About Employer Direct Healthcare

Employer Direct healthcare (EDH) is on a mission to transform access to excellent care for the moments that matter most. As the leading provider of surgical benefits for self-insured employers, we bring guided access to high-quality, affordable care for employers, their employees and the family members. We understand and have experienced the challenges of navigating specialized healthcare and we are dedicated to making a change.

EDH is the market leader for Independent Centers of Excellence (CoE). We have challenged the status quo in healthcare by bringing top quality surgeons within reach of all. Our surgeon-first model is the largest and most accessible network (3-4x larger than our peers), which has delivered an ROI 3x our peers. We serve hundreds of self-funded plan sponsors across 1000+ employers, representing over 4 million people across the U.S. We've saved our clients over $700 million since we were founded! 

Ultimately, the US healthcare system at-large is flawed. Costs continue to rise while life expectancy stagnates. We are moving the needed on this problem by improving surgery outcomes - making people healthier - and lowering healthcare costs at the same time. 

 

About You:

  • You have a drive and AMBITION to tackle big problems. Big problems require big ideas and a team that supports new ideas.
  • You CARE deeply for your customers. Your customers aren’t just the individuals using your product. They are the driving factor in your motivation to make a change.
  • You thrive in a TEAM ENVIRONMENT. Collaboration is key in innovation and creating change.
  • A DIVERSE environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with.
  • You are DETAIL ORIENTED, but more so, focus on the execution of your content while balancing a fast-paced environment.
  • You understand that PROGRESS is critical to making change. You take the time to celebrate the small and big wins. Understanding that each improvement to a process helps move towards a greater change.
  • INTEGRITY guides you in life. Focusing on the truth versus just giving people the answers they want to hear.

 

If this sounds like you, we would love to connect to speak further about career opportunities at Employer Direct Healthcare.

Please apply to our role & someone from our HR Team will reach out to help you navigate our interview process.

 

Vice President, Claims and Provider Services

The Vice President of Claims and Provider Services will oversee and lead daily claims operations, provider support services, and revenue cycle management while driving development and implementation of best practices. This role demands a practical, hands-on leader who can drive efficiency, ensure compliance, and foster strong relationships with providers while optimizing our operational efficiency. The ideal candidate will have a proven track record in claims management and a deep understanding of the health insurance landscape, as well as strong analytical skills and a proven ability to build and lead high-performing teams in a fast-paced, growth-oriented environment. 

Location: Dallas, Texas | Onsite

Responsibilities:

  • Claims Processing: Lead and manage the claims processing function to ensure timely, accurate, and efficient handling of all claims. Develop and implement policies and procedures to streamline operations and enhance the customer experience. 
  • Provider Support: Lead and manage the provider support function to ensure timely and accurate responses to inquiries, timely and effective provider onboarding, and continued development of our dedicated support team. Develop and implement strategies to support provider engagement, address concerns, and ensure smooth interactions between providers and the company. 
  • Revenue Cycle Management: Oversee revenue cycle processes for provider payments, claims receipt, member invoicing and collections. Analyze and improve revenue cycle performance, including billing, collections, and accounts receivable management. 
  • Strategic Leadership: Provide strategic direction and leadership to the claims department. Develop and execute short-term and long-term goals that align with the company’s overall business strategy. 
  • Compliance & Risk Management: Ensure compliance with regulatory requirements, industry standards, and internal policies. Identify and mitigate risks associated with claims processing and revenue cycle management. 
  • Team Development: Build, mentor, and lead a high-performing team of exempt and non-exempt workforce. Foster a culture of continuous improvement, professional development, and accountability. 
  • Data Analysis & Reporting: Utilize data and analytics to drive decision-making and performance improvements. Prepare and present reports to executive leadership on key metrics and strategic initiatives. 

 

Requirements:

  • Education: Bachelor’s degree in Business Administration, Health Administration, Finance, or a related field. Advanced degree (MBA, MHA) preferred. 
  • Experience: Minimum of 10 years of experience in claims management, with at least 5 years in a senior leadership role. Experience in the health insurance industry is highly desirable.
  • Skills: 
    • Strong leadership and management skills with a proven ability to drive organizational change. 
    • In-depth knowledge of healthcare claims processing, managed care network management, and revenue cycle management. 
    • Medicare billing experience strongly preferred, or knowledge of Medicare billing rules 
    • Excellent analytical, problem-solving, and decision-making skills. 
    • Ability to communicate effectively with internal and external stakeholders. 
    • Experience with Zelis-PayerCompass or similar tools (e.g. Plexis, Datagenix)  

 

 Benefits

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • Short & Long Term Disability
  • Life Insurance
  • 401k with company match
  • Paid Time Off
  • Paid Parental Leave

 

Employer Direct Healthcare does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.

Apply for this Job

* Required
resume chosen  
Dropbox Google Drive
(File types: pdf, doc, docx, txt, rtf)
Cancel
cover_letter chosen  
Dropbox Google Drive
(File types: pdf, doc, docx, txt, rtf)
Cancel
When autocomplete results are available use up and down arrows to review
+ Add another education

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey. Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.

As set forth in Employer Direct Healthcare’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law.

Race & Ethnicity Definitions

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Voluntary Self-Identification of Disability

Form CC-305
Page 1 of 1
OMB Control Number 1250-0005
Expires 04/30/2026

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

  • Alcohol or other substance use disorder (not currently using drugs illegally)
  • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
  • Blind or low vision
  • Cancer (past or present)
  • Cardiovascular or heart disease
  • Celiac disease
  • Cerebral palsy
  • Deaf or serious difficulty hearing
  • Diabetes
  • Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
  • Epilepsy or other seizure disorder
  • Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
  • Intellectual or developmental disability
  • Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
  • Missing limbs or partially missing limbs
  • Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
  • Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
  • Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
  • Partial or complete paralysis (any cause)
  • Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
  • Short stature (dwarfism)
  • Traumatic brain injury

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Enter the verification code sent to to confirm you are not a robot, then submit your application.

This application was flagged as potential bot traffic. To resubmit your application, turn off any VPNs, clear the browser's cache and cookies, or try another browser. If you still can't submit it, contact our support team through the help center.