Director of Claims

ABOUT ADOBE Adobe Population Health (APH) is a women-owned health solutions company founded in 2018 with a mission of positively impacting the lives we touch . Headquartered in Phoenix, AZ, with satellite locations across multiple states, APH fosters a culture rooted in inclusivity, human kindness, and high-quality care. Recognized by Inc. 5000 as one of America’s Fastest-Growing Private Companies and honored for a fifth consecutive year as a “Best Place to Work” by the Phoenix Business Journal , APH continues to expand its reach and impact. APH partners with health plans, providers, hospitals, and families to deliver tailored programs including case management, in-home and in-clinic wellness assessments, preventative care, transitional care, and social services. As one of the nation’s few fully integrated healthcare organizations, APH delivers comprehensive, coordinated medical and social support through a wide range of specialized service lines. With continued growth on the horizon, APH is seeking mission-driven individuals who are passionate about improving health outcomes and supporting those in need. POSITION PURPOSE The Director of Claims provides strategic and operational leadership for the organization’s claims lifecycle, ensuring accurate, timely, and compliant claims submission, adjudication, payment, reconciliation, and collection. This role is responsible for managing claims inventory, reducing denials and underpayments, resolving payer disputes, minimizing revenue leakage, and improving reimbursement performance across the organization’s payer portfolio. Working collaboratively with all relevant departments of the organization, the Director of Claims establishes standardized billing procedures, monitors payer requirements, validates billing readiness, and implements processes that support accurate reimbursement and sustainable revenue cycle performance. The ideal candidate combines strong claims expertise with analytical problem-solving, cross-functional leadership, and a continuous improvement mindset. This individual will translate claims data into actionable strategies, establish clear accountability, and build scalable processes that support organizational growth and the delivery of high-quality population health services. This position supports business operations while leveraging data analytics, process improvement, and technology to drive operational excellence, revenue integrity, and exceptional customer service. The position is located at the Phoenix office (near SR-51, Glendale Avenue, and 16th Street) and requires working in the office five days per week. DUTIES & RESPONSIBILITIES Claims Operations & Inventory Management Oversee the end-to-end claims lifecycle, including claims preparation, submission, adjudication, payment, reconciliation, correction, resubmission, and collection. Manage claims inventory to ensure timely processing, appropriate prioritization, and resolution of outstanding claims. Establish and maintain standardized workflows for claims submission, rejection management, denial resolution, appeals, and resubmissions. Monitor claims aging, identify high-risk and high-value outstanding balances, and implement targeted collection action plans. Ensure claims-related eligibility denials are appropriately investigated, documented, communicated to relevant stakeholders, and resolved when possible. Establish procedures for tracking unresolved claims, payer responses, required documentation, filing deadlines, and follow-up activities. Oversee claims billing procedures and maintain clear documentation of workflows, responsibilities, escalation pathways, and performance expectations. Claims Submission, Rejections & Denial Management Ensure claims are submitted accurately and within applicable payer and contractual filing deadlines. Monitor rejected and denied claims, identify root causes, and implement corrective actions to reduce preventable rework and reimburs…

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