Director, Business Systems Claims Implementation

Director, Business Systems Claims Implementation at Webilent Technology, Inc. Director, Business Systems Claims Implementation at Webilent Technology, Inc. in Irving, Texas Posted in 7 days ago.

Type:

full-time

Job Description:

Title:

Director / Senior Manager -

Healthcare Systems & Provider Operations Location:

Irving, TX (Hybrid - 3 days onsite / 2 days remote)

Employment Type:

Full-Time Industry:

Healthcare / Payer (Medicare Advantage, Managed Care) Overview We are seeking a Director / Senior Manager of Healthcare Systems & Provider Operations to lead strategic initiatives across claims systems, provider data, credentialing, and benefit configuration . This role will drive system implementations, operational efficiency, and regulatory compliance within a payer environment. The ideal candidate brings deep expertise in claims platforms, provider operations, and Medicare Advantage , along with strong leadership experience managing cross-functional teams and large-scale system initiatives. Key Responsibilities Lead end-to-end implementations and enhancements of healthcare claims systems (Facets, HealthAxis, or similar) Oversee provider operations , including credentialing, provider data management, and network configuration Drive benefit configuration, pricing methodologies, and claims adjudication optimization Partner with business and IT teams to deliver system integrations (EDI, vendor systems, APIs) Lead UAT cycles, system releases, and production deployments Ensure compliance with CMS, NCQA, HIPAA, and other regulatory standards Identify opportunities to improve auto-adjudication rates and reduce manual claims processing Manage and mentor cross-functional teams (20+ resources) across operations and systems Develop and implement policies, procedures, and governance frameworks Collaborate with executive leadership on strategic planning, budgeting, and roadmap development Required Qualifications 10+ years of experience in the healthcare payer operations and overseeing the implementation of those systems Strong expertise in: Claims systems (Facets, HealthAxis, or similar) Provider operations and credentialing Benefit configuration and pricing methodologies Experience working within Medicare Advantage / Managed Care environments Proven track record of leading system implementations and integrations Strong understanding of CMS, NCQA, and regulatory compliance requirements Experience managing large teams and cross-functional stakeholders Excellent communication and leadership skills Preferred Qualifications Experience with: EDI transactions (837, 835, etc.) Provider data platforms and credentialing systems (eVips, CAQH, Quest Analytics) Claims auto-adjudication optimization Background in healthcare digital transformation or modernization initiatives Experience working with startups or high-growth healthcare organizations PMP or similar leadership certification