Senior Director, Escalated Provider Issue Resolution

📋 Description

• Lead a multi-disciplinary provider issue resolution team.
• Build a scalable operating model for escalated provider issues.
• Oversee resolution of high-impact provider issues across multiple teams.
• Partner with Claims, Network, UM, Payment Integrity, Contact Center, Analytics to improve handoffs and reduce escalations.
• Oversee root-cause remediation by analyzing trends and prioritizing fixes by impact and ROI.
• Establish closed-loop tracking to reduce recurring provider friction.

🎯 Requirements

• 12+ years in healthcare operations, provider operations, payer operations, claims operations, network operations, or provider relations.
• 7+ years of senior leadership experience, including leading managers or multi-team functions.
• Experience leading complex issue resolution, escalation management, or service model design in healthcare.
• Strong understanding of payer operations: claims, provider data, network ops, reimbursement, utilization, and payment integrity.
• Proven ability to build operating models, governance routines, and metrics across teams.
• Experience leading change management across cross-functional teams.

🎁 Benefits

• Medical, dental, and vision benefits.
• 11 paid holidays.
• Paid sick time.
• Paid parental leave.
• 401(k) plan participation.
• Life and disability insurance.