Claims Director

Job Description

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

• A forward-thinking leader who is excited to bring innovative solutions to age-old challenges like inventory backlogs and lean staffing
• 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
• Deep knowledge of claims regulations, policies, and systems, with the ability to translate complex requirements into efficient workflows
• Strategic thinker who can align claims management processes with organizational goals and regulatory requirements
• Experienced in building, coaching, and motivating high-performing teams while fostering accountability and collaboration
• Demonstrates high emotional intelligence, fostering positive relationships with team members, providers, and business partners
• Data-driven leader skilled in using metrics and analytics to monitor performance, identify trends, and implement improvements
• 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 :

WHAT YOU'LL NEED TO BE SUCCESSFUL

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

Direct, manage, supervise, mentor, train, and evaluate the work of staff

Bachelor's degree in Finance, Business Administration, or a related field

OTHER INFORMATION

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

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.

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

Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet .

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.