JS Consulting Solution ยท 2 days ago
Director of Operations with Claims and Medicare Advantage exp || Only USC
United States
Contract
Remote
Director/Executive
8+ years expJS Consulting Solution is seeking a Director of Operations with expertise in claims and Medicare Advantage. The role involves providing strategic leadership for technology-enabled claims operations, ensuring compliance and efficiency across various functions while partnering with IT and vendors to optimize claims platforms.
Information Technology & Services
No H1B
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
Qualification
Required
Medicare Advantage experience
Be from operations side
Claims systems platform experience
Experience migrating to new claims system
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, HealthRules, 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
Preferred
advanced degree or relevant certifications (e.g., PMP, Lean/Six Sigma, AHIP) preferred
Company
JS Consulting Solution
At JS Consulting, we provide end-to-end workforce and project solutions designed to meet the evolving needs of businesses across industries.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase