Director of Claims Operations

🕒 il y a 20 jours

🇺🇸 États-Unis – Télétravail

⏰ Temps Plein

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Sidecar Health

Site WebLinkedInTous les Emplois

201 - 500 employés

Fondée en 2018

⚕️ Assurance santé

Healthcare Insurance

Sidecar Health est une compagnie d'assurance santé qui propose une assurance médicale majeure complète avec des prix affichés à l'avance, sans restrictions de réseau ni exigences de référé. Leur objectif est de donner aux employés le contrôle de leurs soins de santé en leur fournissant un budget clair pour les soins et en leur permettant de choisir n'importe quel médecin sans frais surprise. Ils mettent l'accent sur l'accès aux prescriptions sans limitations et la protection pour les soins non prévus. Sidecar Health propose également des tarifs transparents et donne la possibilité aux membres d'économiser de l'argent s'ils trouvent des prestataires facturant moins que ce que leur plan couvre. Leurs offres incluent des plans d'accès individualisés et des plans pour les employeurs, garantissant aux membres le choix constant de médecins qualifiés.

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

🎯 Exigences

• 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

🏖️ Avantages

• 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.