Administrative Director, Health Plan & Claims Administration


Roseville, CA

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Job Description

Adventist Health is more than an award-winning health system. We provide whole-person care to our communities and champion the greater good - from the operating room to the boardroom, we are driven by our unique passion to live God's love through health, wholeness and hope. From Oregon to Oahu, we have a calling to always do more. Now is your chance to apply your passion to our mission.

We're looking for someone to join our team as a Administrative Director, Health Plan & Claims Administration who:

Leads the operations of a health insurance organization, including but not limited to claims staff, audit and compliance, clinical management, customer service, eligibility, communications, finance, data, and analytics. Prepares and files documents necessary for implementing benefit coverage. Ensures compliance with insurance, tax, and other regulations and filing requirements. Develops short to mid-term strategies for optimizing the health plan's operational performance. Supervises and directs the activities of various levels of assigned personnel utilizing both professional and supervisory discretion and independent judgement.

Essential Functions:
-Directs teams of employees who review claims forms and other records for the determination of denial, acceptance, or a need for further investigation. Oversees the identification of claims where third-party liability exists, such as subrogation.

-Negotiates/settles with a third party within prescribed limits. Goal achievement is typically accomplished through performance of direct and/or indirect reports.

-Partners with leadership on the design, implementation, administration, performance evaluation, and cost analysis of health plan (Medical/RX/Wellness) benefits for Adventist Health associates.

-Maintains responsibility for communication to employees and management on benefit program features, plans, and options available.

-Manages vendor relationships, including but not limited to insurance and pension brokers and consultants for program design advice, etc.

-Establishes and implements strategies that have mid to long-term impact on business results in alignment with organization's strategic objectives.

-Performs other job-related duties as assigned.

You'll be successful with the following qualifications:

-Bachelor's Degree in human resources, business administration or equivalent combination of education/related experience: Required
-Master's Degree: Preferred

Work Experience:
-Ten years related experience: Preferred
-Five years strategic leadership experience: Preferred


Adventist Health

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