Talent.com
Claims Director

Claims Director

Central California Alliance for HealthHollister, CA, United States
23 days ago
Job type
  • Full-time
  • Part-time
Job description

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.

We welcome applicants from across California, with a strong preference for candidates based in our service areas ( Santa Cruz, Monterey, Merced, Mariposa, and San Benito Counties). While this role may offer some remote flexibility, we value team members who are familiar with and connected to our local communities.

The Alliance is seeking a dynamic Claims Director to lead our claims operations and ensure timely, accurate service for members and providers across Santa Cruz, Monterey, Merced, Mariposa, and San Benito counties . This is a unique opportunity to make an impact locally, helping deliver quality, reliable care to more than 400,000 neighbors in our region. We're looking for a leader who brings both technical expertise and a passion for service, collaboration, and continuous improvement.

Be part of a mission-driven organization that values innovation, integrity, and community connection-while building your career in the heart of Central California.

THE IDEAL CANDIDATE

  • ","469777815" : "hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">
  • A forward-thinking leader who is excited to bring innovative solutions to age-old challenges like inventory backlogs and lean staffing
  • ","469777815" : "hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">
  • Proven ability to champion change initiatives by effectively communicating the vision, fostering buy-in, and motivating others to embrace new processes and ways of working
  • ","469777815" : "hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">
  • Deep knowledge of claims regulations, policies, and systems, with the ability to translate complex requirements into efficient workflows
  • ","469777815" : "hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">
  • Strategic thinker who can align claims management processes with organizational goals and regulatory requirements
  • ","469777815" : "hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">
  • Experienced in building, coaching, and motivating high-performing teams while fostering accountability and collaboration
  • ","469777815" : "hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">
  • Demonstrates high emotional intelligence, fostering positive relationships with team members, providers, and business partners
  • ","469777815" : "hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">
  • Data-driven leader skilled in using metrics and analytics to monitor performance, identify trends, and implement improvements
  • ","469777815" : "hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">
  • Proactive problem-solver who can navigate ambiguity, resolve escalated issues, and make sound decisions under pressure
  • WHAT YOU'LL BE RESPONSIBLE FOR :

    Reporting to the Chief Operating Officer, this position :

  • Provides 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
  • Directs and oversees the Claims Department, acts as a subject matter expert, and provides direction and advice related to Claims Department functions and overall business operations
  • Directs, manages, and supervises Claims Department staff
  • WHAT YOU'LL NEED TO BE SUCCESSFUL

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

  • Knowledge of, and proficiency in :
  • The principles and practices of claims operations and the claims function in a managed care environment
  • Promoting and applying change management principles
  • Research, analysis, and reporting methods
  • California Medi-Cal program, Medicaid, Medicare, entitlement programs, and related regulations
  • 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
  • Demonstrate strong analytical skills, accurately collect, manage, and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk
  • Assess departmental operations, identify opportunities for improvement, and advance operational effectiveness
  • 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, a minimum of three years of experience working with Medicare and Medi-Cal Programs, 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 may be qualifying
  • OTHER INFORMATION

  • We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams
  • While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected
  • In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process
  • The full compensation range for this position is listed by location below.

    The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

    Typical areas in Zone 1 : Bay Area, Sacramento, Los Angeles area, San Diego area

    Typical areas in Zone 2 : Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

    Zone 1 (Monterey, San Benito and Santa Cruz)

    $163,470 — $261,560 USD

    Zone 2 (Mariposa and Merced)

    $148,756 — $238,014 USD

    OUR BENEFITS

    Available for all regular Alliance employees working more than 30 hours per week.Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

  • 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
  • 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 members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet .

    The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

    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 any type of employer supported or provided sponsorship.

    Create a job alert for this search

    Director Claim • Hollister, CA, United States

    Related jobs
    • Promoted
    State Licensed Senior Claims Adjuster

    State Licensed Senior Claims Adjuster

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Senior Claims Adjuster - Premises, Slip and Fall / Restaurant and Retail.Key Responsibilities Investigate, evaluate, and resolve complex commercial general liability clai...Show moreLast updated: 30+ days ago
    • Promoted
    Claims Adjuster

    Claims Adjuster

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Claims Adjuster, Tire Operations, L1.Key Responsibilities Process claims accurately and in a timely manner while adhering to established guidelines Handle inquiries fr...Show moreLast updated: 30+ days ago
    • Promoted
    Texas Licensed Claims Examiner

    Texas Licensed Claims Examiner

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Claims Examiner - Liability (REMOTE TX or WI).Key Responsibilities Evaluate commercial auto bodily injury claims and ensure proper documentation and coding Manage the ...Show moreLast updated: 30+ days ago
    • Promoted
    Case Manager- Gilroy, CA

