*There is one Claims Director position that can be filled in our Scotts Valley, Salinas or Merced office.

 

We have an opportunity to join the Alliance as Claims Director overseeing the Claims Department. 

 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Chief Operating Officer, you will provide strategic management oversight in implementing, directing and monitoring the Alliance’s Claims Department functions, including the development and implementation of new programs and services related to claims operations.  You will direct and oversee the Claims Department, acts as a subject matter expert, and provides executive level advice and guidance on Claims Department functions and overall business operations. You will direct, manage and supervise Claims Department staff.

 

THE IDEAL CANDIDATE WILL

  • Have expertise in claims operations in managed healthcare settings
  • Be a strategic leader, with the ability to see the big picture while exhibiting decisiveness in daily operations where needed
  • Have a collaborative management style, with skill in building rapport, and effectively managing internal and external business relationships
  • Bring strength in successfully applying change management principles
  • Be effective at moving the work forward while managing priorities and deadlines, and empowering teams to do their best work

 

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here

  • Knowledge of:
    • Principles and practices of claims operations and the claims function in a managed care environment
    • Promoting and applying change management principles
    • California Medi-Cal program, Medicaid, Medicare, entitlement programs, and related regulations
    • Medical terminology, related procedures and diagnostic coding
    • Healthcare regulatory processes and regulatory and contractual compliance activities
  • Ability to:
    • Direct, manage, supervise, mentor, train and evaluate the work of staff
    • Develop, plan, organize and direct programs and activities that are complex in nature and regional in scope
    • Provide leadership, facilitate meetings, and partner with and guide managers and employees in the resolution of issues
    • Act as a technical resource and explain complex laws, regulations, processes, and programs related to area of responsibility
    • Demonstrate strong analytical skills, accurately collect, manage and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk
  • Education and Experience:
    • Bachelor’s degree in Finance, Business Administration or a related field
    • A minimum of ten years of claims operations experience in a managed care environment, which included some experience with financial management and the Medi-Cal Program and a minimum of five years of management-level experience (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying

 

OTHER DETAILS

  • While this position is connected to one of our Alliance offices, we are in a fully remote work environment right now due to COVID-19. The interview and on-boarding process will be completed remotely
  • When operations resume in the office, the expectation for this position is that it will be in the office, at least a few days a week. For this reason we are only considering candidates who are able to work in-person at an Alliance office 

 

Additionally, all positions at the Alliance are required to meet these minimum qualifications.


OUR BENEFITS

  • Medical, Dental and Vision Plans
  • Ample Paid Time Off
  • 11 Paid Holidays per year
  • 401(a) Retirement Plan
  • 457 Deferred Compensation Plan
  • Robust Health and Wellness Program
  • EV Charging Stations
  • And many more

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 330,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here.


At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for sponsorship.

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