Jefferson Health
Director, Claim Research & Resolution - JHP
Philadelphia, PA · Director · Full-time · Posted Sep 2, 2026
- Experience
- 7 years of progressive experience in insurance claims administration, medical billing, or denials and appeals management; and 5 years of supervisory or departmental management experience.
- Education
- High School Diploma/GED
About the job
Leads claims issue research and resolution, overseeing root cause analysis, corrective actions, reporting, and provider call center operations to improve payment accuracy and compliance.
What you'll do
- Direct intake, investigation, prioritization, root cause analysis, and resolution of complex claims issues.
- Establish monitoring and reporting, assess financial impacts, and coordinate sustainable remediation with internal stakeholders.
- Lead and develop an analyst team and direct daily provider call center operations, including adherence to SLAs and regulatory requirements.
What they ask for
- 7 years of progressive experience in insurance claims administration, medical billing, or denials and appeals management.
- 5 years of supervisory or departmental management experience, demonstrating ability to lead large analyst teams.
- Deep operational experience with complex disputes, complex contract terms, and medical coding reconsiderations.
- Ability to identify systemic flaws in data feeds, provider billing habits, or internal auto-adjudication systems.
Model-written summary · the original posting is authoritative