Director II, Digital Claims Operations

Anticipated End Date:

2025-11-01

Position Title:

Director II, Digital Claims Operations

Job Description:

Director II, Digital Claims Operations (Dir II Digital Ops)

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidate resides within a commutable distance from an office.

The Director II, Digital Claims Operations oversees a combined digital and operations unit(s); executes strategies to deliver industry leading digitized service results.  Serve as a leader across departmental lines in order to further penetration of operational digitization, E2E efficiencies, lowered administrative costs and an excellent member and provider experience.  

How you will make an impact:

• Lead digital transformation initiatives that improve claims operations and overall service delivery.
• Partner with leaders across the organization to implement strategic plans and shared goals.
• Leads overall strategic work streams for transformational priorities which requires significant accountability and management of numerous special projects.
• Plans, directs, and controls the resources and efforts within a blended Digital Claims Operations organization.
• Effectively manage the resolution of intra-organizational issues in the balanced best interests of the business.
• Executes objectives of the company and the blended Digital Ops organization
• Responsible & accountable for implementation / management of digitization initiatives that demonstrates understanding of current and future operational business processes that digitization does/can enable.
• Ensures compliance with state and federal regulations.
• Oversees strategic planning, budget development, and management for a single large or multiple cost centers, contract compliance, and any necessary integration of government regulatory requirements.
• Manages an enterprise suite of applications by developing digitization forecast and delivery plan.
• Ensures disaster recovery and business continuity plan are implemented, monitored, and updated on a recurring basis.
• Delivers operational guidance and offers system solutions that support the operations of their functional areas on a 24x7x365 basis.
• Plans and executes annual projects while maintaining profit and loss (P&L) responsibility.
• Develops a strong team through training and effective organizational development practices.
• Implements the policies, practices, and procedures of the company and blended digital and operations organizations.
• Manages direction of information system and programming activities of technical staff.
• Leveraging reporting and analytics tools, continually monitors procedures and operational metrics to ensure these are met by staff.
• Builds strong partnerships with market and digital leads, Benefits Administration, Provider Engagement and Contracting, Sales and Internal Audit.
• Hires, trains coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

• Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 8 years experience leading technology (application development, configuration, maintenance or implementation and support) teams and/or cross functional project (technology and operations) teams; or any combination of education and experience which would provide an equivalent background.  
• Requires 7 years' management experience.  

Preferred Skills, Capabilities, and Experiences:

• Proven experience leading Claims Operations teams and strategy within a large healthcare payor environment strongly preferred.
• Proven track record leading Digital Transformation in a Claims operational setting strongly preferred.
• Digital literacy strongly preferred.
• Health insurance industry experience strongly preferred.
• Claims operational experience strongly preferred.
• Process Improvement/Six Sigma skillset preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $179,080 to $280,830.

Locations: Illinois; Cali