Claims Director

About the Role

We're looking for a Claims Director to lead claims operations for Contra Costa Health Plan (CCHP), a large public health plan serving over 250,000 residents. This is a contract‑to‑hire leadership role overseeing a team of about 20 (including managers, supervisors, and claims staff). You'll drive strategy, optimize workflows, and ensure accurate, timely claims processing across Medi‑Cal, Medicare, and commercial lines of business.

• Lead and manage all claims operations, including adjudication, adjustments, and payment integrity.
• Oversee and coach managers and supervisors; ensure team performance and development.
• Optimize workflows and implement process improvements for efficiency.
• Manage vendor relationships and Epic Tapestry system enhancements (training provided).
• Ensure compliance with Medi‑Cal, Medicare, and regulatory requirements.
• Monitor KPIs for timeliness, accuracy, and compliance.
• Collaborate with Provider Relations, Finance, Compliance, IT, and other departments.
• Address provider disputes and billing questions; support positive provider relationships.
• Lead initiatives for backlog reduction, performance improvement, and system optimization.

• Reduce a large backlog of pending claims.
• Implement performance improvement initiatives.
• Optimize department workflows for greater efficiency.

• Managed Care Leadership – experience leading claims operations in a health plan environment.
• Regulatory Knowledge – strong understanding of Medi‑Cal and Medicare requirements.
• Strategic & Analytical – ability to translate regulations into operational strategies.
• Communication Skills – comfortable presenting complex issues to leadership and external partners.
• Technology Savvy – familiarity with claims systems (Epic Tapestry experience is a plus).

You’ll shape the strategic direction of claims operations, ensure compliance, and support provider relationships – all while impacting healthcare access for Contra Costa County’s most vulnerable populations.

Full-time, onsite/hybrid leadership role.

Bachelor’s degree in business, finance, or related field.

5+ years in healthcare management, with at least 3 years in claims or patient financial services.

Contract to Hire position based out of Concord, CA.

The pay range for this position is $75.00 - $80.00/hr.

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre‑tax and Roth post‑tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long‑term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Hybrid position in Concord, CA.

This position is anticipated to close on Mar 13, 2026.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.