At CERIS Healthcare, we are a leader in both prospective and retrospective claims review and repricing, combining clinical expertise and cost-containment solutions to ensure accuracy and transparency in healthcare payments. We are dedicated to optimizing financial accuracy and efficiency for our clients, fostering a culture of continuous improvement, collaboration, and customer focus to deliver exceptional value in the vital healthcare payment integrity sector.

Position Summary:

The Director of Process Improvement, is a strategic leadership role responsible for driving significant improvements in operational efficiency, quality, and cost reduction across the organization, with a strong focus on healthcare payment integrity processes. This individual will champion a culture of continuous improvement, leveraging Lean Six Sigma methodologies to identify, analyze, and optimize business processes within our payment integrity operations. The Director will lead and mentor cross-functional teams, implement best practices, and ensure sustainable improvements that align with strategic business objectives.

This is a hybrid role.

Key Responsibilities:

Strategic Leadership: Develop and execute a comprehensive process improvement strategy aligned with the company's overall operational and business goals, specifically targeting enhancements within payment integrity workflows. Process Identification & Analysis: Proactively identify opportunities for process optimization across all operational functions, including intake, claims review, auditing, recovery, provider relations, and correspondence within the payment integrity lifecycle. Conduct thorough analyses to understand current state processes, identify bottlenecks, inefficiencies, and areas for improvement. Lean Six Sigma Implementation: Lead and facilitate Lean Six Sigma projects from conception to completion, utilizing tools and methodologies such as DMAIC, Value Stream Mapping, 5S, Kaizen, SPC, and Root Cause Analysis to address challenges in payment integrity operations. Team Leadership & Mentorship: Build, lead, and mentor a team of project managers and operational leaders, fostering their development in Lean Six Sigma principles and problem-solving Change Management: Drive effective change management strategies to ensure successful adoption of new processes and sustained improvements across the organization. Performance Measurement: Establish and monitor key performance indicators (KPIs) related to payment integrity accuracy, efficiency, and recovery rates to track the effectiveness of process improvements and demonstrate tangible ROI. Develop and present reports on project status, results, and recommendations to senior leadership. Best Practice Development: Research and implement industry best practices in process improvement, automation, and operational excellence, specifically within the healthcare payment integrity landscape. Cross-functional Collaboration: Collaborate closely with departments such as IT, Data Analytics, Client Services, and Product Development to ensure seamless integration of improved processes and alignment with broader business initiatives. Training & Development: Develop and deliver training programs to employees across multiple operational departments, including on-boarding, leadership development and on-going skills improvement. Culture of Continuous Improvement: Champion and embed a culture of continuous improvement throughout the organization, empowering employees to identify and resolve issues. Standard Operating Procedures – Work with various departments to standardize SOP’s language, improve access to policies and help maintain changes to policies or procedures. Qualifications: Education: Bachelor's degree in Business Administration, Operations Management, Industrial Engineering, Supply Chain Management, or a related field is required. Master's degree (MBA or equivalent) is highly preferred. Certifications: Lean Six Sigma Black Belt certification is required. Proven expertise in Lean principles and methodologies is essential. Six Sigma Master Black Belt certification is a strong plus. Experience: Minimum of 8-10 years of progressive experience in operations management, process improvement, or a related field, with at least 3-5 years in a leadership or directorial capacity. Direct experience and deep understanding of healthcare payment integrity processes, including claims auditing, recovery, fraud, waste, and abuse (FWA) detection, and compliance, is essential. Demonstrated success in leading and implementing large-scale process improvement initiatives with measurable results, preferably within a healthcare or insurance setting. Strong track record of applying Lean Six Sigma methodologies to solve complex business problems. Skills: Exceptional analytical and problem-solving skills, with the ability to synthesize complex information and develop practical solutions. Proven leadership and team-building capabilities, with the ability to motivate and inspire others. Excellent communication (written and verbal), presentation, and interpersonal skills. Strong project management skills, with the ability to manage multiple priorities and deadlines effectively. Proficiency in process mapping software (e.g., Visio, Lucidchart), statistical analysis software (e.g., Minitab, JMP), and Microsoft Office Suite. Ability to influence and negotiate with stakeholders at all levels of the organization. Strong understanding of change management principles.

What We Offer: Competitive salary and benefits package Opportunity to make a significant impact on the company's success in the vital healthcare sector Dynamic and collaborative work environment Professional development and growth opportunities

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $129,325 – $167,974

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CERIS:

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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Equal Opportunity Employer

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