Senior Director, Network and File Operations

Job not on LinkedIn

🕒 May 11

🇺🇸 United States – Remote

💵 $102.9k - $193.2k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Health Care Service Corporation serves nearly 23 million people across the United States through its portfolio of health benefit solutions.

📋 Description

• Direct the end-to-end integration of hospital, physician, ancillary, and specialty networks into enterprise systems. • Ensure accurate and timely processing of provider demographics, contracts, fee schedules, reimbursement methodologies, participating status, and network tiering. • Partner with the EDI and Network operations teams to ensure data file flows and standards are maintained; failure points are identified and improved, and automated monitoring alerts are reviewed and resolved quickly. • Develop and maintain standardized workflows for network onboarding, mapping, quality assurance, and validation. • Partner with operational units and client managers to ensure that client needs are clearly understood, and setups are executed to support those needs. • Provide leadership for the modernization, standardization, and governance of provider network integration, ensuring alignment with long-term corporate and operational strategy. • Establish and oversee frameworks for accuracy, quality, automation, and compliance in all provider and file integration activities. • Shape and drive multi-year roadmaps for digital transformation and integration scalability, guiding cross-functional teams. • Lead high-performing teams through a culture of innovation, accountability, and continuous improvement that supports enterprise performance objectives. • Handle personnel matters including mentoring, coaching, motivating, performance management and feedback, recognition, performance evaluation and time tracking of direct reports. • Oversee outbound file integration teams to ensure successful implementation of files to new and existing point solution vendors. • Ensure organization is adhering to all data sharing and security protocols when sending data to outside vendors. • Overall accountability for maintaining relationships with key vendors and partners.

🎯 Requirements

• Bachelor’s Degree and 12 years of related business experience in TPA/Payer operations • 5 years leadership experience • Ability to develop business strategy and convert into action-oriented objectives and measurable results in partnership with product, other operational and IT partners. • Broad understanding of and experience in the health care/insurance industry. • Advanced degree/education preferred. • Experience applying Lean process methodologies to improve operational efficiency. • Experience with network integration, provider maintenance, outbound file integration • Understanding of healthcare data interchange formats, including X12 EDI transactions (834, 835, 837, 820, 270/271, 276/277, 999, and related companion guides). • Ability to interpret vendor file specs and guide teams through mapping, validation, balancing, and certification processes.

🏖️ Benefits

• Health and wellness benefits • 401(k) savings plan • Pension plan • Paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement • Other incentives