Direktor ng Claims

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Lokasyon: Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California

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 Direktor ng Claims 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. 

ANG IDEAL NA KANDIDATO

• 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:

Pag-uulat sa Chief Operating Officer, ang posisyong ito: 

• 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

ANO ANG KAILANGAN MO PARA MAGING MATAGUMPAY

Upang basahin ang buong paglalarawan ng posisyon at listahan ng mga kinakailangan, i-click dito. 

• Knowledge of, and proficiency in:
• The principles and practices of claims operations and the claims function in a managed care environment
• Pagsusulong at paglalapat ng mga prinsipyo sa pamamahala ng pagbabago
• Mga pamamaraan ng pananaliksik, pagsusuri, at pag-uulat
• California Medi-Cal program, Medicaid, Medicare, entitlement programs, and related regulations
• Healthcare regulatory processes and regulatory and contractual compliance activities
• Kakayahang:
  • 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
  • Magbigay ng pamumuno, pangasiwaan ang mga pagpupulong, at kasosyo at gabayan ang mga tagapamahala at empleyado sa paglutas ng mga isyu
  • Magpakita ng malakas na kasanayan sa analitikal, tumpak na mangolekta, mamahala, at magsuri ng data, tukuyin ang mga isyu, mag-alok ng mga rekomendasyon at potensyal na kahihinatnan, at pagaanin ang panganib
  • Assess departmental operations, identify opportunities for improvement, and advance operational effectiveness
• Edukasyon at Karanasan:
  • 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

IBANG IMPORMASYON

• 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

Ang buong hanay ng kabayaran para sa posisyong ito ay nakalista ayon sa lokasyon sa ibaba. 

Ang aktwal na kompensasyon para sa tungkuling ito ay tutukuyin ng aming pilosopiya sa kompensasyon, pagsusuri sa mga kwalipikasyon ng napiling kandidato (direkta o maililipat na karanasan na nauugnay sa posisyon, edukasyon o pagsasanay), pati na rin ang iba pang mga salik (internal equity, market factor, at geographic na lokasyon).

Mga karaniwang lugar sa Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Mga karaniwang lugar sa Zone 2: Fresno area, Bakersfield, Central Valley (maliban sa Sacramento), Eastern California, Eureka area

Apply for Claims Director