"Alerted.org

Job Title: Director, Health Claims Administration

Salary Range: $175,000 – $195,000 + Bonus BOE

Schedule: Hybrid

Overview

We are seeking an experienced and strategic Director of Health Claims Administration to lead and oversee all operational aspects of our Claims Department. This senior-level position plays a key role in ensuring the accurate, timely, and compliant adjudication of medical, dental, vision, and weekly income claims. As a key liaison to the Board of Trustees and a leader within the organization, this individual must bring deep expertise in health claims management, compliance, and team leadership. Travel is anticipated at 10-20% of the year in this a hybrid position based in Newtown Square, PA, offering a dynamic leadership opportunity within a mission-driven, high-impact environment. Apply today for immediate consideration!

Responsibilities

+ Deep understanding of healthcare regulations, claims adjudication, and compliance (HIPAA, PHI, etc.).

+ Proven success in directing teams, managing complex operations, and communicating effectively with senior stakeholders.

+ Strong judgment, attention to detail, and ability to thrive in a fast-paced, self-directed environment.

Requirements

+ Bachelor’s degree in Healthcare Administration, Business Administration, or related field (Master’s preferred).

+ Minimum 10 years of progressive experience in health claims administration and health plan operations.

+ Strong background in ERISA self-funded plans — this is mandatory.

+ Proven leadership and team management experience in high-volume claims environments.

+ Extensive knowledge of healthcare claims processing, adjudication, and compliance.

+ Demonstrated success in managing vendor relationships and ensuring high service standards in national health plans, preferably union or multiemployer-based.

+ Proficiency in medical and health plan terminology and systems.

The company provides competitive total reward offerings that consist of compensation, benefits, recognition, along with a wealth of other well-being, work-life and recognition programs which support in unlocking the potential for you and your family. Included in our expansive list of benefits offerings are multiple group medical, dental and vision plans, a robust wellness program, life insurance and disability coverages, also a variety of voluntary programs such as group accident, hospital indemnity, critical illness, pet insurance and much more. To help you save for retirement, we offer a 401(k) plan with a matching contribution and for work-life balance we have vacation and sick time programs for associates. For us, it’s about protecting the personal welfare of our associates and their families, helping to achieve personal goals and offering those extra touches for convenience, security and overall peace of mind.

#M3

#LI-DW1

Ref: #558-Scientific

System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.