Director Financial Operations - Payment Integrity Operations

Primary duties may include, but are not limited to:

• Counsels senior management on enterprise-wide policies and strategies and provides operational insight regarding performance, risks, business impacts, remediation plans, and go-forward strategies.
• Represents the company in legal matters and testifies as needed.
• Develops and implements vision, strategies, and tactics to maximize the department's effectiveness while minimizing costs, with a focus on operational and process excellence, workforce and inventory management, and opportunities to improve workflows through data and technology.
• Ensures internal controls are appropriate and develops policies and procedures and ensures compliance with government regulations.
• Works with other areas to develop solutions to complex operational problems and participates in critical interactions with both internal and external customers. Partners across operations, data, technology, and other business areas to identify root causes, improve processes, and support enterprise initiatives.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports and provides leadership across multidisciplinary operational, analytical, project support, technical, automation, and quality functions.
• Serves as the primary operational liaison across upstream and downstream partners, collaborating with Payment Integrity Strategy, Product, and Digital teams to align strategic priorities with operational needs, identify dependencies, influence solutions, and support implementation readiness and end-to-end execution.
• Provides oversight of departmental initiatives, coordinating priorities, milestones, deliverables, risks, and cross-functional dependencies to drive accountable execution of operational, process, and technology improvements.
• Leads departmental inventory management and reporting, maintaining visibility into inventory health, workload, productivity, performance trends, and operational risks to inform leadership decisions, resource planning, and continuous improvement.

Minimum Requirements:

Requires minimum of 8 years experience with operations, financial reporting and analysis, audit guidelines, budgeting and multi-state operations and processes and a minimum of 5 years management experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, & Experiences:

• Payment Integrity experience with a strong understanding of claims operations, operational workflows, and the mechanics of Payment Integrity work, preferred.
• Strong data and analytical fluency, including experience using reporting, inventory analytics, and performance data to identify trends, diagnose operational issues, and support decision-making, preferred.
• Operational and process excellence experience, including the ability to evaluate workflows, identify root causes, and determine whether opportunities are related to training, process, goals, or technology, preferred.
• Experience leading in a complex healthcare operations environment with demonstrated agility, responsiveness, sound judgment, and the ability to manage multiple competing priorities, preferred.
• Experience leading or partnering across multidisciplinary functions such as workforce management, project support, reporting and analytics, technology, automation, and quality, preferred.
• Strong executive-level written and verbal communication skills with experience translating operational performance, risks, remediation actions, and go-forward plans for senior leadership, preferred.
• Experience across multiple healthcare lines of business, another health plan or Blue plan, or a Payment Integrity vendor environment, preferred.
• Experience supporting enterprise-level projects and/or managing operational vendor relationships, preferred.
• Knowledge and application of Lean Six Sigma or comparable continuous improvement principles, preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $138,320.00 to $238,602.00.