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Director, Claims Administration

United States - Remote

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.

Point C is seeking a strategic and operationally minded Director, Claims Support to lead and oversee the teams that support the broader claims function—including appeals, mailroom, provider relations, and network operations. This individual will be responsible for ensuring timely, accurate, and compliant processes across these areas while identifying opportunities to enhance efficiency, quality, and service delivery. The ideal candidate is a collaborative leader with strong process orientation and experience managing cross-functional support teams in a healthcare, TPA, or insurance environment.

Responsibilities:

  • Provide strategic and day-to-day leadership for the appeals, mailroom, provider support, Subrogation, stoploss, and network teams, ensuring performance standards are met or exceeded
  • Develop and implement efficient workflows and standard operating procedures that support accuracy, compliance, and service quality
  • Monitor key performance indicators (KPIs) across all support functions, identifying trends, resolving issues, and driving continuous improvement
  • Collaborate closely with claims leadership, compliance, IT, account management, and clinical teams to ensure alignment and integration across functions
  • Ensure timely resolution and quality review of appeals in accordance with regulatory and client-specific requirements
  • Oversee mailroom operations and document management processes to ensure timely handling of incoming and outgoing materials
  • Lead the provider and network support teams, ensuring accurate data maintenance, effective communication, and resolution of provider inquiries or issues
  • Support system enhancements and technology implementations that improve workflow efficiency and data integrity
  • Coach, develop, and mentor team leads and managers; foster a high-performance culture focused on accountability and collaboration

Qualifications:

  • 7+ years of experience in claims operations or healthcare support services, with 3+ years in a leadership role
  • Strong understanding of appeals, provider data management, mailroom logistics, and network support in a healthcare or TPA setting
  • Proven ability to lead and scale operational teams while maintaining quality and compliance standards
  • Excellent problem-solving, analytical, and organizational skills
  • Strong interpersonal and communication skills, with the ability to work cross-functionally and lead through change
  • Familiarity with relevant regulations (e.g., HIPAA, ERISA) and claims adjudication systems
  • Bachelor’s degree required; advanced degree or healthcare/operations certifications a plus

Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.

Pay Transparency

$95,000 - $140,000 USD

Benefits:
  • Comprehensive medical, dental, vision, and life insurance coverage
  • 401(k) retirement plan with employer match
  • Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
  • Paid time off (PTO) and disability leave
  • Employee Assistance Program (EAP)

 

Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.

 

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