Claims Processing Director jobs in San Diego, CA

Claims Processing Director plans and directs one or more departments responsible for administration of health insurance claims, payment processing, billing research, and responding to inquiries. Establishes and implements organizational policies and procedures; may offer guidance on the appropriate handling of complex or high-value claims. Being a Claims Processing Director develops and executes strategic business plans for the department. Coordinates operations with other areas of the organization. Additionally, Claims Processing Director requires a bachelor's degree. Typically reports to top management. The Claims Processing Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Processing Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)

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Director, Sterile Processing Department
  • Kaiser Permanente
  • San Marcos, CA OTHER
  • Job Summary:

    Oversees department(s) applying best standards and practices in Supply Chain and Logistics and advocates and proactively monitors departmental compliance of relevant guidelines. Monitors the resolution of inventory, asset, and vendor/suppliers deficiencies. Monitors the implementation of recommendations suggested to streamline current systems to optimize, maintain, and transform current processes, and approves and makes future-oriented decisions to move forward with research plans to develop innovative strategies to streamline new/existing business operating models according to supply chain future state. Partners with senior leaders and approves next steps based on results from the audits of suppliers, conducts corrective actions based on interpreting needs identified from audits, and facilitates business reviews. Directs the implementation and development of strategic future-oriented plans based on results on utilization, quality, inventory levels, and courier routes for projects, while assessing customer satisfaction levels.

    Essential Responsibilities:

    • Prepares individuals for growth opportunities and advancement; builds internal collaborative networks for self and others. Solicits and acts on performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement. Demonstrates continuous learning; oversees the recruitment, selection, and development of talent; ensures performance management guidelines and expectations to achieve business needs. Stays up to date with organizational best practices, processes, benchmarks, and industry trends; shares best practices within and across teams. Motivates and empowers teams; maintains a highly skilled and engaged workforce by aligning resource plans with business objectives. Provides guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact.

    • Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and/or services meet member requirements and expectations while aligning with organizational strategies. Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues. Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; prioritizes and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; ensures teams accomplish business objectives.

    • Ensures long-term asset accounting by: guiding and providing support, when needed, for the asset approval (e.g., vehicles, medical equipment), transfer, and disposal processes; guiding the development of strategies to improve the maintenance of records of dispositions in the accounting system; developing innovative strategies to implement policies and compliance procedures, by proposing strategies for cost reductions that achieves accountability for the misuse of assets; and establishing innovative strategies to identify, evaluate, and implement cost restructuring and cost reductions.
    • Ensures ongoing quality customer services by: developing innovative strategies to improve the resolution of customer issues; determining innovative strategies to improve the resolution of backorder problems, delivery delays, repairs, and returns; and establishing innovative strategies to improve the efficiency of product returns and limit and address recalls.
    • Ensures adequate levels of inventory are maintained by: developing advanced strategies to resolve major disruptions in inventory, and guiding the development of strategies for administering of transactions and requests for supplies, equipment, and services; developing inventory management strategies to meet future inventory demand to minimize obsolescence or expiration; developing advanced strategies for maintaining automated inventory and ordering systems to support inventory reconciliation and engaging others on the team to implement; engaging others on the team to implement strategies to confirm highly complex and long-term reorder levels are updated, maintained, and adhered to so that proper product rotation remains valid, and inventory levels are accurate; and working collaboratively as an expert internal consultant and external spokesperson to maintain the inventory control system for broad initiatives (e.g., ensure accuracy of product line, proper level of stock, rotation of product, cleanliness of product/carts), and engaging others on the team to implement.
    • Maintains and improves supply chain and operations by: leading complex and long-term activities (i.e., shipping logistics, carrier, and inventory system evaluation) to optimize, maintain, and transform current processes for increased efficiency; developing and leading research plans to identify new/existing business operating models according to supply chain future state functional and technical design, and engaging others on the team to implement; and, as an expert internal consultant and external spokesperson, directing and leading processes on initiatives to determine end-to-end sourcing, procurement, and logistics.
    • Ensures purchasing strategy is consistent with the overall national sourcing strategy by: developing advanced strategies for improving the processing of purchase requests; forming strategies for purchase standardization, quality, amounts, or equivalency across a range of product categories; building advanced strategies to resolve future purchase-related problems and defining advanced long-term cost savings strategies; creating advanced strategies that establish order quantities, and developing innovative long-term strategies for improving product evaluations and trials; and establishing advanced processes to drive novel strategies for selection of new products and equipment.
    • Ensures ongoing compliance with state and federal regulations, and company policy/procedures pertaining to purchasing, inventory management, and distribution by: developing innovative strategies for applying best standards and practices; developing innovative strategies for managing quotations for new stock and non-standard items, fulfilling contracts, monitoring the external environment, and internal trends, ensure compliance; establishing policies and procedures for compliance monitoring (e.g., Joint commission, Sarbanes-Oxley [SOX]) and performance management audits to ensure staff performance is consistent with established standards; building advanced strategies for improving the implementation of corrective action and the resolution of deficiencies as necessary on a timely basis and in accordance with company policy; and developing advanced strategies for improving the educational and training programs for managers/product users.
    • Ensures suppliers/vendors performance and relationships by: developing long-term strategies to evaluate suppliers/vendor compliance with policies and regulations; directing, designing, and integrating components of relevant programs while also supporting the onboarding new suppliers/vendors, guiding contract negotiation, and serving as an external spokesperson regarding broad suppliers/vendor-related organizational initiatives to ensure their continued ability to support KP; promoting innovative strategies for corrective actions at scale; developing innovative strategies for managing the resolution of suppliers/vendor issues; and establishing strategies to broadly improve strategies for meeting operational and cost targets across suppliers/vendors.
    • Provides technical analysis and reporting services for others by: driving analyses and integrating results on utilization, quality, inventory levels, and courier routes for highly complex and long-term projects; forming innovative strategies to continually expand customer services and improve member satisfaction, and forming advanced strategies for the implementation of proven quality improvement procedures; defining tools, techniques, and assumptions to ensure highly complex analyses are appropriate to support operational and business decisions; and distributing reports in response to business needs for broad initiatives documenting complex analytical results.
  • 6 Days Ago

