Director, Health Claims Audit & Recovery

Company Description WellMed Optum Florida is an independent, Florida-focused health organization with a longstanding commitment to delivering high-quality care to older adults and the communities it serves. The organization emphasizes coordinated, value-based care that improves outcomes and enhances the patient experience. Team members collaborate across clinical, operational, and analytical functions to support efficient, patient-centered care delivery. WellMed Optum Florida offers opportunities for professionals to contribute to meaningful health initiatives while working within a mission-driven, community-oriented environment.

Role Description The Director, Health Claims Audit & Recovery is a full-time, on-site role in the Greater Tampa Bay Area. The Director leads our claims audit and recovery department, which independently reviews health plan payments, identifies overpayments and contract discrepancies, and recovers funds owed to the organization. Responsibilities include setting recovery strategy and targets, leading and developing the team, holding Medicare Advantage health plan partners accountable, and reporting results to executive leadership. The Director will also modernize the function through automation, advanced analytics, and AI, and partner with Finance, Contracting, Medical Management, and Operations to fix recurring payment issues at the source.

Qualifications

• 7 to 10 years in health plan payment integrity, claims audit and recovery, or healthcare finance, with deep payer-side knowledge of Medicare Advantage claims payment
• 3 to 5 years leading a team or department with measurable financial accountability
• Working knowledge of CMS pricing, claims adjudication, coordination of benefits, fee schedules, and managed care contracts
• Strong financial analysis and strategic planning skills, with the ability to turn complex claims and contract issues into executive recommendations
• Preferred: Florida Medicare Advantage experience
• Preferred: experience implementing automation, analytics, or AI to improve recovery results
• Bachelor's degree in health administration, public health, economics, business, or a related field; advanced degree preferred. Equivalent experience considered.