[Remote] Sr. Director Claims Operations

Note: The job is a remote job and is open to candidates in USA. UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. They are seeking a strategic leader for Claims Operations who will enhance claims processes and optimize cost structures while driving innovation and operational excellence.ResponsibilitiesEstablish and execute short- and long-term strategic goals for claims processing efficiency and effectivenessDrive continuous improvement initiatives and foster a culture of innovationLead growth initiatives for the claims function, including due diligence, plan integration, staffing, and systemsCollaborate cross-functionally to align claims processing policies with organizational goalsLead and manage all claims-related functions, including: Electronic claim intake, mail distribution, document imaging, data entry, provider maintenance, quality assurance, and trainingEnsure timely and accurate adjudication and payment of hospital, physician, disability, life, and supplementary claimsOversee Short-Term Disability claims in compliance with Department of Labor and Fund guidelinesPartner with Regional Directors and Trustees to improve medical appeals efficiency and transparencyOversee system configuration projects related to benefit plan design, code maintenance, claims editing software, network/vendor mandates, and Fund-wide initiativesDrive auto-adjudication rates (we’re currently at 75%) above industry benchmarks through consistent system configurations and scalable operational strategiesStandardize benefit codes and exceptions and develop master category definitions for use across all plan unitsImplement system changes to support new plan units, benefit updates, vendor transitions, and legislative requirements, as well as recommend system upgradesDefine analytical requirements for claims-related reports, KPIs, and metrics within the enterprise data warehouseMonitor performance metrics and prepare management reportsConduct claims studies to inform strategic decisions and partner with service areas ensuring claims accuracy and understandingPropose benefit changes based on claims and appeals trends to reduce member abrasionCollaborate with IT and network vendors to ensure electronic claim files comply with HIPAA standards and regulatory changes, including the No Surprises ActDevelop and enforce operational policies, procedures, and utilization safeguardsManage RFP processes for claims vendors and ensures timely resolution of customer service inquiriesImplement cost management strategies and fiscal risk mitigation practicesAuthorize exceptions to standard operating procedures and manage departmental budgetsCoach and develop managers and supervisors for future leadership rolesLead HR functions including hiring, performance evaluation, and employee developmentExemplify the organization’s values in fostering a respectful, trusting, and engaged culture of inclusionSkillsMinimum 15 years of progressive leadership experience in automated group health claims environments, preferably within organizations of 300+ employeesAt least 10 years of team management experience, including 5+ years in senior leadership roles5+ years of experience in system configuration and benefit plan designBachelor's degree in business administration, healthcare, or related field preferred (or equivalent experience required)Deep knowledge of group health benefits and claims processing systemsFamiliarity with DOL, ERISA, ACA, and other regulatory requirements related to group health plan administrationThe ability to travel 15+% as neededExperience with Taft-Hartley plan administration strongly preferredBenefitsMedicalDentalVisionPaid Time-Off (PTO)Paid Holidays401(k)Short- & Long-term DisabilityPensionLifeAD&DFlexible Spending Accounts (healthcare & dependent care)Commuter TransitTuition AssistanceEmployee Assistance Program (EAP)Company OverviewUnite Here Health is a non-profit organization that provides health benefits and healthcare services. It was founded in undefined, and is headquartered in Oak Brook, Illinois, USA, with a workforce of 501-1000 employees. Its website is https://www.uhh.org/.