Director, Claims Management Ancillary Services (CMAS)

Plan Documents Strategy & Compliance:

• Own the strategy, quality, and regulatory compliance of plan document function including SPDs, SMMs, amendments, and SBCs.
• Ensure processes remain current with ERISA, Internal Revenue Code, HIPAA, MSP, COBRA, ACA, and WHCRA.
• Establish governance standards, review workflows, and quality checkpoints for audit-ready documents.

CMAS Operational Leadership:

• Own end-to-end performance of claims audit, appeals, escalations, recoveries, subrogation, and NSA functions.
• Establish and monitor operational and quality KPIs, using data to identify trends and report performance.
• Drive process improvement, workflow standardization, and automation across CMAS and plan document workflows.

People Leadership & Cross-Functional Collaboration:

• Directly manage the Plan Documents Manager and CMAS Manager, providing coaching and development.
• Set clear performance expectations and goals aligned to organizational priorities.
• Represent CMAS and Plan Documents in cross-functional meetings and client calls.