Claims Director
About The Position
We’re looking for a Claims Director to lead claims operations for Contra Costa Health Plan (CCHP), a large public health plan serving over 250,000 residents. This is a contract-to-hire leadership role overseeing a team of about 20 (including managers, supervisors, and claims staff). You’ll drive strategy, optimize workflows, and ensure accurate, timely claims processing across Medi-Cal, Medicare, and commercial lines of business. Top Priorities When You Start: Reduce a large backlog of pending claims. Implement performance improvement initiatives. Optimize department workflows for greater efficiency. Why This Role Matters: You’ll shape the strategic direction of claims operations, ensure compliance, and support provider relationships—all while impacting healthcare access for Contra Costa County’s most vulnerable populations.
Requirements
- Managed Care Leadership: Experience leading claims operations in a health plan environment.
- Regulatory Knowledge: Strong understanding of Medi-Cal and Medicare requirements.
- Strategic & Analytical: Ability to translate regulations into operational strategies.
- Communication Skills: Comfortable presenting complex issues to leadership and external partners.
- Technology Savvy: Familiarity with claims systems (Epic Tapestry experience is a plus).
- 5+ years in healthcare management, with at least 3 years in claims or patient financial services
- Bachelor’s degree in business, finance, or related field
Nice To Haves
- Familiarity with claims systems (Epic Tapestry experience is a plus).
Responsibilities
- Lead and manage all claims operations, including adjudication, adjustments, and payment integrity.
- Oversee and coach managers and supervisors; ensure team performance and development.
- Optimize workflows and implement process improvements for efficiency.
- Manage vendor relationships and Epic Tapestry system enhancements (training provided).
- Ensure compliance with Medi-Cal, Medicare, and regulatory requirements.
- Monitor KPIs for timeliness, accuracy, and compliance.
- Collaborate with Provider Relations, Finance, Compliance, IT, and other departments.
- Address provider disputes and billing questions; support positive provider relationships.
- Lead initiatives for backlog reduction, performance improvement, and system optimization.
Benefits
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Number of Employees
501-1,000 employees
