Leads large-scale workers’ compensation bill review operations, overseeing service delivery, client satisfaction, workforce planning, process optimization, budgets, and business growth. Manages multiple leadership layers and operational teams while establishing performance goals, monitoring service metrics, driving automation and AI initiatives, and partnering with technology, product, quality, compliance, sales, and clients. Requires extensive healthcare, claims, payment integrity, or medical bill review leadership experience.
We are seeking an experienced and strategic Senior Director of Bill Review Operations to lead and optimize large-scale workers' compensation bill review operations. This senior leader will be responsible for operational performance, client satisfaction, workforce management, process optimization, and business growth across a complex, high-volume service organization.
The ideal candidate is a transformational operations leader with deep experience in workers' compensation, healthcare reimbursement, claims operations, medical bill review, or payment integrity. This individual will drive operational excellence while partnering across the organization to deliver exceptional service, scalable solutions, and innovative approaches that improve outcomes for clients and injured workers.
What You'll DoOperational Leadership
- Provide strategic and operational leadership for bill review operations, ensuring efficient service delivery, productivity, and client satisfaction.
- Lead large-scale teams responsible for medical bill review, provider support functions, operational reporting, and related service delivery activities.
- Establish operational priorities, performance goals, and accountability measures that support company objectives.
- Monitor service levels, inventory, turnaround times, and key performance indicators to ensure operational excellence.
- Drive organizational readiness to support growth, new client implementations, and business expansion initiatives.
- Serve as a senior operational leader for strategic client relationships.
- Participate in client meetings, business reviews, operational discussions, and service improvement initiatives.
- Partner with sales and account management teams to support client retention, implementations, and growth opportunities.
- Collaborate with clients to identify operational enhancements that improve results and customer experience.
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- Lead, mentor, and develop Directors, Managers, Supervisors, and operational teams.
- Build high-performing organizations through coaching, succession planning, performance management, and employee engagement.
- Foster a culture of accountability, collaboration, innovation, and continuous improvement.
- Develop workforce strategies that support long-term organizational growth and operational stability.
- Identify opportunities to improve efficiency, reduce operational complexity, and enhance scalability.
- Lead initiatives involving workflow optimization, automation, artificial intelligence, and advanced analytics.
- Partner with technology and product teams to implement solutions that improve operational effectiveness and customer outcomes.
- Drive continuous improvement efforts that increase productivity and reduce operating costs.
- Develop operational plans that align with organizational priorities and growth objectives.
- Manage budgets, staffing models, resource allocation, and financial performance metrics.
- Utilize data and analytics to identify trends, assess performance, and support decision-making.
- Present operational performance, recommendations, and strategic initiatives to executive leadership.
- Partner closely with Quality and Compliance teams to ensure medical bill review services are performed accurately, timely, and in accordance with applicable state regulations, fee schedules, and client requirements.
- Support training, process optimization, and operational improvements that strengthen service delivery and customer outcomes.
- Collaborate on performance improvement initiatives and operational best practices across the organization.
- Bachelor's degree in Business, Healthcare Administration, Operations Management, Finance, Insurance, or a related field.
- 10+ years of progressive leadership experience in workers' compensation, healthcare operations, medical bill review, payment integrity, claims operations, or a related industry.
- 5+ years leading large-scale operational teams with multiple levels of management responsibility.
- Demonstrated experience managing high-volume operational environments and complex client relationships.
- Proven track record of driving operational improvements and leading transformational initiatives.
- Master's degree (MBA, MHA, or related field).
- Experience within workers' compensation bill review, managed care, third-party administration, or healthcare payment integrity organizations.
- Experience leading distributed, remote, or global workforce environments.
- Experience implementing automation, AI-enabled solutions, or large-scale process improvement initiatives.
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