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UNITE HERE HEALTH · 2 weeks ago

Director of Claims Cost Management

Oak Brook, IL

Full-time

Hybrid

Director/Executive

$137K/yr - $175K/yr

10+ years exp

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. They are looking for a strategic leader to shape and drive their Claims Cost Management Program, focusing on payment integrity, reimbursement accuracy, and analytics-driven insights.

ConsultingHealth CareHospitalNon Profit

Comp. & Benefits

Responsibilities

Build and lead a comprehensive CCM strategy, leveraging internal tools and external vendors

Oversee programs for claim editing, coding validation, anomaly detection, and payment accuracy

Collaborate with network partners to ensure reimbursement integrity and address emerging billing trends

Integrate claims insights into prior authorization and early intervention strategies

Develop dashboards, cost-savings reports, predictive analyses, and financial impact assessments for leadership and Trustees

Identify inappropriate claim submissions and translate findings into actionable recommendations

Drive initiatives that improve billing accuracy, reduce rework, and promote high-value care

Lead cost-management pilots, system enhancements, and vendor-supported programs

Ensure compliance with national standards, audit expectations, and Fund policies

Manage CCM vendor relationships and performance in partnership with MCVA

Foster a culture of continuous improvement, accountability, and innovation

Qualification

Claims operationsPayment integrityCost managementData-driven decision-makingProgram/project managementAdvanced ExcelCoding certificationFinancial acumenRegulatory knowledgeCompliance knowledgeStrategic acumenLeadership