Hiring: Director, Claims (Commercial-Self-Funded) Company: The Health Plan (THP) Location: Wheeling, WV Job Posted Time: 2026-09-10 13:33:49 Target Skills & Keywords : ICD-10, Project Management About the job Experience: •5 years of previous claims leadership/management experience. •At least 5 years of previous claims leadership/management experience. Required Skills: •Directs all aspects of institutional and professional claims review for medical appropriateness and compliance with prompt pay regulations. •Assists with the development, implementation, and updates to claims review procedures/criteria, physician and ancillary fee schedules and hospital contractual rates. •Monitors check runs and monthly reports to detect potential problems or issues. •Coordinates claim review activities with internal departments as well as participants on internal committees representing the claims department and formulates workflow between all departments. •Lead and oversee interviewing and hiring of all staff and conducts annual employee performance reviews for direct reports. •Monitors all daily activities with the assistance direct reports regarding claims processing/review, productivity, timeliness of payments and quality indicators of services. •Conducts second reviews for Self Funded claims. •Monitors and distributes reports as necessary. Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!