Claims Operations Director

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity

We are seeking a remote / work from home seasoned, strategic leader to oversee and optimize our Claims Operations function. This individual will bring a strong operational foundation combined with deep claims expertise, enabling Claims to drive efficiency, innovation, and long-term growth. The ideal candidate is currently at a Director level or higher, with experience spanning claims and broader operations, and a proven track record of delivering measurable improvements in cost management, governance, and member experience.

KEY RESPONSIBILITIES:

Strategic Leadership & Growth

• Establish and execute short- and long-term strategic goals for claims processing efficiency and effectiveness.
• Drive continuous improvement initiatives and foster a culture of innovation.
• Lead growth initiatives for the claims function, including due diligence, plan integration, staffing, and systems.
• Collaborate cross-functionally to align claims processing policies with organizational goals.

Claims Operations Oversight

• Lead and manage all claims-related functions, including:
  • Electronic claim intake, mail distribution, document imaging, data entry, provider maintenance, quality assurance, and training.
• Ensure timely and accurate adjudication and