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Workers Compensation Claims Examiner | Must Reside in California
  • Sedgwick Claims Management Services Inc.
  • San Diego, CA FULL_TIME
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flex...
  • 19 Days Ago

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CA - Field Representative
  • Hancock Claims Consultants
  • San Diego, CA FULL_TIME
  • With a 20-year history supporting property insurers, Hancock Claims Consultants provides a nationwide network of inspectors, contractors, and engineers who help adjusters quickly process claims. All 5...
  • 3 Days Ago

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Senior Workers Compensation Adjuster
  • TheBest Claims Solutions
  • San Diego, CA FULL_TIME
  • Senior Workers Compensation Adjuster SAN DIEGO, CA 92101 $85,000 - $95,000, DEPENDING ON EXPERIENCE Job Description Our client, a National Insurance Carrier, is looking for a Senior Workers Compensati...
  • 24 Days Ago

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Processing worker
  • Goodwill Industries of San Diego County
  • Encinitas, CA FULL_TIME
  • POSITION SUMMARY : Sorts, cleans, prices and stocks donated goods in a Goodwill store. Accepts donations and provides assistance on sales floor as needed. Provides excellent customer service to donors...
  • 17 Days Ago

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Cycle Processing
  • Polaris Pharmacy Services
  • San Diego, CA OTHER
  • Job Details Job Location: Polaris Pharmacy Services of San Diego - San Diego, CA Position Type: Full Time Salary Range: Undisclosed Job Category: Pharmaceutical DescriptionCYCLE PROCESSING WHO WE ARE ...
  • 7 Days Ago

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0 Claims Processing Director jobs found in San Diego, CA area

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Claims Supervisor
  • San Diego Metropolitan Transit System (mts)
  • San Diego, CA
  • Advertised Title: Claims Supervisor Internal Title: Liability Claims Supervisor The Liability Claims Supervisor provides...
  • 4/22/2024 12:00:00 AM

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QA & Regulatory Compliance Manager
  • Galderma S.A.
  • Carlsbad, CA
  • With a unique legacy in dermatology as well as decades of cutting-edge innovation, Galderma is the pure-play dermatology...
  • 4/22/2024 12:00:00 AM

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Workers' Compensation Defense Attorney (Hybrid/Remote)
  • Hinshaw & Culbertson Llp
  • San Diego, CA
  • Hinshaw & Culbertson, a leading national law firm, is seeking an associate with 1-3 years of workers' compensation exper...
  • 4/22/2024 12:00:00 AM

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Medicare Program Manager (100% REMOTE/NO C2C)
  • Amerit Consulting
  • San Diego, CA
  • Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health de...
  • 4/22/2024 12:00:00 AM

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Geriatric Physician
  • Southern Indian Health Council, Inc
  • San Diego, CA
  • Job Description Job Description Job Announcement Position Title: Geriatric Physician (#ZR) Department: Medical Supervise...
  • 4/21/2024 12:00:00 AM

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Claims Supervisor
  • San Diego Metropolitan Transit System (MTS)
  • San Diego, CA
  • Advertised Title: Claims Supervisor Internal Title: Liability Claims Supervisor The Liability Claims Supervisor provides...
  • 4/20/2024 12:00:00 AM

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Associate Director, Access & Reimbursement - Oncology - REMOTE
  • Proclinical Staffing
  • San Diego, CA
  • Associate Director, Access & Reimbursement (Oncology) - Permanent - Remote Proclinical Staffing is seeking an Associate ...
  • 4/20/2024 12:00:00 AM

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SUPERVISORY QUALITY ASSURANCE SPECIALIST
  • Naval Sea Systems Command
  • San Diego, CA
  • Summary You will serve as a SUPERVISORY QUALITY ASSURANCE SPECIALIST in the QUALITY ASSURANCE DIRECTORATE of SUPERVISOR ...
  • 4/20/2024 12:00:00 AM

According to SDSU professor emeritus Monte Marshall, San Diego Bay is "the surface expression of a north-south-trending, nested graben". The Rose Canyon and Point Loma fault zones are part of the San Andreas Fault system. About 40 miles (64 km) east of the bay are the Laguna Mountains in the Peninsular Ranges, which are part of the backbone of the American continents. The city lies on approximately 200 deep canyons and hills separating its mesas, creating small pockets of natural open space scattered throughout the city and giving it a hilly geography. Traditionally, San Diegans have built the...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Processing Director jobs
$170,348 to $228,914
San Diego, California area prices
were up 2.6% from a year ago

Claims Processing Director in Portsmouth, NH
Insurance claims and processing clerks work closely with insurance brokers and agents, handling the administrative duties behind insurance policy renewals, claims processing and new policies.
December 28, 2019
Claims Processing Director in Santa Barbara, CA
Complete with new dashboards, reporting functionality, business intelligence tools, and improved security, FileHandler Enterprise is the new benchmark for Claims Management Software.
February 08, 2020
Claims Processing Director in San Diego, CA
Pulpstream makes it possible for you to have one system for tracking all claims.
January 07, 2020