California Licensed Claims Director

Job Summary

A company is looking for a Claims Director to lead claims operations and ensure timely, accurate service for members and providers across several counties.

Key Responsibilities

• Provide strategic management oversight of the Claims Department functions and implement new programs related to claims operations
• Direct and oversee the Claims Department, acting as a subject matter expert and providing guidance on business operations
• Manage and supervise Claims Department staff to ensure effective performance and accountability

Required Qualifications, Training, and Education

• Bachelor's degree in Finance, Business Administration, or a related field
• A minimum of ten years of claims operations experience in a managed care environment
• At least three years of experience working with Medicare and Medi-Cal Programs
• A minimum of five years of management-level experience
• Knowledge of claims regulations, policies, and systems, as well as healthcare regulatory processes