Director, Integrity; Fully Remote

• This exempt position reports to the Vice President, Operations and sets strategy for QA, Grievances & Appeals, and FWA teams.
• This role manages day-to-day operations and interacts with all SIHO departments, external stakeholders, and customers.

Key Responsibilities:

• Oversee staffing, performance management, and regulatory interpretation to maintain CMS and state compliance.
• Monitor FWA trends, manage vendor data transfers, and support claims quality assurance programs.

Qualifications:

• Requires a B.S. degree or equivalent healthcare operations experience with 3-5 years in managed care.
• Proficiency in Excel and strong understanding of Medicare Advantage, ACA, and state insurance regulations.

Compliance:

• Lead compliance initiatives including SOC audits, CMS Part C Reporting, and ODAG.
• Work with SIHO Legal and external parties including CMS and law enforcement on special cases.

SIHO Insurance Services provides health insurance administration and related services, focusing on payment integrity and regulatory compliance. The company operates in a managed care environment and emphasizes collaboration, professionalism, and adaptability among its employees.