Director of Medical Claims

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Lakeshore Talent is in search of a Director of Claims for a direct hire opportunity with a mission-driven healthcare organization based in Denver, CO. This is a hybrid role that offers a meaningful leadership opportunity for a highly experienced professional in healthcare claims management. 

Location: Remote – with travel to Denver, CO quarterly
Compensation: $103,300 – $134,400 annually (Bonus potential TBD)
Reports to: VP of Operations

Overview:

The Director of Claims is responsible for overseeing the daily operations of the claims department to ensure the timely, accurate, and compliant adjudication of healthcare claims. Reporting to the VP of Operational Accounting, this position leads a team of claims professionals, provides technical and strategic guidance, ensures regulatory compliance, and collaborates with other departments on process improvements and data reporting.

Key Responsibilities:

Claims Management (80%)

• Oversee and manage claims adjudication, appeals, adjustments, and support functions.

• Ensure accurate, timely processing of claims and adherence to all regulatory guidelines.

• Monitor and report on performance metrics and departmental KPIs.

• Evaluate, maintain, and improve claims processing systems and tools.

• Partner with vendors and internal stakeholders to address and resolve claims-related issues.

• Lead initiatives around data accuracy, software improvements, and operational scalability.

• Prepare and deliver analytical reports to leadership and cross-functional partners.

• Serve as the claims liaison for cross-departmental initiatives and committees.

• Address and resolve escalated provider or participant claims grievances.

Team Leadership (20%)

• Supervise, develop, and support claims department staff.

• Conduct performance reviews, manage hiring and training processes, and handle disciplinary matters.

• Promote a collaborative and productive team environment with a focus on high standards and accountability.

• Lead regular department meetings and 1:1s to support communication, alignment, and performance.

Must-Have Qualifications:

• 10+ years of experience in healthcare claims processing, including error resolution, coordination of benefits, and adjudication practices.

• 2+ years of supervisory experience in a claims or operational setting.

• Strong working knowledge of CMS 1500, UB2004, ICD-9, CPT coding, co-pays, deductibles, and coordination of benefits.

• Proficiency in Microsoft Office Suite, and familiarity with claims processing systems like Managed Claim Optimizer (MCO) and Check-writer.

• Bachelor’s degree in Accounting or related field from an accredited institution.

Additional Skills & Competencies:

• Deep understanding of healthcare claims, accounting principles, and insurance processes.

• Analytical thinker with experience in P&L, budgeting, and statistical reporting.

• Excellent written and verbal communication skills.

• Strong interpersonal and organizational abilities.

• Culturally competent with experience working in diverse environments.

• Ability to manage multiple priorities and deadlines in a fast-paced setting.

Benefits:

• Start Day 1!

• Medical (United Healthcare), Dental, and Vision (VSP)

• 401(k) with 50% match on first 4%

• 11 paid holidays + earned PTO

• FSA/HSA options, wellness program, life insurance, disability coverage, tuition reimbursement, and EAP

This is a fantastic opportunity for a seasoned claims leader to bring operational excellence and strategic leadership to a growing organization focused on delivering high-quality, accessible care. If you’re ready to lead and innovate in a collaborative environment, we’d love to connect.

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