Sr. Director, Claims Operations

About Curative Curative is building the future of health insurance with a first-of-its-kind employer-based plan designed to remove financial barriers and make care truly accessible: one monthly premium with $0 copays and $0 deductibles*. Backed by our recent $150M in Series B funding and valuation at $1.275B , Curative is scaling rapidly and investing in AI-powered service, deeper member engagement, and a smart network designed for today’s workforce. Our north star guides everything we do: healthcare only works when people can actually use it . That belief drives every decision we make: from how we design our plan, support our members, to how we collaborate as a team. If you want to do meaningful work with a team that moves fast, experiments boldly, and cares deeply, Curative is the place to do it. We’re growing fast and looking for teammates who want to help transform health insurance for the better. Role Overview The Sr. Director, Claims Operations is responsible for the end-to-end performance of the claims function, including adjudication accuracy, operational efficiency, compliance, vendor oversight, and technology optimization. This leader will partner across the organization to ensure claims operations support Curative’s rapid growth and exceptional member and provider experience. Key Responsibilities Operational Leadership Lead and scale end-to-end claims operations, including intake, adjudication, payment accuracy, and appeals coordination. Establish performance standards and drive operational excellence across cycle time, cost per claim, accuracy, and productivity metrics. Develop workforce planning models and resource strategies to support growth and changing claim volumes. Build, mentor, and retain high-performing operational teams. Claims Strategy & Transformation Identify and implement automation, AI, and workflow optimization initiatives to improve scalability and operational efficiency. Lead continuous improvement initiatives focused on reducing administrative costs and improving turnaround time. Partner with technology teams to optimize claims platforms, configuration, and system integrations. Data & Analytics Leverage advanced analytics to monitor claims trends, identify operational gaps, and drive strategic improvements. Develop dashboards and performance reporting to support executive decision-making. Translate operational data into actionable insights that improve claim accuracy and cost management. Quality & Compliance Establish and oversee claims quality assurance and audit programs to ensure payment accuracy and regulatory compliance. Serve as a key leader for state regulatory audits, compliance reviews, and market expansion readiness. Ensure adherence to HIPAA, CMS requirements, and state regulations. Cross-Functional Collaboration Partner with internal stakeholders including Network, Utilization Management, Provider Operations, Member Services, Compliance, and Technology. Act as a strategic liaison for complex provider or claims issues. Lead cross-functional initiatives that improve provider experience and operational scalability. Oversee third-party vendors and BPO relationships supporting claims operations. Establish vendor performance standards and ensure alignment with operational KPIs and service level agreements. Qualifications Education Bachelor’s degree in Healthcare Administration, Business, Finance, or related field required MBA or Master’s degree in Healthcare Management, Analytics, or related field preferred Experience 10+ years of experience in health insurance claims operations 7+ years of leadership experience managing large claims teams or multi-functional operations Experience scaling employer group health plan operations Demonstrated success leading claims transformation, automation, or process improvement initiatives Experience managing claims vendors, BPO partnerships, or third-party administrators Proven ability to build and lead high-performing operational teams Expertise Deep knowledge of health plan claims lifecycle, adjudication systems, and payment workflows Strong understanding of payer regulatory frameworks, CMS requirements, and HIPAA compliance Experience improving claims payment accuracy and operational cost structures Expertise in operational metrics such as inventory management, productivity, quality scores, and cycle time Preferred: Background implementing AI-enabled claims automation or advanced editing systems Preferred: System integration / replacement while maintaining performance metrics Technical Skills Experience working with claims platforms (HealthEdge HealthRules Payer preferred) Proficiency with data analytics tools and dashboards (Looker, Power BI, Snowflake, or similar) Familiarity with automation, workflow optimization, and AI-driven operational tools Leadership Competencies Strategic thinker with the ability to balance operational execution and long-term transformation Strong executive communication and stakeholder management skills Proven ability to lead through change and scale operations in high-growth environments Perks & Benefits Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.) $0 copays and $0 deductibles (with completion of our Baseline Visit ) Preventive and primary care built in Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged) One-on-one care navigation Chronic condition programs (diabetes, weight, hypertension) Maternity and family planning support 24/7/365 Curative Telehealth Pharmacy benefits Comprehensive dental and vision coverage Employer-provided life and disability coverage with additional supplemental options Flexible spending accounts Flexible work options: remote and in-person opportunities Generous PTO policy plus 11 paid annual company holidays 401K for full-time employees Generous Up to 8–12 weeks paid parental leave, based on role eligibility.