Company Culture: A people-centric culture that values collaboration and work-life balance. If you are enthusiastic about helping those in need, then your enthusiasm is welcomed here.
Job Description: The Claims Director is responsible for the leadership, operational management, and regulatory oversight of the Claims Department. This position directs all aspects of claims administration, including claims adjudication, payment accuracy, delegated claims oversight, regulatory compliance, claims process vendor management, process improvement, and staff development. The Claims Director ensures timely and accurate claims processing while maintaining compliance with Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), contractual requirements, and health plan requirements.
Skill & Experience Requirements:
- Bachelor’s degree in healthcare administration, Business Administration, Finance, or related field preferred.
- Strong knowledge of Medi-Cal and Medicare managed care claims processing and compliance guidelines.
- Experience reviewing and interpreting regulatory and health plan requirements to implement operational changes to affected claims processes, benefit configurations, payment methodologies, and business workflows.
- Minimum seven to ten years of progressively responsible managed care claims experience.
- Minimum five years of leadership experience managing claims operations.
- Experience with delegation oversight audit process including policy and procedure review, audit tool completion, and corrective action processes.
- Strong experience monitoring claims trends, utilization patterns, payment variance, and recovery opportunities.
To Apply copy/paste link:
https://insperity.avature.net/careers/JobDetails?jobId=22038
Pay: $130,000.00 - $160,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Paid training
- Parental leave
- Professional development assistance
- Tuition reimbursement
- Vision insurance
- Wellness program
Experience:
- Healthcare Claims processing : 5 years (Required)
Ability to Commute:
- Chatsworth, CA 91311 (Preferred)
Work Location: In person
