Senior Director, Claims

Overview

What you can expect! 

 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

 

The Senior Director of Claims is responsible for the strategy, design, and implementation of claims payment processes. Provide regulatory directive and operational guidance to ensure the organization’s compliance requirements are met.

 

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits

Perks

 

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary.
• Hybrid schedule.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Key Responsibilities

Oversee Claims Production and vendor oversight for all lines of business

Ensure adequate quality controls and participate with support departments to analyze the root cause of claim payment variations.

Ensure claim support services achieve high provider satisfaction and timely dispute/appeal responsiveness

Establish, implement, and provide improvements to internal controls and department policies and procedures

Interact with Core Configuration team and vendors to ensure claims systems are robust, compliant and supports business developmental needs

Influence and drive change among executive leadership and others within the organization

Draft and oversee implementation of future state processes and systems needed to support strategic direction

Provide coaching and guidance to the Director of Claims to ensure staffing and operational support needs are met

Qualifications

Education & Requirements 

• Ten (10) years healthcare administration experience, four (4) years minimum in a Director level role or above
• Two (2) years of experience with an HMO or managed care experience
• Medi-Cal and/or Medicare claims experience preferred
• Bachelor's degree in business administration, accounting or health care from an accredited institution required
• Master’s degree from an accredited institution preferred

 

Key Qualifications

• Must have a valid California Driver's license and valid automobile insurance
• Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points
• Solid understandings of rules and regulations governing Medi-Cal benefits and claims adjudication practices and procedures
• Principles and techniques of supervision and training
• Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence
• Microcomputer literacy preferred

 

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)

Pay Range

USD $193,003.20 - USD $265,387.20 /Yr.