Strategic Claims Director — Health Plan Operations

County of Contra Costa; Martinez (CA); On-site; USD 180,000 - 260,000; Full time

Job summary

Contra Costa Health Plan seeks a Health Plan Division Director – Exempt (Claims Director) to lead and optimize our claims operations across Medi-Cal, Medicare, and commercial lines. You will guide executives and staff, ensure payment integrity, and maintain strong provider relationships with a focus on compliance and financial health.

We expect a master’s degree and extensive managed care leadership experience, plus the ability to translate complex rules into practical processes and coach

Qualifications

• Extensive leadership in health plan claims operations within a managed care environment.
• Deep understanding of Medicaid, Medicare, and regulatory oversight.
• Ability to translate regulations into sustainable operational strategies.

Responsibilities

• Provide leadership and oversight of all CCHP claims operations, including adjudication and recovery activities.
• Direct, coach, and evaluate managers and supervisors responsible for daily claims operations.
• Oversee clearinghouses and vendor performance, including contract management and issue resolution.
• Direct the use of Epic Tapestry for claims adjudication, rules, and reporting; ensure tested changes are implemented.
• Ensure full regulatory compliance with federal, state, and local requirements.

Skills

Managed care leadership

Medicare/Medicaid knowledge

Strategic thinking

Effective communication

Risk management

Cross‑functional collaboration

Discretion and judgment

Education

Master’s degree in Business Administration

Tools

Epic Tapestry

Job description

Contra Costa Health Plan seeks a Health Plan Division Director – Exempt (Claims Director) to lead and optimize our claims operations across Medi-Cal, Medicare, and commercial lines. You will guide executives and staff, ensure payment integrity, and maintain strong provider relationships with a focus on compliance and financial health.

We expect a master’s degree and extensive managed care leadership experience, plus the ability to translate complex rules into practical processes and coach