We’re seeking a self-directed individual with:

• A Bachelor’s degree in business administration, healthcare administration or related field, preferred

• 7 to 10 years of experience in a Medicare or Managed Care environment with responsibility for overseeing operations in appeals & grievances, claims processing, and/or payment integrity, highly desired

• 5 or more years of management or progressive leadership experience in Medicare or Managed Care Operations, required

• Management or progressive leadership experience in Appeals and Grievances, Claims, and Payment Integrity, a plus

• 5 or more years of experience with Medicare Advantage Health Plan operations, highly desired

• Knowledge of Centers for Medicare & Medicaid Services (CMS) and the Department of Health Care Services (DHCS) jurisdictions

• Proven experience overseeing operations and vendor performance.

• Advanced proficiency in Microsoft Office Suite, particularly Excel (pivot tables, VLOOKUP), Word, and PowerPoint.

• Familiarity with SQL, data visualization tools, and healthcare-related software (e.g., claims processing systems, Tapestry, etc.), preferred

• Strong oral and written communication skills with the ability to articulate complex healthcare operations and technical processes to diverse audiences, required