Company Description WellMed Optum Florida is an independent, Florida-focused health organization with a longstanding commitment to delivering high-quality care to older adults and the communities it serves. The organization emphasizes coordinated, value-based care that improves outcomes and enhances the patient experience. Team members collaborate across clinical, operational, and analytical functions to support efficient, patient-centered care delivery. WellMed Optum Florida offers opportunities for professionals to contribute to meaningful health initiatives while working within a mission-driven, community-oriented environment.
\n \nRole Description The Director, Health Claims Audit & Recovery is a full-time, on-site role in the Greater Tampa Bay Area. The Director leads our claims audit and recovery department, which independently reviews health plan payments, identifies overpayments and contract discrepancies, and recovers funds owed to the organization. Responsibilities include setting recovery strategy and targets, leading and developing the team, holding Medicare Advantage health plan partners accountable, and reporting results to executive leadership. The Director will also modernize the function through automation, advanced analytics, and AI, and partner with Finance, Contracting, Medical Management, and Operations to fix recurring payment issues at the source.
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