Grow Healthy
If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.
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.
Compensation
$147,829.76 - $184,787.20 annuallyCompensation Disclaimer
Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.
Benefits & Career Development
Job Advertisement & Application Compliance Statement
AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.
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