California Claims Operations Manager

Job Summary

Leading claims governance and operational strategy, the full-time Manager, Claims Strategy & Operations Governance will oversee quality assurance and recovery functions while ensuring enterprise alignment and operational readiness in a remote role based in California.

Key responsibilities

• Develops and implements strategic and operational plans to align departmental objectives with enterprise priorities
• Establishes governance infrastructure for Claims Operations, including performance monitoring and issue escalation tracking
• Oversees Quality Assurance and Recovery/Payment Integrity programs, ensuring compliance and operational efficiency

Required qualifications

• Bachelor's Degree and at least seven years of progressively responsible healthcare claims experience
• Minimum of four years of Medi-Cal claims experience and four years of supervisory experience
• In-depth knowledge of Medi-Cal regulations and claims operations
• Strong understanding of audit processes, quality metrics, and recovery methodologies
• Ability to influence across functional areas without direct authority