Director of Claims Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Build and Lead a High-Performance Claims Operation.

• Guide and expand a multidisciplinary Claims Operations team — encompassing claims adjudication, quality, operations, and clinical — to ensure accurate, timely claims processing and an outstanding member experience.

• Cultivate a culture focused on metrics-driven continuous improvement, accountability, and high performance across all Claims functions.

• Nurture future leaders within the team and establish a strong foundation for a growing, complex operation.

• Propel AI, Automation, and Operational Transformation initiatives.

• Identify, prioritize, and spearhead automation efforts that significantly enhance end-to-end auto-adjudication rates, shorten claims processing time, and elevate quality and accuracy.

• Collaborate with Product and Engineering to define the roadmap for claims technology — serving as a strategic voice rather than merely an operator.

• Lead change management initiatives as the team integrates new tools, workflows, and methodologies.

• Create and uphold governance structures that promote scalable, compliant, and data-informed operations.

• Take ownership of Claims Strategy & Business Outcomes.

• Align claims operations with Sidecar Health's overarching business objectives — including ongoing growth, sustainable MLR, and a strong emphasis on member experience.

• Enhance payment accuracy, fraud prevention, and claims expenditure optimization through proactive stakeholder engagement and cross-functional initiatives.

• Convert operational data into strategic insights and recommendations for senior leadership.

• Mitigate operational and regulatory risk while ensuring complete compliance with healthcare regulations.

• Oversee budget development and resource allocation, ensuring alignment with organizational priorities.

⛳️ Requirements

• Over 15 years of operations experience, with a minimum of 5 years in the healthcare sector.

• More than 8 years in senior leadership positions, managing large teams in complex environments.

• Experience in a high-growth, tech-enabled health insurance or benefits organization is preferred.

• Proficient with data — capable of constructing and interpreting operational dashboards and holding teams accountable to metric-based objectives.

• Proven track record of leading through uncertainty, managing cross-functional stakeholders, and driving change in dynamic environments.

• Strong financial insight — experience in budget ownership, headcount planning, and cost-per-claim targets.

• Demonstrated success in deploying AI or automation within a claims or complex operations context.

🏝️ Benefits

• Competitive salary, bonus opportunities, and equity package.

• Comprehensive Medical, Dental, and Vision benefits.

• A 401k retirement plan.

• Paid vacation and company holidays.

• Opportunity to make a meaningful impact at a rapidly growing mission-driven company transforming healthcare in the U.S.