Job description

ASSOCIATE DIRECTOR OF CLAIMS OPERATIONS

• Provide leadership & oversight of claims adjudication
• Optimize fiscal & operational functions
• 100% telecommuting option for candidates in California

–Position is not eligible for sponsorship –

The Associate Director of Claims helps ensure that provider claims are accurately adjudicated within regulatory requirement timeframes. Supervising a dynamic team of professionals, they partner with other departments and external vendors to maximize claims processing effectiveness. If you are highly organized, detail-oriented person who wants to help a nonprofit community-based health plan’s 160,000+ members get high-quality care, then this is the job for you.

Position overview

• Manage a high-performing team through mentoring, evaluating performance and promoting continuous learning
• Monitor and manage claims processing metrics to ensure compliance with regulatory guidelines for quality and timeliness
• Ensure that provider claims disputes are addressed and resolved according to regulatory requirements

Key skills

• Analyze the results of HPSM’s claims auditing program to identify process deficiencies and strategize improvement opportunities
• Work with other departments to develop, implement and achieve annual departmental goals and long-range organizational objectives
• Oversee and manage processes outsourced to delegated vendors (including claims scanning and editing)
• Develop and implement operational strategy to reduce claims inventory, increase auto-adjudication rate, improve quality, reduce cost and maximize compliance
• Manage regulatory audits and respond to inquiries related to claims services

Requirements
These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.

Education and experience

• Bachelor’s degree in business, finance, health care or related field
• At least seven years’ experience in managed care or claims processing
• At least five years’ experience with claims operations management

Knowledge of:

• Health care claims processing, payment methodologies and related systems
• Billing practices in the health care industry
• Process improvement methodologies

Ability to:

• Manage direct reports and achieve measurable results
• Perform qualitative and quantitative analyses
• Investigate issues and resolve problems with minimal guidance

Salary and benefits
The starting salary range depends on the candidate’s work experience.

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation on top of salary)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

To apply, complete an HPSM Employment Application and submit it with a resume and cover letter that includes salary expectations to careers@hpsm . org. Submissions without a cover letter and salary expectations may not be considered.

Health Plan of San Mateo (HPSM) is a local community-based health plan that manages the health care of over 160,000 low-income people San Mateo County, including all its Medi-Cal eligible residents. HPSM is proud to be an Equal Opportunity Employer and an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

Job Type: Full-time

Pay: $113,000.00 - $150,000.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Referral program
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• This position is not eligible for sponsorship.
• Please do not apply unless you currently reside in California. This position can be fully remote only if you reside in the state of California.

Experience:

• Medical (Managed Care) Claims: 5 years (Required)
• managed care or healthcare claims processing: 7 years (Required)

Work Location: Hybrid remote in South San Francisco, CA 94080

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