Central California Alliance for Health
Claims Director
Central California Alliance for Health, Merced, California, United States, 95343
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:
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.
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:
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.