Claims Director

Company DescriptionAltais is dedicated to transforming healthcare by centering its efforts on physicians and patients. With a focus on value-based care, the organization operates through primary care, multi-specialty physician groups, clinically integrated networks, and a population health service organization. Altais supports over 10,000 physicians and clinicians, providing care to more than 500,000 patients across California and Hawaii. The Managed Care Operations division provides payer administration services, including claim adjudication, enrollment, provider data management, credentialling and customer service. As the organization grows nationwide, its mission remains steadfast: to help physicians thrive while ensuring communities receive high-quality, compassionate, and affordable care.Role DescriptionThis is a full-time remote role. The Claims Director, a leader in the Managed Care Operations division will oversee and lead all aspects of claims management, ensuring accurate and efficient processing. Responsibilities include managing claims operations, analyzing data to improve performance, ensuring compliance with regulatory standards, and collaborating across teams to optimize performance. As a leader, the Claims Director will also mentor team members and drive strategic initiatives to improve organizational claims processes.QualificationsStrong expertise in Claims Management, Claims Handling, and Insurance practicesDemonstrated Analytical Skills to assess claims data and identify areas for improvementProven ability to maintain high-quality Customer Service standards while addressing complex issuesVendor Management experience with the ability to drive high quality vendor performanceLeadership experience with the ability to guide and develop team membersIn-depth knowledge of regulatory compliance related to claims administrationExcellent organizational and problem-solving skillsBachelor’s degree in Business Administration, Risk Management, or a related field; relevant certifications are a plusPrior work experience in healthcare claims or insurance industry is required