Overview Join Us in Strengthening Care in Our Communities! Bring your vision and innovation to claims processing and help transform care for over 400,000 neighbors in five counties. We welcome applicants from across California, with a strong preference for candidates based in our service areas (Santa Cruz, Monterey, Merced, Mariposa, and San Benito Counties). While this role may offer some remote flexibility, we value team members who are familiar with and connected to our local communities. The Alliance is seeking a dynamic Claims Director to lead our claims operations and ensure timely, accurate service for members and providers across Santa Cruz, Monterey, Merced, Mariposa, and San Benito counties. This is a unique opportunity to make an impact locally, helping deliver quality, reliable care to more than 400,000 neighbors in our region. We’re looking for a leader who brings both technical expertise and a passion for service, collaboration, and continuous improvement. Be part of a mission-driven organization that values innovation, integrity, and community connection—while building your career in the heart of Central California. THE IDEAL CANDIDATE A forward-thinking leader who is excited to bring innovative solutions to age-old challenges like inventory backlogs and lean staffing Proven ability to champion change initiatives by effectively communicating the vision, fostering buy-in, and motivating others to embrace new processes and ways of working Deep knowledge of claims regulations, policies, and systems, with the ability to translate complex requirements into efficient workflows Strategic thinker who can align claims management processes with organizational goals and regulatory requirements Experienced in building, coaching, and motivating high-performing teams while fostering accountability and collaboration Demonstrates high emotional intelligence, fostering positive relationships with team members, providers, and business partners Data-driven leader skilled in using metrics and analytics to monitor performance, identify trends, and implement improvements Proactive problem-solver who can navigate ambiguity, resolve escalated issues, and make sound decisions under pressure WHAT YOU’LL BE RESPONSIBLE FOR Reporting to the Chief Operating Officer, this position: Provides strategic management oversight in implementing, directing, and monitoring the Alliance’s Claims Department functions, including the development and implementation of new programs and services related to claims operations Directs and oversees the Claims Department, acts as a subject matter expert, and provides direction and advice related to Claims Department functions and overall business operations Directs, manages, and supervises Claims Department staff WHAT YOU’LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, please view attached link. Knowledge of, and proficiency in: The principles and practices of claims operations and the claims function in a managed care environment Promoting and applying change management principles Research, analysis, and reporting methods California Medi-Cal program, Medicaid, Medicare, entitlement programs, and related regulations Healthcare regulatory processes and regulatory and contractual compliance activities Ability to: Direct, manage, supervise, mentor, train, and evaluate the work of staff Develop, plan, organize, and direct programs and activities that are complex in nature and regional in scope Provide leadership, facilitate meetings, and partner with and guide managers and employees in the resolution of issues Demonstrate strong analytical skills, accurately collect, manage, and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk Assess departmental operations, identify opportunities for improvement, and advance operational effectiveness Education and Experience Bachelor’s degree in Finance, Business Administration, or a related field A minimum of ten years of claims operations experience in a managed care environment, which included some experience with financial management, a minimum of three years of experience working with Medicare and Medi-Cal Programs, and a minimum of five years of management-level experience (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, 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. Details about this can be reviewed during the interview process

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