Director Claims Processing

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director, Applications - Claims Processing based in United States.

This senior technology leadership role oversees the applications portfolio supporting complex healthcare claims processing and payment operations.

You will lead teams responsible for cloud-native solutions across adjudication, reimbursement, payment integrity, authorization, workflow, and regulatory programs.

The role combines strategic architecture, hands-on technical leadership, application delivery, and people management.

You will drive the adoption of Microsoft Azure, AI-enabled development, automation, and modern Dev Ops practices across the organization.

Success will depend on close collaboration with claims, product, provider, health plan, clinical, financial, and operational stakeholders.

The position offers the opportunity to modernize large-scale healthcare technology platforms while improving processing efficiency, scalability, quality, and operational outcomes.

This is a fully remote, full-time leadership opportunity with significant influence across technology and business functions.

• Lead the claims custom-solutions portfolio covering adjudication, payment integrity, provider reimbursement, accumulators, authorization integration, workflow, and regulatory initiatives.

• Govern solution intake, prioritization, funding, delivery, lifecycle management, and operational support across claims-related applications.

• Partner with Claims Operations, Product, Payment Integrity, Provider Services, Health Plans, and other business stakeholders to translate complex business needs into scalable technology solutions.

• Lead and develop a team of Forward Deployed Engineers, establishing performance expectations centered on end-to-end ownership and measurable healthcare business outcomes.

• Champion AI-first development practices using Visual Studio, Git Hub Copilot, Azure AI services, and machine-learning capabilities.

• Drive cloud-native application architecture and development across Azure services, including App Services, Functions, AKS, Azure SQL, Data Factory, Synapse, and Azure Dev Ops.

• Lead enterprise quality-assurance automation strategies and promote automated testing, CI/CD, Agile delivery, and Dev Ops practices.

• Oversee application implementations, integrations, enhancements, support activities, break-fix work, and large requests while maintaining established service levels.

• Drive strategic integrations with low-code platforms such as Pega, Salesforce, and Sitecore.

• Lead architecture and design reviews, ensuring alignment with Azure cloud patterns, the Azure Well-Architected Framework, security standards, enterprise architecture, HIPAA, and healthcare data-governance requirements.

• Monitor application stability, performance, and scalability using tools such as Azure Monitor and Application Insights, while implementing proactive alerting and operational improvements.

• Manage strategic vendor relationships, Azure cloud partnerships, third-party consultancies, and build-versus-buy evaluations.

• Establish KPIs covering claims inventory reduction, auto-adjudication, processing efficiency, automation, quality, and operational cost reduction.

• Gather requirements and develop conceptual and technical designs for multiple large-scale initiatives while providing architectural guidance to technical teams and business leadership.

• Participate in hands-on software development on Azure when required and provide technical expertise across complex .NET and serverless solutions.

• Coordinate cross-functional projects, deliverables, governance, change management, budgeting, planning, and enterprise standards.

• Hire, mentor, train, and develop a high-performing engineering organization focused on business ownership, collaboration, accountability, and continuous improvement.

• At least 8 years of IT applications or software development experience within large organizations, preferably in the managed care or healthcare industry, or an equivalent combination of education and relevant experience.

• At least 3 years of management or technology leadership experience, including experience building and developing high-performing engineering teams.

• Advanced Microsoft Azure expertise, including App Services, Functions, AKS, Azure SQL, Data Factory, Synapse, Azure Dev Ops, and related cloud architecture capabilities.

• Strong proficiency with Visual Studio and…