Executive Director, Medicaid & Duals Claims Operations
Confidential
Executive Director, Medicaid & Duals Claims Operations
About the Company
Respected chain of medical clinics & retail pharmacies
Industry
Health, Wellness and Fitness
Type
Public Company
Founded
1963
Employees
10,001+
Categories
- Health and Wellness
- Health Care
- Medical
- Pharmaceutical
- Personal Health
- Sales
- Retail
- Health & Wellness
- BioTech
- Drugs
- Healthcare
Specialties
- retail
- pharmacy benefits management
- health insurance
- health care
- pharmacy
- care management
- and primary care
Business Classifications
- B2C
About the Role
The Company is in search of an Executive Director for Claims Service Operations, with a focus on Medicaid and Duals businesses. The successful candidate will be responsible for driving operational excellence in a large-scale, complex environment, ensuring claims performance, regulatory execution, and the advancement of automation and vendor governance. This leadership role demands a strategic partner who can translate priorities into operational execution, improve claims accuracy, productivity, and service performance, and enhance the overall experience for both providers and members. Key responsibilities include leading a multi-market claims operations organization, establishing governance routines, advancing automation strategies, and developing high-performing teams. Applicants must have a minimum of 12 years' experience in healthcare operations, managed care, claims, or health plan, with a strong preference for those with a background in Medicaid and/or Duals. The role requires a proven track record in leading large-scale operations, driving process improvement, and operational transformation initiatives. The ideal candidate will have a strong knowledge of claims operations, regulatory requirements, and operational performance management, as well as experience in partnering across various organizational functions. A Bachelor's degree or equivalent experience is required, and the candidate should be a strong people leader with excellent communication, change leadership, and problem-solving skills. The ability to thrive in a fast-paced, ambiguous environment and a focus on continuous improvement are essential.
Functions
- Operations
Vacancy posted 2 days ago
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