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Director, Health Plan Operations (Claims) Florida
Molina Healthcare
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Miami, United States
Location
Miami
Posted
June 24, 2026
Commute
Local Area
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Job Description
JOB DESCRIPTION Job Summary
Leads and directs team responsible for the development and administration of state health plan operational functions, programs and services - ensuring functional operations, contractual compliance, and alignment with health plan member satisfaction, retention, quality, and financial goals.
**Essential Job Duties**
β’ Under the direction of senior leadership, organizes, plans, staffs, and coordinates health plan operations for market-specific designated lines of business (Medicaid, Medicare, Marketplace, Children's Health Insurance Program (CHIP), Medicare-Medicaid Plan (MMP), etc.).
β’ Collaborates with staff and senior leadership to develop and implement provider and member service strategies to improve access and satisfaction for designated health plan(s).
β’ In conjunction with senior leadership, liaises with corporate operations functions including: claims, configuration information management, provider data management, credentia...
Leads and directs team responsible for the development and administration of state health plan operational functions, programs and services - ensuring functional operations, contractual compliance, and alignment with health plan member satisfaction, retention, quality, and financial goals.
**Essential Job Duties**
β’ Under the direction of senior leadership, organizes, plans, staffs, and coordinates health plan operations for market-specific designated lines of business (Medicaid, Medicare, Marketplace, Children's Health Insurance Program (CHIP), Medicare-Medicaid Plan (MMP), etc.).
β’ Collaborates with staff and senior leadership to develop and implement provider and member service strategies to improve access and satisfaction for designated health plan(s).
β’ In conjunction with senior leadership, liaises with corporate operations functions including: claims, configuration information management, provider data management, credentia...