We are seeking an experienced Healthcare Claims Director to oversee our claims processing operations and drive data-driven process improvements. This leadership role will manage a team of claims managers and analysts, ensure compliance, and leverage data analytics to enhance claims performance.

Responsibilities:

• Provide strategic direction and operational oversight for healthcare claims processing across multiple lines of business
• Manage a team of claims managers, analysts and supporting staff across multiple locations
• Develop and implement policies, procedures and workflows for efficient claims adjudication
• Monitor performance metrics and identify opportunities for process optimization
• Leverage data analytics tools to analyze claims data, identify trends and generate actionable insights
• Develop reporting dashboards and visualizations to share key metrics with leadership
• Ensure adherence to regulatory compliance, coding guidelines and revenue cycle best practices
• Collaborate with IT, clinical, and business teams on systems improvements and integrations
• Manage relationships and resolve escalated issues with healthcare providers and payers
• Mentor, coach and provide professional development for team members

Requirements:

• Bachelor's degree in healthcare administration, business or related field
• 7 years of management experience in healthcare claims processing
• Deep understanding of claims operations, revenue cycle management and compliance
• Strong data analytics skills and experience using tools like Tableau, SQL, PowerBI
• Proven ability to analyze data, synthesize insights and drive process improvements
• Excellent communication, presentation and leadership abilities
• Motivated team player with a customer-focused mindset

We offer a competitive compensation and benefits package commensurate with experience. This is an office-based position.

COMPANY OVERVIEW

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.

Imagenet LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.