The Director of Claims Management Ancillary Services oversees the strategy, performance, and regulatory compliance of claims ancillary functions and plan document administration. This role manages key teams, establishes operational KPIs, and serves as the primary authority for clients and partners regarding claims and plan document standards.
The VP of Data Architecture & Integration is responsible for defining the enterprise data strategy, governance, and integration services to support operational and analytical business needs. This leader oversees the delivery of secure, scalable data platforms and ensures consistent data modeling across the organization.
The Plan Documents Manager will oversee the drafting and management of benefit plan documents such as SPDs, SBCs, and SMMs while ensuring compliance with federal regulations. They will also lead the document team, implement process improvements, and collaborate with internal departments and external vendors to support client onboarding and plan changes.
The Senior Plan Documents Specialist facilitates client onboarding and manages the drafting, maintenance, and compliance of complex benefit plan documents. They work cross-functionally with internal teams and external vendors to ensure accurate plan administration and client satisfaction.
The Client Success Executive will serve as the primary point of contact for Middle Market employer clients, managing relationships and ensuring the successful delivery of health plan products. They are responsible for driving client retention, leading the renewal process, and collaborating cross-functionally to resolve issues and improve service delivery.
The Client Success Manager provides operational support for client relationships, including resolving claims, benefit, and enrollment issues. They also coordinate client projects, support open enrollment sessions, and maintain accurate client data in systems like Salesforce.
The Claims Business Analyst will triage operational issues, lead projects to improve claims team efficiency, and coordinate with business units and vendors during implementations. They are responsible for analyzing operational reports, developing KPIs, and acting as a liaison between business and technical resources to ensure system requirements are met.
The Claims Adjustor is responsible for reviewing, assessing, and adjudicating healthcare claims for self-funded employer groups in accordance with plan policies. They must maintain production and quality standards while collaborating with internal teams to resolve discrepancies and process claims accurately.
Conduct pre-payment and post-payment claims audits to ensure financial accuracy and adherence to processing standards. Identify quality trends and collaborate with leadership to implement corrective actions and performance improvement plans.
Own and grow strategic relationships with large enterprise employer clients, serving as a trusted advisor to senior HR and Finance leaders. Lead the end-to-end renewal strategy and orchestrate cross-functional teams to ensure a high-touch, white-glove client experience.
The Director of Product Management owns the stop loss and captive product portfolio, defining how risk is structured, priced, and transferred. They lead the full product lifecycle from design and underwriting alignment to reinsurance structure and performance management.
