More jobs:
Director of Operations
Job in
California, Moniteau County, Missouri, 65018, USA
Listed on 2026-01-14
Listing for:
JS Consulting
Full Time
position Listed on 2026-01-14
Job specializations:
-
IT/Tech
IT Project Manager
Job Description & How to Apply Below
Director of Operations
Company: JS Consulting
Location: Remote
Duration: 6+ months contract to hire
Job PurposeProvide strategic leadership and oversight for all technology-enabled claims operations, ensuring accuracy, compliance, system integrity, and efficiency across adjudication, audits, automation, and related IT and business functions. This role will partner closely with IT, vendors, and operations leadership to optimize claims platforms and drive digital transformation.
Key Responsibilities- Direct and oversee end-to-end claims processing, including system configuration, adjudication logic, integrations, and performance monitoring.
- Develop, implement, and optimize technology-enabled policies, workflows, automation, and quality assurance standards across claims systems.
- Lead, mentor, and develop managers and technical/operational staff, fostering excellence, collaboration, and scalable processes.
- Partner with IT, Data, Compliance, Finance, and external vendors to resolve complex system issues, enhance capabilities, and drive continuous improvement.
- Ensure adherence to regulatory requirements (CMS, state, Medicaid, Medicare Advantage, SNP) and support technology and operational readiness for audits.
- Drive automation, system enhancements, and process optimization initiatives to improve accuracy, reduce manual work, and increase throughput.
- Oversee upgrades, testing, and change management for claims platforms and related technologies.
- 8+ years of experience in claims operations with significant involvement in claims systems, technology, or systems optimization; at least 3 years in leadership roles.
- Strong knowledge of claims platforms (e.g., Facets, QNXT, Health Rules, Javelina, Amisys), configuration, compliance standards, and operational best practices.
- Proven ability to lead cross-functional technology initiatives and translate business needs into system requirements.
- Excellent leadership, analytical, and communication skills.
- Health Plan, Medicare Advantage, and SNP experience required.
- Bachelor's degree required; advanced degree or relevant certifications (e.g., PMP, Lean/Six Sigma, AHIP) preferred.
- Employment type: Contract
- Seniority level: Director
- Industry: Human Resources Services
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