Central California Alliance for Health
health care
ClaimsOperationsManager
“Claims Operations Manager at Central California Alliance for Health. Skills: process management, cross-functional coordination, vendor/stakeholder management, operational metrics, resource planning, continuous improvement, Claims operations, Provider Dispute Resolution (PDR), Medi-Cal, Medicare, claims processing, workflow design, inventory management, audit processes, quality standards, compliance requirements, research, analysis, reporting, training, mentoring, supervising, evaluating work, de”
What You'll Achieve.
ensure accurate, timely, and compliant dispute resolution; meet performance metrics; drive better outcomes
Industry & Context.
root-cause analysis; Uses data and tools to spot trends, make decisions, and actively identify opportunities for automation; Focuses on fixing root causes instead of quick fixes; Interpret operational data, identify trends, and apply insights
expected travel to Alliance service area(s) once a quarter, attendance at quarterly company-wide events or department meetings will be expected, In-office or in-community presence may be required for some positions and is dependent on business need, Must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship
What They're Looking For.
Must Have
Bachelor's degree in Business, Healthcare Administration, Public Health, or a related field, A minimum of six years of experience in a healthcare or managed care environment, a minimum of three years of supervisory or management experience in Medi-Cal and Medicare claims operations, Must reside in California upon hire
Nice to Have
Master’s degree may substitute for two years of the general healthcare or managed care experience
What You'll Do.
Manages and leads the Claims Operations Unit
acts as a subject matter expert
provides guidance on claims operations functions and departmental operations
Provides management oversight related to planning
and implementing claims operations activities
compliance coordination
and governance of claims policies and procedures
Oversees the full Provider Dispute Resolution (PDR) lifecycle to ensure accurate
and compliant dispute resolution
and trains assigned staff
How You'll Work.
Team & Collaboration
Works closely with other teams to drive better outcomes; collaborate with Claims Quality on PDR analytics; promote an atmosphere of teamwork and cooperation
Process & Methodology
planning, leading, implementing claims operations activities, Develop work plans and workflows, organize and prioritize unit activities to meet performance metrics, Organize and prioritize the work of others, delegate effectively, follow up on work assignments
Applying for this Claims Operations Manager role?
Most applicants get filtered before a human reads their resume. See if yours makes the cut.
How to Apply on Greenhouse
- Create a Greenhouse profile before applying — it saves time across multiple applications.
- Upload your resume as a PDF; the parser handles it better than Word.
- Answer all knockout questions carefully — wrong answers auto-reject before a human sees you.
- Enable email notifications to track application status in real time.
ANONYMOUS · UNFILTERED
What do employees actually say about Central California Alliance for Health?
Real rants from real employees. Read before you apply.