Claims Director - Remote

Overview

Join Us in Strengthening Care in Our Communities! Bring your vision and innovation to claims processing and help transform care for over 400,000 neighbors in five counties.

In Short

• Lead claims operations to ensure timely, accurate service for members and providers.
• Work in a mission-driven organization focused on community connection.
• Manage and supervise Claims Department staff.
• Implement and direct claims management processes.
• Champion change initiatives and motivate team members.
• Utilize analytics to monitor performance and implement improvements.
• Foster positive relationships with team members and stakeholders.
• Navigate ambiguity and resolve escalated issues effectively.
• Align claims processes with organizational goals and regulations.
• Contribute to a culture of collaboration and continuous improvement.

Requirements

• Bachelor’s degree in Finance, Business Administration, or related field.
• Minimum of ten years of claims operations experience in a managed care environment.
• Experience with Medicare and Medi-Cal Programs.
• Strong analytical skills and ability to manage complex data.
• Experience in building and motivating high-performing teams.
• Knowledge of healthcare regulatory processes and compliance.
• Ability to develop and direct complex programs and activities.
• Excellent communication and leadership skills.
• Proven problem-solving skills in high-pressure situations.
• Deep knowledge of claims regulations and policies.

Benefits

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