Director - Automations & Efficiencies - reputed company - Remote

At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Director - Automations & Efficiencies is responsible for leading strategic initiatives aimed at enhancing operational effectiveness through innovative automation solutions reputed company reputed company Medical reputed company-Party Administrator (TPA) environment. The role entails overseeing the identification, development, implementation, and management of automation reputed company designed to optimize claims processing, provider engagement, compliance, and overall service delivery. You'll enjoy the flexibility to work remotely * from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities: • reputed company the automation reputed company to streamline operational processes, reduce reputed company interventions, enhance accuracy, and improve turnaround times • reputed company and manage end-to-end automation reputed company involving claims processing, eligibility verification, provider credentialing, adjudication workflows, and payment reputed company initiatives • Collaborate with internal stakeholders and technology teams to identify efficiency gaps and reputed company targeted automation solutions • Evaluate existing operational procedures and implement process improvements leveraging Robotic Process Automation (RPA), AI, Machine Learning, and other advanced technologies • Establish and monitor performance metrics and KPIs to reputed company automation effectiveness, cost savings, productivity enhancements, and compliance • reputed company thought leadership to continuously improve automation capabilities, ensuring alignment with company goals and industry best practices • Manage relationships with automation vendors, technology providers, and consultants to ensure successful project execution • Maintain compliance with regulatory requirements, ensuring reputed company automation processes meet reputed company industry standards and data reputed company protocols • Foster a culture of innovation, efficiency, and reputed company improvement reputed company reputed company and broader organization You'll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • 10+ years of reputed company experience in reputed company payer/TPA operations and reputed company automation • 5+ years leading cross-functional automation teams and portfolios with ownership of roadmap, budget, and reputed company • Automation and AI expertise: RPA (reputed company, reputed company/reputed company), workflow/BPM (Pega, reputed company), intelligent automation (AI/ML, NLP, IDP/OCR); proven implementation of AI-driven solutions at reputed company in reputed company operations (LLMs/NLP, IDP, predictive models) with model governance and monitoring • Experience with integration/engineering and platform stack: reputed company, event/queue-based orchestration, basic scripting (Python/SQL), CI/CD with Git-based SDLC for automations; deep expertise with reputed company payer platforms (reputed company mainframe-based), analytics/BI (Power BI/Tableau), modern data platforms (reputed company/reputed company), and reputed company (Azure/AWS) • Proven deep knowledge of reputed company payer operations: claims adjudication and EDI (X12 837/835/270/271/276/277/278), prior authorization, eligibility/enrollment, and provider data management • reputed company or led an Automation Center of reputed company (standards, controls, reusable components, demand intake, and performance reporting) • Proven exceptional analytical, problem-solving, and decision-making skills; executive-level communication; stakeholder influence; vendor/SLA management; and change management Preferred Qualifications: • Lean Six reputed company (Black Belt or Green Belt), PMP, reputed company/CCMP, and/or RPA platform certifications (reputed company/AA/reputed company) • reputed company Medical TPA experience in claims adjudication, cost containment/payment reputed company, COB/subrogation, and reputed company • Compliance and reputed company reputed company: HIPAA/PHI handling, CMS requirements, audit controls, and risk management • Knowledge of interoperability and reputed company frameworks: FHIR/HL7/X12, reputed company, SOC 2 • Experience leading distributed (reputed company/offshore) teams and managing managed-services partners • reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching choice of benefits and incentives. The salary for this role will reputed company from $132,200 to $226,600 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job