Senior Director, Escalated Provider Issue Resolution
Core
Lead a multi-disciplinary organization to resolve high-complexity escalated provider issues, build scalable operating models, and drive root-cause remediation for strategic provider accounts.
Role type
Senior Director, Provider Operations & Escalation Management
Builds
Scalable operating models for issue resolution, governance routines, and cross-functional escalation pathways for health insurance providers.
Domain
Health Insurance / Payer Operations / Provider Relations
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Healthcare operations leadership, complex issue resolution, operating model design, cross-functional partnership, root-cause analysis, change management, executive reporting, stakeholder management
Preferred skills
Provider service transformation, large health system experience, workflow management tools (Jira, Salesforce, ServiceNow), data analytics (SQL, Excel), dashboarding
Technologies
Jira, Salesforce, ServiceNow, Zendesk, SQL, Excel
Responsibilities
Lead and develop a multi-disciplinary provider issue resolution organization; Build a scalable operating model for escalated provider issues; Oversee resolution of high-impact provider issues; Partner with leaders across Claims, Network, and Analytics to improve handoffs; Oversee root-cause remediation by analyzing escalated issue trends; Create executive-ready reporting on provider issue trends; Serve as a senior escalation leader for urgent, complex, or high-profile provider issues.
Seniority
Senior Director, strategic leadership & multi-team management
