham qualquer médico, sem custos surpresa. Eles enfatizam o acesso a medicamentos prescritos sem limitações e a proteção para cuidados não planejados. A Sidecar Health também oferece preços transparentes e a opção de os membros economizarem dinheiro se encontrarem prestadores que cobrem menos do que o plano paga. Suas ofertas incluem planos de acesso individualizados e planos empresariais, garantindo que os membros sempre tenham a escolha de médicos qualificados.

Descrição

• 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

🎯 Requisitos

• 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

🏖️ Benefícios

• 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.