Claims Director

S&S Health is a leading healthcare administration company based in Cincinnati, Ohio, specializing in self, level, and fully funded solutions aimed at lowering costs and improving outcomes while providing a consumer-centric experience. With a nationwide presence, S&S Health delivers comprehensive benefits, services, and technology platforms tailored to meet the unique needs of employers, third-party administrators (TPAs), and health systems.

The Claims Director is a strategic leadership role responsible for overseeing the complete claims process within the organization. This includes managing a team of supervisors, developing training materials, creating and enforcing documentation and Standard Operating Procedures (SOPs), leading quality assurance efforts, supporting audits, and providing key insights to senior leadership. The Claims Director will play a vital role in ensuring that claims are processed accurately, efficiently, and in compliance with industry regulations, while also contributing to S&S Health’s client-facing initiatives.

Responsibilities:

• Team Leadership: Manage and lead a team of supervisors, offering guidance, support, and development opportunities to enhance team performance. Support the creation and development of training materials, ensuring claims staff are equipped to process claims efficiently and interact with customers effectively.
• Process Development: Develop and maintain comprehensive documentation of claims processes, including Standard Operating Procedures (SOPs) and guidelines that ensure consistency and compliance. Create and implement processes to track Key Performance Indicators (KPIs) and align them with company goals and compliance standards.
• Quality Assurance and Auditing: Lead internal audits and quality assurance initiatives to ensure accuracy, efficiency, and compliance with company policies and industry regulations. Work closely with external auditors to support SOC2 and HITRUST audits, assisting with testing and deployment activities.
• Presenting and Reporting: Prepare and present detailed reports on claims performance, operational metrics, and process improvements to senior leadership. Contribute to presentations for prospective clients, highlighting the effectiveness and efficiency of the claims process to support business development.

Qualifications:

• Proven experience as a Claims Director or in a similar leadership role within the claims or insurance industry.
• Advanced proficiency in Microsoft Office, especially Excel (VLOOKUP, Pivot Tables, etc.).
• Strong skills in documentation management, process development, and KPI tracking specific to claims operations.
• Experience with quality assurance, internal auditing, and supporting external audits (e.g., SOC2, HITRUST).
• Excellent analytical and reporting skills, with the ability to interpret data and present actionable insights to senior leadership.
• Demonstrated success in managing remote teams across multiple time zones.
• Exceptional communication and presentation skills, with experience in developing training materials and presenting to clients.
• Highly organized with a strong attention to detail and the ability to manage multiple priorities in a fast-paced environment.

S&S Health is committed to providing a safe and secure workplace for all employees. Please note that all final candidates will undergo a comprehensive background check and drug testing as part of our hiring process.