Claims Operations & Transformation Director

Paycom - ATS; Santa Barbara (CA); Hybrid; USD 175,000 - 262,000; Full time

Job summary

CenCal Health is seeking a Director of Claims in California to lead the Claims Department, drive transformation, enhance accuracy, and ensure regulatory compliance. The role oversees staff, budgets, and vendor relationships while aligning with strategic goals.

The Director will optimize end-to-end claims processes, leverage automation and analytics, and collaborate with senior leadership to improve provider satisfaction and service levels.

Qualifications

• Five+ years of management at director level in a healthcare environment.
• Extensive Medicare and Medi-Cal claims leadership experience.
• Knowledge of NCQA, HIPAA, CMS regulations.
• Strong data analytics and performance metrics skills.
• Excellent leadership and communication abilities.

Responsibilities

• Direct and optimize end-to-end claims processing and support.
• Lead enterprise claims transformation and automation initiatives.
• Ensure regulatory compliance and timely service to providers and members.
• Develop operational strategy for modernization including AI workflows.
• Oversee staffing, budgeting, and vendor management for the Claims Dept.
• Provide monthly board reports on claims metrics and performance.

Skills

Operational leadership

Automation

Data analytics

Regulatory compliance

Strategic thinking

Education

Bachelor's degree

Health plan experience

Tools

Claims systems

Microsoft Office

Job description

CenCal Health is seeking a Director of Claims in California to lead the Claims Department, drive transformation, enhance accuracy, and ensure regulatory compliance. The role oversees staff, budgets, and vendor relationships while aligning with strategic goals.

The Director will optimize end-to-end claims processes, leverage automation and analytics, and collaborate with senior leadership to improve provider satisfaction and service levels.