Central California Alliance for Health
Claims Director
Central California Alliance for Health, Merced, California, United States, 95343
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). 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 are 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 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, serves 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 and proficiency in: The principles and practices of claims operations 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 issue resolution Demonstrate strong analytical skills, collect, manage, and analyze data, identify issues, offer recommendations, 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 Minimum of ten years of claims operations experience in a managed care environment, including some experience with financial management, at least three years with Medicare and Medi-Cal Programs, and at least five years of management-level experience (Master's degree may substitute for two years)
Other Information
We are in a hybrid work environment; interviews may be conducted remotely via Microsoft Teams. Some staff may work full telecommuting schedules, but 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 will be reviewed during the interview process.
Compensation and Benefits
The full compensation range for this position is listed by location below. Actual compensation will be determined by our compensation philosophy, analysis of the selected candidate’s qualifications, internal equity, market factors, and geographic location. 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 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 guided by local innovation. We serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more, see our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity, national origin, age, marital status, protected veteran status, or disability. We are an E-Verify participating employer. At this time, the Alliance does not provide sponsorship. Applicants must be authorized to work in the United States on a full-time, ongoing basis without current or future sponsorship needs.
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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 are 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 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, serves 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 and proficiency in: The principles and practices of claims operations 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 issue resolution Demonstrate strong analytical skills, collect, manage, and analyze data, identify issues, offer recommendations, 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 Minimum of ten years of claims operations experience in a managed care environment, including some experience with financial management, at least three years with Medicare and Medi-Cal Programs, and at least five years of management-level experience (Master's degree may substitute for two years)
Other Information
We are in a hybrid work environment; interviews may be conducted remotely via Microsoft Teams. Some staff may work full telecommuting schedules, but 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 will be reviewed during the interview process.
Compensation and Benefits
The full compensation range for this position is listed by location below. Actual compensation will be determined by our compensation philosophy, analysis of the selected candidate’s qualifications, internal equity, market factors, and geographic location. 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 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 guided by local innovation. We serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more, see our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity, national origin, age, marital status, protected veteran status, or disability. We are an E-Verify participating employer. At this time, the Alliance does not provide sponsorship. Applicants must be authorized to work in the United States on a full-time, ongoing basis without current or future sponsorship needs.
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