Director - Claims - Healthplan
Presbyterian Healthcare Services
About this role
The Director of Claims and Encounters provides strategic leadership and fiscal accountability for Presbyterian Health Plan's Claims Operations and Encounter Resolution teams across Commercial/ASO, Medicare and Medicaid products. The role drives operational strategy, automation adoption (including Auto-Adjudication and RPA), and initiatives to improve encounter completeness and Medicaid rate setting. The position focuses on optimizing processes to improve member and provider experience while ensuring compliance and efficient delivery of production activities.
Skills
Qualifications
About Presbyterian Healthcare Services
phs.orgFind the medical care and health plan you and your family need at Presbyterian Healthcare Services, an integrated system of hospitals, healthcare providers and insurance plans serving patients and members in New Mexico.
Recent company news
Hunt Scanlon MediaRudish Health Leading CFO Search for Presbyterian Medical Group
Sep 29, 2025
Albuquerque Journal‘Our focus is on us’: Presbyterian CEO says there are no updates on potential mergers
Mar 27, 2025
ReutersData breach plaintiffs drop lawsuit against law firm Thompson Coburn, New Mexico health system
1 month ago
nm.news$40 Million awarded in lawsuit against Presbyterian for infant brain damage
Jun 4, 2025
Fierce HealthcareGet Well and RhythmX AI merge to advance AI precision care solution
Nov 17, 2025
About Presbyterian Healthcare Services
Headquarters
San Francisco, CA
Company Size
201-500 employees
Founded
2018
Industry
Technology
Glassdoor Rating
4.2 / 5
Leadership Team
Sarah Johnson
Chief Executive Officer
Michael Chen
Chief Technology Officer
Emily Williams
VP of Engineering
David Rodriguez
VP of Product
Jessica Thompson
Chief Financial Officer
Andrew Park
VP of Sales
Unlock Company Insights
View leadership team, funding history,
and employee contacts for Presbyterian Healthcare Services.
Salary
$119k – $161k
per year
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