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Provides strategic oversight of claims delegation and operations to ensure accurate adjudication and regulatory compliance. Leads cross-functional initiatives, monitors performance metrics, and manages a team of claims specialists and analysts.
Requires a Bachelor's degree and over 10 years of experience in claims operations, including at least 5 years in healthcare. Must have at least 5 years of experience managing staff.
Position: Senior Director of Claims Delegation
Location: Hybrid (Must Reside in NY/NJ/CT)
Work Schedule: Monday - Friday, 9:00am - 5:00pm
Compensation: $153,978.55 - $173,225.87
VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services.
Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.
The Senior Director Claims Delegation provides strategic oversight of claims delegation and claims operations projects to ensure timely, accurate adjudication and strong regulatory alignment. This senior leader drives cross-functional execution, strengthens controls, and elevates performance against service expectations.
Key responsibilities include leading claims-related initiatives end to end; setting project priorities across internal and external workstreams; expanding claims reviews and audits in line with VillageCare policy, NYS Prompt Pay, DOH, and CMS; delivering monthly status reporting to Finance leadership and updates to senior leaders; partnering with Utilization Management on authorization-driven changes impacting claims; monitoring claims metrics against SLAs; directing root-cause analysis for processing risks; serving as claims data steward during migration efforts; and recruiting, coaching, and developing a team of managers, specialists, and analysts.
Qualifications:
- Bachelor's degree
- 10+ years in claims operations (5+ in healthcare)
- 5+ years managing staff
If you're ready to lead complex claims delegation work with integrity and precision, apply today.
Your day typically starts with a review of overnight claims dashboards and open action logs, followed by brief check-ins with managers to confirm priorities and remove blockers. You'll spend focused time validating audit findings, reconciling trends against SLAs, and preparing clear rollups for monthly Finance reporting.
Midday, you'll partner with Utilization Management leaders to align authorization changes with downstream claims outcomes, then join working sessions with Business Intelligence and Compliance to confirm definitions, controls, and reporting logic. Afternoons often include reviewing project timelines, escalating risks with practical options, and guiding data-migration decisions as the claims data steward.
Throughout the day, you'll maintain steady communication across Network Management and Member Services to ensure issues are triaged, documented, and resolved with speed and accuracy.
See What's Possible When Health Care Gets Personal
VillageCare is a pioneering and innovative continuing care organization that provides managed care and community care options. We strive to understand the current state of need of those we serve and pursue appropriate responses. VillageCare recognizes and supports self-directed, interactive care. This enables being served to control aspects of their own care and helps them maintain their independence. VillageCare delivers care and services for more than 35,000 unique individuals annually through its health plan and community programs. Guided by the people we serve, we provide leadership to improve the health and quality of life of the diverse communities we serve and the quality of care and well-being of the people we serve.
Offices: 120 Broadway, 2840, New York, NY 10271, US
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