理赔主管

申请

地点： 加利福尼亚州马里波萨县；加利福尼亚州默塞德县；加利福尼亚州蒙特雷县；加利福尼亚州圣贝尼托县；加利福尼亚州圣克鲁斯县

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 理赔主管 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. 

理想候选人

• 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:

该职位向首席运营官汇报： 

• 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

你需要什么才能成功

要阅读完整的职位描述和要求列表， 点击这里. 

• Knowledge of, and proficiency in:
• The principles and practices of claims operations and the claims function in a managed care environment
• 推广和应用变革管理原则
• 研究、分析和报告方法
• California Medi-Cal program, Medicaid, Medicare, entitlement programs, and related regulations
• Healthcare regulatory processes and regulatory and contractual compliance activities
• 有能力：
  • 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
  • 发挥领导作用，促进会议，与管理人员和员工合作并指导他们解决问题
  • 展示强大的分析能力，准确收集、管理和分析数据，识别问题，提供建议和潜在后果，并降低风险
  • Assess departmental operations, identify opportunities for improvement, and advance operational effectiveness
• 教育和经验：
  • 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

其他信息

• 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

该职位的全部薪酬范围按地点列出如下。 

该职位的实际薪酬将取决于我们的薪酬理念、对选定候选人的资历（与职位、教育或培训相关的直接或可转移经验）的分析，以及其他因素（内部公平、市场因素和地理位置）。

1区典型区域：湾区、萨克拉门托、洛杉矶地区、圣地亚哥地区

2 区典型地区：弗雷斯诺地区、贝克斯菲尔德、中央谷地（萨克拉门托除外）、加州东部、尤里卡地区

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