Morgan Consulting Resources, Inc. - Healthcare Executive Search
Senior Director, Claims
Morgan Consulting Resources, Inc. - Healthcare Executive Search, Rancho Cucamonga, California, United States, 91739
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Senior Director, Claims
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Morgan Consulting Resources, Inc. - Healthcare Executive Search Direct message the job poster from Morgan Consulting Resources, Inc. - Healthcare Executive Search About the Organization
Inland Empire Health Plan (IEHP) is a top 10 Medicaid health plan and the largest not-for-profit Medicare-Medicaid plan in the country. IEHP supports nearly 1.6 million members with a network of over 8,000 providers and nearly 4,000 team members. IEHP is fully committed to its Mission, Vision, and Values and has been recognized with a Great Place to Work designation. For details regarding IEHP, please visit: iehp.org. About the Position
Reporting to the Chief Financial Officer, the Senior Director, Claims will manage the Director, Claims and be responsible for the strategy, design, and implementation of claims payment processes. The Senior Director will provide regulatory directive and operational guidance to ensure the organization’s compliance requirements are met. This role is based in Rancho Cucamonga, CA with a hybrid schedule (three days in the office, two remote). Responsibilities
Oversee claims production and vendor oversight for all lines of business Ensure adequate quality controls and analyze root causes of claim payment variations with support departments Ensure claim support services achieve high provider satisfaction and timely dispute/appeal responsiveness Establish, implement, and improve internal controls and department policies and procedures Collaborate with Core Configuration team and vendors to ensure robust, compliant claims systems that support business needs Influence and drive change among executive leadership Draft and oversee implementation of future state processes and systems to support strategic direction Provide coaching and guidance to the Director of Claims to ensure staffing and operational support needs are met Experience Requirements
Ten (10) years of healthcare administration experience Four (4) years minimum in a Director level role or above Two (2) years of experience with an HMO or managed care Medi-Cal/Medicaid claims experience required; Medicare/DSNP/ACA Exchange experience preferred Educational Requirements
Bachelor's degree in business administration, accounting, or healthcare from an accredited institution required Master’s degree from an accredited institution preferred Knowledge & Skills
Solid understanding of Medi-Cal benefits, claims adjudication rules and procedures Supervision and training principles and techniques Data entry and related administrative tasks Presented by:
Erica Eikelboom , Principal & Executive Search Consultant
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Senior Director, Claims
role at
Morgan Consulting Resources, Inc. - Healthcare Executive Search Direct message the job poster from Morgan Consulting Resources, Inc. - Healthcare Executive Search About the Organization
Inland Empire Health Plan (IEHP) is a top 10 Medicaid health plan and the largest not-for-profit Medicare-Medicaid plan in the country. IEHP supports nearly 1.6 million members with a network of over 8,000 providers and nearly 4,000 team members. IEHP is fully committed to its Mission, Vision, and Values and has been recognized with a Great Place to Work designation. For details regarding IEHP, please visit: iehp.org. About the Position
Reporting to the Chief Financial Officer, the Senior Director, Claims will manage the Director, Claims and be responsible for the strategy, design, and implementation of claims payment processes. The Senior Director will provide regulatory directive and operational guidance to ensure the organization’s compliance requirements are met. This role is based in Rancho Cucamonga, CA with a hybrid schedule (three days in the office, two remote). Responsibilities
Oversee claims production and vendor oversight for all lines of business Ensure adequate quality controls and analyze root causes of claim payment variations with support departments Ensure claim support services achieve high provider satisfaction and timely dispute/appeal responsiveness Establish, implement, and improve internal controls and department policies and procedures Collaborate with Core Configuration team and vendors to ensure robust, compliant claims systems that support business needs Influence and drive change among executive leadership Draft and oversee implementation of future state processes and systems to support strategic direction Provide coaching and guidance to the Director of Claims to ensure staffing and operational support needs are met Experience Requirements
Ten (10) years of healthcare administration experience Four (4) years minimum in a Director level role or above Two (2) years of experience with an HMO or managed care Medi-Cal/Medicaid claims experience required; Medicare/DSNP/ACA Exchange experience preferred Educational Requirements
Bachelor's degree in business administration, accounting, or healthcare from an accredited institution required Master’s degree from an accredited institution preferred Knowledge & Skills
Solid understanding of Medi-Cal benefits, claims adjudication rules and procedures Supervision and training principles and techniques Data entry and related administrative tasks Presented by:
Erica Eikelboom , Principal & Executive Search Consultant
#J-18808-Ljbffr