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Claims Director
Ref No.: 20-02875
Location: Alhambra, California
Claims Director
Pasadena, CA

Company Info:
  • Leading managed care organization serving Medicare and Medi-Cal populations in Southern California
    Position Details:
  • Responsible for the operations and performance of Claims Department.
  • Maintain consistent compliance in all aspect of claims operations.
  • Collaborate with other stakeholders in developing process improvements as they relate to claims payment accuracy and timeliness.
  • Provide direct support and leadership to the management and staff of Claims.
  • Develop processes and/or systems as they relate to the department and company's initiatives/programs and/or regulatory changes/requirements.
  • Interact with other departments to define project parameters such as claim auto adjudication improvements and regulatory report requirements.
  • Ensure compliance in all areas of operations such as accurate and timely processing of claims.
  • Develop and implement policies and procedures as they relate to claims operations.
  • Analyze, design and manage project workflow processes, timeframes and resources.
  • Oversee the development and improvements of claims related projects to ensure compliance and accuracy.
  • Stay abreast on all regulatory and/or contractual changes, communicates changes to appropriate staff and department.
  • Develop reports as required by Senior Management and regulatory agencies.
    Qualifications:
  • Bachelor's Degree; Master's Degree preferred
  • 4+ years management experience, ideally in managed care environment
  • Knowledge of different regulatory requirements
  • Expertise on medical claims systems platforms, preferably Power MHC
    Compensation:

    Competitive - Based on experience
    Full Medical Benefits (Free for Employee!) + PTO Package