Director of Claims
UHS
Summary
The Director of Claims is responsible for leading the strategic direction, planning, and execution of all claims operations. This role oversees departmental leadership, ensures compliance with federal, state, and payer regulations. This role drives innovation through technology and process optimization. The Director collaborates with executive leadership to align claims operations with organizational goals, manages departmental budgets, and leads cross-functional initiatives to improve service delivery, quality, and operational efficiency.
Job description
The ideal Director candidate has extensive Commercial, ASO, Medicare and Medicaid claims experience, expertise in claims adjudication systems (QNXT preferred), and a proven track record of strategic leadership in healthcare claims management.
Requirements
- Bachelor's degree in health care administration or business management, or equivalent work experience
- 5+ years' experience in claims management with direct Medicare claims experience
- 5+ years' experience managing, budgeting, forecasting and collaboration with executive leadership
- Strong leadership skills with an ability to influence and persuade internally and externally while driving cross-functional collaboration
- Deep understanding of medical terminology, coding systems (CPT, ICD-10), and insurance billing practices
- Comprehensive knowledge of healthcare regulations, including HIPAA, CMS guidelines, state laws and experience in information preparation for required regulatory audits
- Ability to promote data driven decision making throughout the organization
- Knowledge of benefits, pricing and inventory management and reporting
- Expertise in software implementation, technology adoption and an understanding of which tools work best to meet the needs of organization
- Outstanding interpersonal skills
- Excellent written, oral, and active listening communication skills
- Proficient in MS Office, contact center and training platforms, workforce management and project/team management software
- Strong project management skills and experience managing large scale projects
- Familiarity with claims systems and processes, QNXT system experience strongly preferred
Benefits
- Loan Forgiveness Program
- Competitive Compensation
- Paid Time Off
- Medical, Dental & Vision
- Prescription Drug Plans
- 401(k) Matching
- Discounted Stock Plan
- Student Loan Refinancing
- Career Development
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.