Director, Part C & Authorizations

📋 Description

• Sets vision and governance for Part C authorizations and claims processing.
• Manages end-to-end encounter data operations and regulatory compliance.
• Oversees day-to-day adjudication operations to ensure timely, accurate outcomes.
• Builds scalable processes for accurate authorizations, adjudication, and data quality.
• Partners with cross-functional teams to resolve data discrepancies and production issues.
• Provides leadership with actionable insights to drive continuous improvement.

🎯 Requirements

• 8+ years in health insurance operations with leadership.
• Bachelor's degree required; Master's preferred.
• Deep expertise in claims processing and utilization management.
• Experience with encounter data processing, reporting KPIs, and data quality.
• Ability to lead cross-functional teams and present insights to senior leadership.
• Proficient in Microsoft Office; excellent verbal and written communication.

🎁 Benefits

• Health insurance
• Life insurance
• Equity program
• Paid time off including vacation and sick leave