Director, Health Plan Operations (Claims) Florida

JOB DESCRIPTION Job Summary
Leads and directs team responsible for the development and administration of state health plan operational functions, programs and services - ensuring functional operations, contractual compliance, and alignment with health plan member satisfaction, retention, quality, and financial goals.

**Essential Job Duties**

• Under the direction of senior leadership, organizes, plans, staffs, and coordinates health plan operations for market-specific designated lines of business (Medicaid, Medicare, Marketplace, Children's Health Insurance Program (CHIP), Medicare-Medicaid Plan (MMP), etc.).
• Collaborates with staff and senior leadership to develop and implement provider and member service strategies to improve access and satisfaction for designated health plan(s).
• In conjunction with senior leadership, liaises with corporate operations functions including: claims, configuration information management, provider data management, credentia...