Senior Director, Network and File Operations

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Luminare Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Luminare Health is a leading provider of self-funded health plan administration services with over 50 years of industry experience. The company specializes in offering flexible and innovative solutions for hospitals, health systems, and direct-to-employer initiatives, focusing on administration, cost management, and digital reporting tools. Luminare Health is dedicated to being a reliable partner in managing healthcare costs and supporting strategic growth for its clients. The company emphasizes a member-centered approach to healthcare while delivering significant savings through expert claim analysis and management of high-cost claims.

📋 Description

• Direct 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 EDI and Network Operations teams to maintain data file flows and standards, identify failure points, and resolve monitoring alerts • Develop standardized workflows for network onboarding, mapping, quality assurance, and validation • Partner with operational units, client managers, and hospital system clients to deliver scalable processes and meet client needs • Lead modernization, standardization, governance, automation, quality, and compliance for provider and file integration • Shape multi-year roadmaps for digital transformation and integration scalability • Lead high-performing teams and develop leaders through mentoring, coaching, performance management, and feedback • Set, communicate, and deliver team and individual goals • Manage staffing decisions, onboarding, offboarding, promotions, compensation input, interviews, and recommendations • Oversee outbound file integration teams implementing files for new and existing point-solution vendors • Ensure adherence to data-sharing and security protocols for external vendors • Maintain relationships with key vendors and partners • Collaborate with IT to manage and troubleshoot day-to-day file integration issues • Track metrics and adhere to outbound file KPIs and client SLAs • Oversee outbound file process documentation • Own the lifecycle of file integrations, including requirements gathering, file layout design, mapping, validation, scheduling, and monitoring • Establish SLAs for file delivery, error resolution, and quality control • Evaluate technologies, automation tools, and integration platforms to improve operational performance

🎯 Requirements

• Bachelor’s Degree • 12 years of related business experience in TPA/Payer operations • 5 years of leadership experience • Ability to develop business strategy and convert it into action-oriented objectives and measurable results • Ability to partner with product, operational, and IT teams • Broad understanding of and experience in the health care/insurance industry • Experience with network integration, provider maintenance, and outbound file integration • Hands-on experience supporting business operations leveraging the HealthEdge platform • Experience with claims administration, provider configuration, network management, enrollment, benefits, payment integrity, and related operational workflows • Proven success partnering with business stakeholders to optimize HealthEdge-enabled processes and improve service delivery • 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 specifications and guide mapping, validation, balancing, and certification processes • Remote employees must live within the continental United States, excluding Alaska, California, Hawaii, or New York • Sponsorship is not available

🏖️ Benefits

• Thoughtful development opportunities • 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 • Annual incentive bonus plan