Strategic Claims Director – Managed Care Leader

Contra Costa County; Martinez (CA); Sur place; USD 150 000 - 190 000; Plein temps

Résumé du poste

Contra Costa Health Plan (CCHP) seeks a Deputy Executive Director, Health Plan – Exempt, to provide strategic and operational oversight of the claims function. You will guide claims adjudication, payment integrity, and vendor oversight across Medi‑Cal, Medicare, and commercial lines, while aligning with executive leadership on regulatory compliance and financial integrity.

The role partners with finance, IT, compliance, utilization management, and external vendors to drive improvements, risk

Qualifications

• Master’s degree in a relevant field or equivalent with management experience.
• Five years of progressively responsible professional experience in health care administration, health plan operations, or related field; at least two years in a management/supervisory role.
• Substitution rule: Bachelor's degree and two extra years of qualifying experience may substitute for a Master’s degree.

Responsabilités

• Provide leadership and oversight of all CCHP claims operations, including adjudication, adjustments, payment integrity, and recovery activities.
• Direct, coach, and evaluate managers and supervisors responsible for daily claims operations.
• Oversee clearinghouses and vendors, including performance and issue resolution.
• Direct the use and optimization of Epic Tapestry for claims adjudication, payment rules, edits, and reporting; ensure testing, documentation, and implementation of changes.
• Ensure full compliance with federal, state, and local regulations (DHCS, DMHC, CMS).
• Establish and monitor KPIs related to timeliness, accuracy, financial controls, and regulatory compliance.
• Serve as primary liaison for claims matters with providers, county partners, auditors, and regulators.
• Identify operational risks and systemic issues; ensure timely corrective action and reporting to leadership.

Connaissances

Leadership

Strategic thinking

Communication

Problem solving

Collaboration

Change management

Delegating

Coaching and developing

Performance management

Visionary leadership

Teamwork

Cross-functional collaboration

Change agent

Public speaking

Fact finding

Formation

Master’s degree in Business Administration / Health Administration / Public Administration / Public Health

Bachelor’s degree + 2 extra years of relevant experience (substitution)

Description du poste

Contra Costa Health Plan (CCHP) seeks a Deputy Executive Director, Health Plan – Exempt, to provide strategic and operational oversight of the claims function. You will guide claims adjudication, payment integrity, and vendor oversight across Medi‑Cal, Medicare, and commercial lines, while aligning with executive leadership on regulatory compliance and financial integrity.

The role partners with finance, IT, compliance, utilization management, and external vendors to drive improvements, risk