    Case Manager- Gilroy, CA

    The Camden CenterGilroy, CA, US
    Full-time
    Within the chain of command, the mentor’s and companion’s direct supervisor is the client’s respective Case Manager.The mentor / companion reports to the case manager for all ...Show moreLast updated: 30+ days ago
    • Promoted
    Travel Nurse RN - Labor / Delivery - $2,451 per week in Hollister, CA

    Travel Nurse RN - Labor / Delivery - $2,451 per week in Hollister, CA

    TravelNurseSourceHollister, CA, US
    Full-time
    TravelNurseSource is working with GetMed Staffing to find a qualified Labor / Delivery RN in Hollister, California, 95023!. GetMed Staffing is searching for a strong L&D RN to assist our traveler-...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Medicare Claims Specialist

    Medicare Claims Specialist

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Medicare Specialist to manage and resolve Medicare claims for multiple hospital or physician groups. Key Responsibilities Resolve aged, outstanding, and denied medical c...Show moreLast updated: 16 hours ago
    • Promoted
    Claims Supervisor

    Claims Supervisor

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Claims Supervisor to lead a team of Claims Processors and ensure accurate claims processing for employer-sponsored health plans. Key Responsibilities Oversee claims proc...Show moreLast updated: 30+ days ago
    • Promoted
    Principal Claims Policy Expert

    Principal Claims Policy Expert

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Principal Claims & Payments Expert to serve as a lead authority on claims-related policy matters. Key Responsibilities Interface directly with providers on claims polici...Show moreLast updated: 1 day ago
    • Promoted
    Travel Non-Clinical Tech in Hollister, CA

    Travel Non-Clinical Tech in Hollister, CA

    AlliedTravelCareersHollister, CA, US
    Full-time +1
    AlliedTravelCareers is working with Infojini Healthcare to find a qualified Non-Clinical Tech in Hollister, California, 95023!. Non-Clinical travel Non-Clinical needed in Hollister, California.Self ...Show moreLast updated: 25 days ago
    • Promoted
    Senior General Liability Adjuster

    Senior General Liability Adjuster

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Senior General Liability Claims Adjuster.Key Responsibilities Analyze claims exposure and execute decision-making to resolve claims effectively Interact with various p...Show moreLast updated: 30+ days ago
    • Promoted
    Claims Team Lead

    Claims Team Lead

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Team Lead, Claims.Key Responsibilities Manage a team of 12-15 claims examiners and adjusters Ensure adherence to client guidelines and monitor staff productivity and a...Show moreLast updated: 1 day ago
    • Promoted
    • New!
    California Licensed Eligibility Director

    California Licensed Eligibility Director

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Senior Director, Eligibility Excellence.Key Responsibilities Lead the design and execution of a scalable Eligibility Center of Excellence, overseeing policies and opera...Show moreLast updated: 20 hours ago
    • Promoted
    Remote Finance Director - AI Trainer

    Remote Finance Director - AI Trainer

    Data AnnotationGilroy, California
    Remote
    Full-time +1
    We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the q...Show moreLast updated: 22 days ago
    • Promoted
    Illinois Licensed Senior Claims Adjuster

    Illinois Licensed Senior Claims Adjuster

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Senior Claims Adjuster - Premises, Slip and Fall / Restaurant and Retail.Key Responsibilities Investigate, evaluate, and settle complex claims with minimal supervision I...Show moreLast updated: 1 day ago
    • Promoted
    Claims Specialist

    Claims Specialist

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Claims Specialist to resolve complex claims and advocate for members navigating their healthcare benefits. Key Responsibilities Resolve complex claims issues by investig...Show moreLast updated: 30+ days ago
    • Promoted
    California Licensed Claims Adjuster

    California Licensed Claims Adjuster

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Claims Adjuster Workers Compensation.Key Responsibilities Analyze claims exposure and execute decision-making to resolve claims effectively Interact with various parti...Show moreLast updated: 30+ days ago
    • Promoted
    Division Director - Mental Health

    Division Director - Mental Health

    JobotTurlock, CA, US
    Full-time
    Leading Non-Profit | Sign on / Relo bonus! | Help grow new location!.This Jobot Job is hosted by : Kristin Lederer.Are you a fit? Easy Apply now by clicking the "Apply Now" buttonand sending...Show moreLast updated: 30+ days ago
    • Promoted
    Healthcare Claims Operations Supervisor

    Healthcare Claims Operations Supervisor

    VirtualVocationsSalinas, California, United States
    Full-time
    A company is looking for a Service Operations Supervisor in the Healthcare Claims Department.Key Responsibilities Oversee daily tasks and workflow of a team of associates, ensuring quality manage...Show moreLast updated: 1 day ago