Senior Director, Escalated Provider Issue Resolution

📋 Description

• Lead a multidisciplinary provider issue resolution organization.
• Build scalable operating model for escalated provider issues.
• Oversee high-impact provider issue resolutions across cross-functional teams.
• Partner with Claims, Network, Utilization Mgmt, Payment Integrity, Tech, Analytics to improve handoffs.
• Oversee root-cause remediation via trend analysis; prioritize fixes by ROI and impact.
• Establish closed-loop tracking to ensure root causes are addressed and improvements adopted.

🎯 Requirements

• 12+ years in healthcare operations (provider/claims/network) or related field.
• 7+ years of senior leadership experience leading managers or multi-team functions.
• Experience leading complex issue resolution, escalation, or service model design in healthcare.
• Strong understanding of payer ops: claims, network, reimbursement, utilization, payment integrity.
• Proven ability to build operating models, governance, metrics, and accountability across teams.
• Experience leading change management for new operating models across teams.

🎁 Benefits

• Medical, dental, and vision benefits
• 11 paid holidays and paid sick time
• Paid parental leave
• 401(k) plan participation
• Equity grants and annual performance bonuses
• Unlimited vacation program