Health Plan Business Services Manager (Claims Manager)

Full Job Description

Why Join Contra Costa County Health Services?

The Contra Costa Health Plan is offering an excellent career opportunity to fill one (1) Health Plan Business Services Manager (Claims Manager) position assigned to the Claims Department located in Martinez, CA.

CCHP is the first federally qualified, state-licensed, county-sponsored HMO in the United States. Its aim is to provide managed care health insurance with its safety net community and county provider partners.

This Claims Manager oversees integrity and systems, connecting claims operations, configuration, compliance, and encounter reporting.

This role oversees claims configuration, auditing, payment integrity monitoring, and encounter data submission to ensure the accuracy and reliability of the health plan’s core payment systems.

The position also partners closely with IT, compliance, provider relations, and finance to identify systemic issues, implement corrective actions, and continuously improve claims processing.

This is an opportunity for someone who enjoys solving complex operational problems, strengthening system integrity, and using data and audits to improve processes across a large public health plan.

We are looking for someone who is:

• A strong analytical thinker who enjoys identifying root causes and solving complex operational problems
• A detail-oriented leader who understands the importance of accuracy in claims systems and regulatory reporting
• A collaborative partner who can work effectively with IT, compliance, provider relations, and finance teams
• Comfortable navigating ambiguity and improving legacy processes and system workflows
• An accountable manager who can prioritize multiple projects and ensure deadlines and compliance requirements are met
• Process improvement-minded with a focus on preventing issues rather than reacting to them

What you will typically be responsible for:

• Overseeing claims configuration, including fee schedule updates, benefit setup, and configuration of claims edits
• Managing claims quality assurance activities, including pre-payment and post-payment audits
• Monitoring payment integrity processes and overseeing refunds, recoupments, and overpayment recovery efforts
• Leading encounter data rejection review, resubmission, reconciliation, and reporting to regulatory agencies
• Monitoring claims system issues and configuration requests through IT ticket management and coordinating resolution with technical teams
• Conducting or overseeing operational and compliance audits and ensuring corrective actions are implemented
• Monitoring claims editing performance and ensuring edits are functioning as intended and resolved within service level expectations
• Supervising staff responsible for claims integrity functions, including medical records coders, and supporting their professional development

A few reasons you might love this job:

• Opportunity to improve how a large public health plan pays providers and manages claims accuracy
• Meaningful work that directly supports Medi-Cal members and the providers who care for them
• A collaborative environment that works closely with public health, clinical services, and health plan operations
• The chance to lead system improvements and strengthen payment integrity across the organization

A few challenges you might face in this job:

• Navigating complex Medi-Cal regulations and requirements for claims and encounter data reporting
• Working with legacy processes and systems that require thoughtful improvement and coordination with IT
• Managing competing priorities such as audits, system updates, and regulatory deadlines
• Identifying and addressing systemic issues that may involve multiple operational teams

Competencies Required:

• Critical Thinking: Analytically and logically evaluating information, propositions, and claims
• Decision Making: Choosing optimal courses of action in a timely manner
• Attention to Detail: Focusing on the details of work content, work steps, and final work products
• Delivering Results: Meeting organizational goals and customer expectations and making decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks
• Customer Focus: Attending to the needs and expectations of customers
• Group Facilitation: Enabling constructive and productive group interaction
• Handling Stress: Maintaining emotional stability and self-control under pressure, challenge, or adversity
• Involving Others (Engaging Teams): Engaging others for input, contribution, and shared responsibility for outcomes
• Leadership: Guiding and encouraging others to accomplish a common goal
• Managing Performance: Ensuring superior individual and group performance
• Professional Integrity & Ethics: Displaying honesty, adherence to principles, and personal accountability
• Thinking & Acting Systematically: Formulating objectives and priorities, and implementing plans consistent with the long-term interests of the organization in a global environment

To read the complete job description, please visit the website: www.cccounty.us/hr

The eligible list established from this recruitment may remain in effect for six months.

Qualifications

Education: Successful completion of at least 60 semester or 90 quarter units from an accredited college or university with a major in business, health sciences, or closely related field. College degree preferred but will consider experience.

Experience: Three (3) years of full-time, or equivalent, experience in an administrative, managerial, or supervisory position with direct responsibility for managed care business services functions or medical claims processing.

Certification: May be required to obtain and maintain vendor-specific training and/or certifications on the applications supported. This training or certification is required within six (6) months of notification from the supervisor.

Substitution: Additional qualifying experience may be substituted for the required education on a year-for-year basis up to a maximum of two (2) years.

Desirable Qualifications:

• Experience managing claims operations, claims configuration, or payment integrity functions in a health plan or managed care organization
• Knowledge of Medi-Cal or Medicaid claims processing and encounter data submission requirements
• Experience overseeing claims audits, payment integrity programs, or overpayment recovery processes
• Familiarity with claims editing logic, fee schedule configuration, and benefit setup in a claims adjudication system
• Experience working with cross-functional teams including IT, compliance, provider relations, and finance
• Supervisory experience managing analysts, coders, or claims integrity staff
• Professional coding certification such as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist)

Additional Information

1. Application Filing and Evaluation: Applicants will be required to complete a supplemental questionnaire at the time of application. Applications will be evaluated to determine which candidates will move forward in the next phase of the recruitment process.

Online Interview: Candidates that meet the minimum qualifications will be invited to participate in an online, on-demand interview.

The interview will measure candidates' competencies as they relate to the job and will be rated by subject matter experts.

In the interview, candidates must achieve an average passing score of 70% or higher on each of the competencies, as well as an overall passing score of 70% or higher.

These may include, but are not limited to: Critical Thinking, Attention to Detail, Delivering Results, Professional Integrity & Ethics. (Weighted 100%).




TENTATIVE DATES
Oral Interview: April 14-19, 2026


The online interview will be administered remotely using a computer or mobile device such as a tablet or smartphone. You will need access to a reliable internet connection to take the assessment, as well as a computer or mobile device with a camera.

The Human Resources Department may change the examination steps noted above in accordance with the Personnel Management Regulations and accepted selection practices.





For recruitment questions, please contact Health Services Personnel, Recruitment Team at Exams@cchealth.org. For any technical issues, please contact the Government Jobs’ applicant support team for assistance at +1-855-524-5627.



CONVICTION HISTORY

After you receive a conditional job offer, you will be fingerprinted, and your fingerprints will be sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI).

The resulting report of your conviction history (if any) will be used to determine whether the nature of your conviction conflicts with the specific duties and responsibilities of the job for which you have received a conditional job offer.

If a conflict exists, you will be asked to present any evidence of rehabilitation that may mitigate the conflict, except when federal or state regulations bar employment in specific circumstances.

Having a conviction history does not automatically preclude you from a job with Contra Costa County.

If you accept a conditional job offer, the Human Resources department will contact you to schedule a fingerprinting appointment.

DISASTER SERVICE WORKER

All Contra Costa County employees are designated Disaster Service Workers through state and local law. Employment with the County requires the affirmation of a loyalty oath to this effect.

Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.


EQUAL EMPLOYMENT OPPORTUNITY

It is the policy of Contra Costa County to consider all applicants for employment without regard to race, color, religion, sex, national origin, ethnicity, age, disability, sexual orientation, gender, gender identify, gender expression, marital status, ancestry, medical condition, genetic information, military or veteran status, or other protected category under the law.