Senior Director, Claims & Payment Integrity

🕒 2 days ago

🦞 Maine – Remote

🦞 Maine – Remote

⏰ Full Time

🟠 Senior

👔 Director

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Martin's Point Health Care

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Wellness

Martin's Point Health Care is a healthcare organization committed to serving its local communities through high-quality primary and specialty care services. The organization places a strong emphasis on creating a positive workplace culture, recognizing employee contributions, and fostering workforce diversity. Martin's Point Health Care offers a range of career opportunities across various departments, from healthcare providers to corporate roles, and supports employee growth through competitive compensation, development programs, and generous perks. Additionally, the company is recognized for its community impact efforts, raising significant funds for community organizations and encouraging employee volunteerism.

📋 Description

• Responsible for oversight of health plan claims administration and payment integrity functions • Develop, maintain, and optimize process flows to maintain claims payment accuracy • Drives quality, timely claims processing to achieve regulatory compliance and robust financial management • Oversee strong inventory management processes and enhance auto adjudication • Delivers strong vendor oversight to optimize system processing to improve efficiency and accuracy • Collaborates with business and IT teams to ensure system operational readiness • Ensures operational readiness, testing, training, reporting, and communications are in place • Acts as business owner for claims processing and edit vendors • Oversees, develops, and maintains documentation for claims and configuration processes • Develops work intake mechanisms and implements tools to manage claims processing tickets • Supports regular audits and quality checks to ensure data accuracy and system performance

🎯 Requirements

• Bachelor’s degree required • Master’s in business administration or comparable advanced degree strongly preferred • 10+ years health plan management experience required • Experience managing vended system applications • Experience with test plan development, strategy, and execution

🏖️ Benefits

• Organizational culture of trust and respect • Continuous learning opportunities • Opportunities for professional development