Salary Range: $200,000 – $215,000 per year
Location: New York, NY  |  Hybrid  |  Full-Time, Permanent
2 Days a week in NYC office and 3 days a week Remote

Position Summary

RCM Healthcare Services is recruiting a Senior Director of Claims for a New York City-based managed care health plan. This senior leader will serve as the primary deputy to the Vice President of Claims, directing claims operations, financial accuracy, regulatory compliance, and performance across multiple product lines. The position will guide a large leadership team, oversee delegated partners, and drive claims optimization, automation, and systems modernization. The role offers the opportunity to make a meaningful impact on operational effectiveness and the member and provider experience.

Responsibilities

Schedule / Shift: Full-time; hybrid work arrangement. Specific onsite schedule and weekly hours will be discussed during the interview process.

• Lead medical, behavioral health, and delegated BPaaS claims operations, including adjudication, adjustments, inquiries, provider reimbursement, configuration testing, quality assurance, and auditing.
• Manage departmental goals and metrics for claims inventory, turnaround time, productivity, auto-adjudication, payment accuracy, financial performance, and quality; report results to senior leadership.
• Drive strategic planning, automation, system modernization, workflow redesign, operational transformation, and cross-functional initiatives.
• Ensure compliance with CMS, federal and New York State requirements, prompt-pay standards, contractual obligations, and regulatory audits; oversee delegated vendors and service-level agreements.
• Coach and develop directors and managers, oversee staffing and succession planning, and serve as acting department leader when designated.

Requirements

Education

• Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Information Systems, or a related field required.
• Master’s degree in a related discipline preferred.

Licenses & Certifications
No specific professional licensure or certification required.
Experience

• 8+ years of progressive health plan claims operations experience; 7+ years of experience leading managers and senior leaders.
• Experience with Medicare, Medicaid, Commercial, Marketplace, and Special Needs products.
• Background leading regulatory audits, major operational change initiatives, and large teams; deep understanding of claims systems and CMS/New York regulations.

Skills

• Executive presence, strategic thinking, business acumen, and change leadership.
• Strong data analysis, financial judgment, operational problem-solving, and decision-making.
• Excellent communication and presentation skills, with the ability to influence cross-functional partners.
• Proven accountability, talent development, relationship management, and continuous improvement.

About Us

RCM Healthcare Services works with professionals across schools, healthcare, and community-based settings nationwide. We support both contract and direct hire opportunities, connecting people early in their careers and experienced professionals to roles that align with their experience and preferences. With more than 50 years of staffing experience, our team understands the environments you’re stepping into and what it takes to be successful in them. We stay closely involved from first conversation through placement, with consistent communication, a reliable point of contact, and follow-through at every step. We’re committed to caring for the professionals we work with and the communities they support, and offer competitive pay and benefits designed to support your well-being. RCM Healthcare Services is Joint Commission certified, reflecting a commitment to quality, compliance, and a consistent experience.

Equal Employment Opportunity & Reasonable Accommodation

RCM Technologies is an equal opportunity employer and values diversity. We are committed to providing reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act (ADA) and applicable state laws. If you require a reasonable accommodation to apply for or perform this role, please contact us and we will engage in an interactive process to support your needs.

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