Director of Claims and Tariff Management (Remote) at Reliance Health

Job Title: Director of Claims and Tariff Management

Key Responsibilities

• Cost Reduction and Fast Reimbursement Cycles: Implement strategies to reduce costs and ensure rapid reimbursement cycles for claims across all active markets, enhancing overall operational efficiency and customer satisfaction.
• Efficiency Improvement and Unpaid Claims Reduction: Oversee initiatives to enhance the efficiency of claims and optimize team productivity and processing systems to reduce unpaid claims backlogs and streamlining workflows for faster adjudication.
• Automation and Rules-Based Claims Processing: Lead the improvement of rules-based automated claims processing engines, leveraging technology to enhance accuracy, speed, and consistency in claims adjudication.
• Prior Authorization Enhancement: Enhance the accuracy and turnaround time for complex prior authorization requests, ensuring timely access to necessary healthcare services for our members.
• Cost Reduction and Fast Reimbursement Cycles: Implement strategies to reduce costs and ensure rapid reimbursement cycles for claims across all active markets, enhancing overall operational efficiency and customer satisfaction.
• Efficiency Improvement and Unpaid Claims Reduction: Oversee initiatives to enhance the efficiency of claims and optimize team productivity and processing systems to reduce unpaid claims backlogs and streamlining workflows for faster adjudication.
• Automation and Rules-Based Claims Processing: Lead the improvement of rules-based automated claims processing engines, leveraging technology to enhance accuracy, speed, and consistency in claims adjudication.
• Prior Authorization Enhancement: Enhance the accuracy and turnaround time for complex prior authorization requests, ensuring timely access to necessary healthcare services for our members.

Requirements

• MBBS or Bachelor’s Degree in Healthcare Administration, Business Management, with a preferred background of master’s level studies in data analysis or business administration  
• 8+ years of experience in claims management and tariff negotiation within the healthcare industry
• Proven track record of implementing process improvements to enhance claims efficiency and reduce costs.
• Strong background in data analysis and demonstrated ability to work with data to solve complex problems, utilizing advanced analytical tools and methodologies
• Strong understanding of rules-based automated claims processing systems and prior authorization workflows.
• Experience in tariff negotiation, provider network management, and benefits design across diverse markets.
• Excellent leadership and communication skills, with the ability to collaborate effectively across cross-functional teams.
• Analytical mindset with proficiency in data-driven decision-making and performance metrics evaluation.

Benefits
At Reliance Health, we prioritize our people and their well-being. Our benefits package is designed to support your success, growth, and happiness. Here’s what you’ll enjoy:
Hybrid, Flexible Environment:

• Experience the best of both worlds with our hybrid setup—work from home when you need focus, and connect with a vibrant, collaborative team in the office.

Competitive Salary and Benefits:

• We offer a salary that’s benchmarked against the best in the industry, ensuring your expertise and impact are fully rewarded.

Premium Health Insurance:

• Comprehensive health coverage for you and your family, because your well-being comes first.

Unlimited Leave:

• Take the time you need when you need it—no limits, no questions.

Meaningful Impact:

• Play a key role in transforming customer experiences and shaping healthcare innovation.

Collaborative Work Culture:

• Join a supportive, inclusive, and team-focused environment that celebrates diversity.

Growth Opportunities:

• Access tools, mentorship, and resources to elevate your skills and career.

Learning & Development Allowance:

• We provide an allowance to support your ongoing professional growth and skill enhancement. 

Application Instructions:

The application deadline is Not Specified. Qualified and interested candidates can “CLICK HERE TO SUBMIT APPLICATION” It is important to visit the official website (link found below) for detailed information on how to apply successfully for this vacancy.