Director, Claims Business Implementation (Healthcare)

Location: Remote-MO (United States)

Salary: $148,000–$274,200 per year

Company

hirify.global provides healthcare services and supports access to care for individuals, families, and communities.

What you will do

• Oversee the implementation of products and health plans across Claims business units, including new markets, reprocurements, expansions, and regulatory or contract changes.
• Direct the creation and maintenance of standard models, methodologies, and processes for claims implementation.
• Lead Claims and Configuration Operations during the implementation phase.
• Provide strategic oversight and enforce adherence to standard implementation processes, including Business Requirements Document approvals.
• Contribute to operating models, functional and information system models, performance metrics, expected outcomes, and plan impacts.
• Manage implementation delivery against budget, timelines, scope, and new health plan business requirements.

Requirements

• Bachelor’s degree in a related field or equivalent experience.
• At least 7 years of project management experience, including practical knowledge of project management methodologies and tools.
• At least 5 years of Government Programs Managed Care experience across multiple operations areas, such as Claims, Provider or Member Services, Medical Management, or Network operations.
• Experience with Medicaid Managed Care is preferred.
• Master’s degree is preferred.
• Work location: Remote-MO in the United States.

Culture & Benefits

• Health insurance and paid time off, including holidays.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Flexible work approaches may include remote, hybrid, field, or office schedules.
• Compensation may vary based on skills, experience, education, job-related factors, and employment status.