Central California Alliance for Health
Claims Director
Central California Alliance for Health, Salinas, California, United States, 93911
Overview
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). This role may offer remote flexibility, but local connection is valued.
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 an opportunity to impact locally, delivering quality, reliable care to our region. We seek a leader with 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 Central California.
The Ideal Candidate
A forward-thinking leader who brings innovative solutions to challenges like inventory backlogs and lean staffing
Proven ability to champion change initiatives by communicating the vision, fostering buy-in, and motivating others to embrace new processes
Deep knowledge of claims regulations, policies, and systems, and the ability to translate complex requirements into efficient workflows
Strategic thinker who aligns claims management with organizational goals and regulatory requirements
Experience in building, coaching, and motivating high-performing teams with accountability and collaboration
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 drive 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 development and implementation of new programs and services related to claims operations
Directs and oversees the Claims Department, serves as a subject matter expert, and provides direction related to Claims Department functions and overall 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 and proficiency
The principles and practices of claims operations in a managed care environment
Change management principles
Research, analysis, and reporting methods
California Medi-Cal, Medicaid, Medicare, entitlement programs, and related regulations
Healthcare regulatory processes and compliance activities
Ability
Direct, manage, supervise, mentor, train, and evaluate staff
Develop and direct complex, regional programs and activities
Provide leadership, facilitate meetings, and guide managers and employees to resolve issues
Demonstrate strong analytical skills, manage data, identify issues, and mitigate risk
Assess operations and identify opportunities for improvement
Education and Experience
Bachelor's degree in Finance, Business Administration, or related field
Ten years of claims operations experience in a managed care environment, including some financial management; at least three years with Medicare and Medi-Cal; and at least five years of management experience
A Master's degree may substitute for two years of required experience; or equivalent combination of education and experience
Other Information
Hybrid work environment; interview process likely remote via Microsoft Teams
Some roles may require in-office or in-community presence based on business need; details reviewed during interview
The full compensation range is listed by location. Actual compensation will be determined by the Alliance's compensation philosophy, candidate qualifications, internal equity, market factors, and geographic location.
Typical areas in Zone 1 : Bay Area, Sacramento, Los Angeles, San Diego
Typical areas in Zone 2 : Fresno, Bakersfield, Central Valley (excluding Sacramento), Eastern California, Eureka
Zone 1 (Monterey, San Benito and Santa Cruz) $163,470 — $261,560 USD
Zone 2 (Mariposa and Merced) $148,756 — $238,014 USD
Benefits
Medical, Dental and Vision plans
Paid Time Off
12 paid holidays per year
401(a) retirement plan
457 Deferred Compensation Plan
Health and wellness programs
Onsite EV charging stations
About Us We are a group of over 500 dedicated employees committed to accessible, quality health care guided by local innovation. We serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. Learn more in our Fact Sheet.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer.
Note: We do not sponsor at this time. Applicants must be authorized to work in the United States on a full-time, ongoing basis without current or future needs for sponsorship.
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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). This role may offer remote flexibility, but local connection is valued.
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 an opportunity to impact locally, delivering quality, reliable care to our region. We seek a leader with 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 Central California.
The Ideal Candidate
A forward-thinking leader who brings innovative solutions to challenges like inventory backlogs and lean staffing
Proven ability to champion change initiatives by communicating the vision, fostering buy-in, and motivating others to embrace new processes
Deep knowledge of claims regulations, policies, and systems, and the ability to translate complex requirements into efficient workflows
Strategic thinker who aligns claims management with organizational goals and regulatory requirements
Experience in building, coaching, and motivating high-performing teams with accountability and collaboration
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 drive 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 development and implementation of new programs and services related to claims operations
Directs and oversees the Claims Department, serves as a subject matter expert, and provides direction related to Claims Department functions and overall 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 and proficiency
The principles and practices of claims operations in a managed care environment
Change management principles
Research, analysis, and reporting methods
California Medi-Cal, Medicaid, Medicare, entitlement programs, and related regulations
Healthcare regulatory processes and compliance activities
Ability
Direct, manage, supervise, mentor, train, and evaluate staff
Develop and direct complex, regional programs and activities
Provide leadership, facilitate meetings, and guide managers and employees to resolve issues
Demonstrate strong analytical skills, manage data, identify issues, and mitigate risk
Assess operations and identify opportunities for improvement
Education and Experience
Bachelor's degree in Finance, Business Administration, or related field
Ten years of claims operations experience in a managed care environment, including some financial management; at least three years with Medicare and Medi-Cal; and at least five years of management experience
A Master's degree may substitute for two years of required experience; or equivalent combination of education and experience
Other Information
Hybrid work environment; interview process likely remote via Microsoft Teams
Some roles may require in-office or in-community presence based on business need; details reviewed during interview
The full compensation range is listed by location. Actual compensation will be determined by the Alliance's compensation philosophy, candidate qualifications, internal equity, market factors, and geographic location.
Typical areas in Zone 1 : Bay Area, Sacramento, Los Angeles, San Diego
Typical areas in Zone 2 : Fresno, Bakersfield, Central Valley (excluding Sacramento), Eastern California, Eureka
Zone 1 (Monterey, San Benito and Santa Cruz) $163,470 — $261,560 USD
Zone 2 (Mariposa and Merced) $148,756 — $238,014 USD
Benefits
Medical, Dental and Vision plans
Paid Time Off
12 paid holidays per year
401(a) retirement plan
457 Deferred Compensation Plan
Health and wellness programs
Onsite EV charging stations
About Us We are a group of over 500 dedicated employees committed to accessible, quality health care guided by local innovation. We serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. Learn more in our Fact Sheet.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer.
Note: We do not sponsor at this time. Applicants must be authorized to work in the United States on a full-time, ongoing basis without current or future needs for sponsorship.
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