Director of Claims

Principal & Executive Search Consultant @ Morgan Consulting Resources | Elite Certified Recruitment Expert (ECRE)

Morgan Consulting Resources, Inc. has been retained to conduct the search for the Director, Claims for Inland Empire Health Plan
. The role is based in Rancho Cucamonga, CA. A hybrid schedule is available allowing three days in the office and two days working remotely.

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.

Reporting to the Senior Director, Claims, the Director, Claims is responsible for the direction and oversight of all medical claims processing, provider disputes & appeals, quality assurance, and training activities. Additional responsibilities include ensuring regulatory compliance, strategic planning, and staff development.

• Ensure all claims, appeals and disputes are accurately handled within Federal and State regulatory requirements
• Oversight of quality assurance audits and initiatives focused on payment accuracy and streamlined processes
• Oversight of all department training activities
• Primary department representation for internal/external claim audits and regulatory appeals and inquiries
• Responsible for ensuring regulatory reporting and fulfilling corrective action plans for identified deficiencies
• Coordinates department purchasing needs and originates RFPs and RFQs for needed services
• Prepares department budget and staffing plan
• Ensures all department policies and provider manual claim policies are maintained
• Interacts with other IEHP departments to collaborate on key initiatives, issue resolution and Lean activities

• Five (5) years of healthcare administration experience required
• Four (4) or more years in a leadership capacity required
• Two (2) years of experience with an HMO or managed care experience required
• Medi-Cal/Medicaid claims experience required and Medicare/DSNP/ACA Exchange experience preferred

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

• Solid understanding of rules and regulations governing Medi-Cal benefits and claims adjudication practices and procedures.
• Principles and techniques of supervision and training.

To express interest, apply online and contact:

Erica Eikelboom, Principal & Executive Search Consultant