Senior Director, Network and File Operations

Direct the end-to-end integration of hospital, physician, ancillary, and specialty networks into enterprise systems. Ensure accurate and timely processing of provider demographics, contracts, fee schedules, reimbursement methodologies, participating status, and network tiering. Partner with the EDI and Network operations teams to ensure data file flows and standards are maintained; Develop and maintain standardized workflows for network onboarding, mapping, quality assurance, and validation. Partner with operational units and client managers to ensure that client needs are clearly understood, and setups are executed to support those needs. Provide leadership for the modernization, standardization, and governance of provider network integration, ensuring alignment with long-term corporate and operational strategy. Establish and oversee frameworks for accuracy, quality, automation, and compliance in all provider and file integration activities. Shape and drive multi-year roadmaps for digital transformation and integration scalability, guiding cross-functional teams. Lead high-performing teams through a culture of innovation, accountability, and continuous improvement that supports enterprise performance objectives. Handle personnel matters including mentoring, coaching, motivating, performance management and feedback, recognition, performance evaluation and time tracking of direct reports. Oversee outbound file integration teams to ensure successful implementation of files to new and existing point solution vendors. Ensure organization is adhering to all data sharing and security protocols when sending data to outside vendors. Bachelor’s Degree and 12 years of related business experience in TPA/Payer operations Ability to develop business strategy and convert into action-oriented objectives and measurable results in partnership with product, other operational and IT partners. Broad understanding of and experience in the health care/insurance industry. Experience with network integration, provider maintenance, outbound file integration Understanding of healthcare data interchange formats, including X12 EDI transactions (834, 835, 837, 820, 270/271, 276/277, 999, and related companion guides). Pension plan Disability insurance Supplemental life insurance Employee assistance program Paid holidays Tuition reimbursement