Claims Director Position Available In Miami-Dade, Florida

Location:

REMOTE Salary:

$80.00 USD Hourly – $90.00

USD Hourly Description:

Our client is currently seeking a Claims Director –

Remote Description:

A director level claims resource to help triage and diagnose claim inventory and other issues. Data driven leader with the demonstrated ability to find root cause and develop solutions Lead and oversee the healthcare claims operations , ensuring timely and accurate adjudication of claims in compliance with regulatory and contractual requirements. Triage and diagnose claim inventory issues , identifying bottlenecks, inefficiencies, and anomalies in claims processing workflows. Utilize data-driven methodologies to analyze claims trends, uncover root causes of systemic issues, and implement corrective action plans. Develop and execute strategic initiatives to improve claims accuracy, turnaround time, and overall operational performance. Collaborate cross-functionally with IT, provider relations, finance, and compliance teams to resolve complex claims issues and support enterprise goals. Mentor and manage claims teams , fostering a culture of accountability, continuous improvement, and professional development. Design and monitor KPIs and dashboards to track claims performance, identify emerging issues, and report findings to executive leadership. Ensure adherence to payer policies and industry regulations , including

HIPAA, CMS

guidelines, and state-specific requirements. Lead root cause analysis (RCA) initiatives , leveraging insights to drive sustainable process improvements and reduce rework. Bring hands-on experience in claims processing , with a strong understanding of both manual and automated adjudication systems, ideally having led or directly managed claims teams.

Required skills:

Well-rounded payer claims experience, ideally someone who has paid and/or led claims teams. By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively “Judge”) to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge’s Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.

Contact:

aarya@judge.com This job and many more are available through The Judge Group. Find us on the web at www.judge.com