Director I, Digital Claims Operations

Director I, Digital Claims Operations (Dir I Digital Ops)

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidate resides within a commutable distance from an office.

The Director I, Digital Claims Operations will lead key operational functions within Claims, including oversight of teams requiring more complex processes or support. This may include responsibility for production support to ensure timely issue resolution, root-cause identification, and stability across Claims platforms and processes, and focus on JAA / TPA (Jointly Administered Agreements; Third Party Administrator) operations and improvement. May also oversee other specialty inventory such as worker's compensation claims to ensure consistent quality, accuracy, and adherence to regulatory and contractual requirements. The role will identify digital and automation opportunities that enhance Claims workflows in partnership with IT and delivery teams, and drive process optimization efforts across Claims operations to improve cycle time, reduce rework, and strengthen operational readiness for new benefits, products, or regulatory mandates.

How you will make an impact:

• Serves as a leader across departmental lines in order to further penetration of operational digitization, E2E efficiencies, lowered administrative costs and an excellent member and provider experience.  
• Enables effective achievement of digital operations organizational objectives.
• Participates with peers and digital operations leadership to deliver on strategic plans and objectives.
• Provides a broad range of services needed by operational & technology teams to satisfy strategic initiatives, and leads and executes strategic business transformation projects along with complex/new processes.  
• Plans, directs, and controls the resources and efforts of a unit(s) within blended Digital Operations organization.  
• Executes objectives of the company and the blended Digital Ops organization.
• Effectively leads implementation / management of digitization initiatives that demonstrates understanding of current and future operational business processes that digitization does/can enable.
• Obtains resources (people, funding, material, support) to get things accomplished within units of responsibility.  
• Management of digitization initiatives that demonstrates understanding of current and future operational business processes that digitization does/can enable.
• Obtains resources (people, funding, material, support) to get things accomplished within units of responsibility.  
• Ensures compliance with state and federal regulations.  
• Directs multiple work functions/applications or major projects/programs with broad scope and strategic business impact.  
• Manages an enterprise suite of applications by developing digitization forecast and delivery plan.  
• Ensures disaster recovery and business continuity plan are implemented, monitored, and updated on a recurring basis.
• Delivers operational guidance and offers system solutions that enable the operations of functional areas on a 24x7x365 basis.  
• And/or provides oversight of transactional operations staff management, ensuring production levels and quality are maintained.
• Ensures teams are meeting production (inventory levels, aging and quality) and guides teams to take immediate corrective actions as needed.  
• Hires, trains, coaches and evaluates performance of direct reports.  
• Provides leadership in motivating subordinates to accomplish the Digital Ops organization goals and objectives.
• Develops a strong team through training and effective organizational development practices.  
• Implements the policies, practices, and procedures of the company and blended digital and operations organizations.  
• Manages direction of information system and programming activities of technical staff.  
• Leveraging reporting and analytics tools, continually monitors procedures and operational metrics to ensure these are met by staff.  
• Manages across geographically diverse associates and vendor partners.  
• Has fiscal responsibility for unit budget.  
• Builds strong partnerships with market and digital leads, Benefits Administration, Provider Engagement and Contracting, Sales and Internal Audit.  
• Effectively adjusts communications depending upon audience; translates technical and/or business issues in non-technical/non-jargon terms to non-technical or executive audiences.  
• Effectively consults, facilitates, negotiates and persuades.  
• Effectively interfaces with external contacts, e.g. customers and agencies. Negotiates the resolution of intra-organizational issues in the balanced best interests of the business.  

Minimum Requirements:

Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 7 years of experience leading technology (application development, configuration, maintenance or implementation and support) teams and/or cross functional project (technology and operations) teams; with 5 years management and/or leadership experience; or any combination of education and experience which would provide an equivalent background.  

Preferred Skills, Capabilities, and Experiences:

• Proven experience leading Claims Operations teams and strategy within a large healthcare payor environment strongly preferred.
• Proven track record leading Digital Transformation in a Claims operational setting strongly preferred.
• Digital literacy strongly preferred.
• Health insurance industry experience strongly preferred.
• Claims operational experience strongly preferred.
• Process Improvement/Six Sigma skillset preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $148,984 to $223,476.

Locations:  Massachusetts

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company.  The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.