| Claims Processing Director - Healthcare Job Description |
 |
| The following is a full job description for Claims Processing Director - Healthcare. Here are the requirements and responsibilities for Claims Processing Director - Healthcare along with statistics. If after reading this page you determine that Claims Processing Director - Healthcare is not the position you are looking for, you may want to try one of these similar titles: Claims Processing Director - Healthcare, Claims Processing Manager - Healthcare, Claims Processing Clerk I - Healthcare, Claims Processing Clerk III - Healthcare, Claims Processing Supervisor - Healthcare, Claims Processing Clerk II - Healthcare, Claims Clerk IV, VP of Claims, Claims Clerk II, Claims Clerk III |
|
| Requirements and Responsibilities For Claims Processing Director - Healthcare |
| Directs healthcare claims processing operations to ensure accurate, timely, and compliant adjudication and payment of medical claims. Oversees managers and supervisors responsible for claims intake, adjudication, and reimbursement functions. Develops operational strategy, productivity standards, and quality controls to meet financial and service objectives. Manages budgets, staffing, and vendor relationships to optimize processing efficiency and accuracy. Analyzes claims data, error trends, and turnaround metrics to drive continuous improvement. Ensures compliance with HIPAA, CMS guidelines, and applicable state and federal regulations. Requires a bachelor's degree. Typically reports to senior management. Manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. |
| |
|
| Also referred to as: Healthcare Claims Operations Director, Medical Claims Operations Director |
|
| Similar Jobs: Claims Processing Director - Healthcare, Claims Processing Manager - Healthcare, Claims Processing Clerk I - Healthcare, Claims Processing Clerk III - Healthcare, Claims Processing Supervisor - Healthcare, Claims Processing Clerk II - Healthcare, Claims Clerk IV, VP of Claims, Claims Clerk II, Claims Clerk III |
|
| Level of Education: Claims Processing Director - Healthcare Salaries with No Diploma, Claims Processing Director - Healthcare Salaries with a High School Diploma or Technical Certificate, Claims Processing Director - Healthcare Salaries with an Associate's Degree, Claims Processing Director - Healthcare Salaries with a Bachelor's Degree, Claims Processing Director - Healthcare Salaries with a Master's Degree or MBA, Claims Processing Director - Healthcare Salaries with a JD, MD, PhD or Equivalent |
|
|
| Industries: Edu., Gov't. & Nonprofit, Healthcare, Insurance | |
