job

About the Organization:

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. In its 29th year, IEHP supports nearly 1.6 million members who are enrolled in Medicaid and has a growing network of over 8,000 providers and nearly 4,000 Team Members (Employees). Through dynamic partnerships, award-winning service, and a tradition of quality care, IEHP is fully committed to its Mission, Vision, and Values.

IEHP has consistently achieved outstanding employee engagement scores from their 4,000+ Team Members and was most recently recognized and awarded the designation of ‘Great Place to Work’ for a third year in a row! For details regarding IEHP, please visit: iehp.org.

About the Position:

Reporting to the Chief Financial Officer, the Senior Director, Claims will manage the Director, Claims and will be responsible for the strategy, design, and implementation of claims payment processes. The Senior Director will provide regulatory directive and operational guidance to ensure the organization’s compliance requirements are met.

Responsibilities:

• Oversee claims production and vendor oversight for all lines of business
• Ensure adequate quality controls and participate with support departments to analyze the root cause of claim payment variations
• Ensure claim support services achieve high provider satisfaction and timely dispute/appeal responsiveness
• Establish, implement, and provide improvements to internal controls and department policies and procedures
• Interact with Core Configuration team and vendors to ensure claims systems are robust, compliant and supports business developmental needs
• Influence and drive change among executive leadership and others within the organization
• Draft and oversee implementation of future state processes and systems needed to support strategic direction
• Provide coaching and guidance to the Director of Claims to ensure staffing and operational support needs are met

Experience Requirements:

• Ten (10) years healthcare administration experience
• Four (4) years minimum in a Director level role or above
• Two (2) years of experience with an HMO or managed care experience
• Medi-Cal/Medicaid claims experience required and Medicare/DSNP/ACA Exchange experience preferred

Educational Requirements:

• Bachelor’s degree in business administration, accounting, or healthcare from an accredited institution required
• Master’s degree from an accredited institution preferred

Knowledge & Skills:

• Solid understandings of rules and regulations governing Medi-Cal benefits and claims adjudication practices and procedures
• Principles and techniques of supervision and training
• Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence
• Microcomputer literacy preferred

Commitment to Team Culture:

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Salary range: $193,003.20 – $337,771.20 based upon related/relevant experience and internal equity.

Position Description »