Claims Ops Director

Work Boldly. Live Brilliantly. At AltaMed, we don't just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challenges because this is more than a job. It's the calling of our lives and it compels us to keep moving forward. Job Overview The Director, Claims position has overall responsibility and accountability for all aspects of claims operations while effectively and efficiently delivering and enhancing the claims processing experience. This position is responsible for overseeing the daily claims, including timely and accurate processing of specialty claims for managed care members. The Director will leverage experience and integrate various components of cross-functional business decisions to continuously improve claims' processes and procedures. This position oversees the claims inventory by setting, evaluating, and monitoring the claims inventory baseline and examiner productivity metrics to ensure the timely and accurate processing of claims in compliance with regulatory requirements and organizational expectations. This position will participate in various forums, company initiatives, and other internal/external workgroups to support Claims integrity. Directs all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. Additional responsibilities include supervision and training of department staff, compliance with health plan and governmental regulations and standards, coordinating and overseeing health plan audits, and generations of management reports for fiscal and productivity analysis. Minimum Requirements 1. Bachelor's degree or equivalent required. 2. Minimum of 8 years of experience in the areas of managed care Health Care Claims management required. 3. Minimum of 2 years of prior supervisory experience also required. 4. Must be highly collaborative and maintain a consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas. 5. Must be able to present findings to various levels of management, across all organizations. Benefits & Career Development * Medical, Dental and Vision insurance * 403(b) Retirement savings plans with employer matching contributions * Flexible Spending Accounts * Commuter Flexible Spending * Career Advancement & Development opportunities * Paid Time Off & Holidays * Paid CME Days * Malpractice insurance and tail coverage * Tuition Reimbursement Program * Corporate Employee Discounts * Employee Referral Bonus Program * Pet Care Insurance

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