L.A. Care Health Plan · 6 days ago
Senior Director, Core Administrative Operations
1200 Building
Full-time
Onsite
Director/Executive
$172K/yr - $292K/yr
9+ years expL.A. Care Health Plan is the nation’s largest publicly operated health plan, dedicated to providing health coverage to low-income residents of Los Angeles County. The Senior Director, Core Administrative Operations will lead and optimize core administrative functions, ensuring efficient and compliant operations while collaborating with cross-functional teams to drive modernization and continuous improvement.
FitnessGovernmentHealth Care
Responsibilities
Translates strategy into disciplined operational execution
Sets clear expectations, drives cross-functional alignment, and ensures that teams have the tools, data, and governance needed to operate effectively
Collaborates across multiple administrative functions, ensuring workflows, technical changes, performance indicators, and regulatory requirements are understood, synchronized, and executed consistently
Anticipates operational challenges, removes barriers, and strengthens end-to-end processes
Collaborates, plans, proactively problem-solves, leads with transparency, accountability, and focuses on continuous improvement
Elevates operational reliability and positions the organization for sustained success as systems, products, and regulatory standards evolve
Leads strategy, operations, and modernization across service areas accuracy, efficiency, and strong control environments
Establishes and manages operational goals, key performance indicators (KPIs)/objectives and key results (OKRs), dashboards, and other metrics to transparently drive consistent performance and compliance
Develops and implements standardized workflows, governance structures, and operating procedures
Fosters a culture of proactive issue identification, cross-functional communication, accountability, transparency, and continuous operational improvement
Directs EDI operations supporting claims submissions, remittance transactions, provider and member exchanges, and other electronic transactions
Drives automation, data accuracy, and improved electronic submission performance
Oversees monitoring and timely resolution of technical issues, rejections, and systemic defects
Ensures high-quality adjudication with strong accuracy, first-pass rates, correct benefit application, and compliance with DHCS, DMHC, CMS, Covered California, and NCQA requirement
Oversees configuration of benefits, reimbursement logic, pricing methodologies, and adjudication controls
Collaborates with key stakeholders on prioritization, execution, and validation of configuration updates, system enhancements, and benefit launches
Leads strategy and operations related to pre-pay controls, cost-avoidance, post-pay recovery, clinical editing, coordination of benefits (COB), overpayments, and third-party liability (TPL)/subrogation
Partners with cross functional teams to support fraud mitigation and compliance with state and federal requirements
Improves financial accuracy and reduces inappropriate payments through robust controls and audit-ready processes
Oversees QA programs across all Core Administrative Operations to ensure ongoing accuracy and compliance
Strengthens control environments through audits, desktop and other standard operating procedures, and performance monitoring
Partners with Compliance, Internal Audit, and Enterprise Risk Management on CAPs, audit responses, remediation plans, and sustainability efforts
Oversees the performance of operational vendors in assigned areas
Ensures compliance with service level agreements (SLAs), audit standards, quality expectations, and contractual obligations
Evaluates vendor performance and ensures the implementation of improvements
Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees
Manages budgets and resources effectively
Conducts strategic planning to utilize resources in order to meet current and future departmental and Enterprise-wide goals
Identifies and actualizes enhancements to support company vision
Identifies and drives change initiatives
Collaborates with cross-functional teams to achieve common goals
Leads discussions on policy operationalization and oversees key policy perspective sharing
Represents the company or organization in external interactions
Develops and maintains relationships with key stakeholders
Develops and implements communication strategies
Performs other duties as assigned
Qualification
Required
Bachelor's Degree
At least 9 years of progressively responsible experience leading large operational teams and multi-functional departments in managed care operations, including Claims Administration, Payment Integrity, Configuration, or similar functions
At least 8 years of management/supervisory experience
At least 5 years of experience with Payment Integrity operations
At least 5 years of experience with claims system configuration, technical changes, and operational readiness for products, benefits, and system updates
Demonstrated successful experience improving operational accuracy, reducing inappropriate payments, and driving regulatory compliance
At least 5 years of experience supporting regulatory audits
Strong interpersonal leadership skills and an ability to motivate and develop talent while driving accountability
Expert knowledge of managed care administrative operations
Strong strategic, analytical, and financial skills, including the ability to interpret trends, assess risk, and evaluate cost-avoidance opportunities
Deep understanding of regulatory requirements for Medicaid (Medi-Cal), Medicare, Marketplace, and commercial lines of business
Proven ability to lead in complex, high-volume, highly regulated environments with competing priorities
Exceptional communication and stakeholder management skills, with the ability to translate complex concepts into actionable plans
Exceptional leadership skills and abilities, with demonstrated ability to manage, mentor, and develop multi-level teams
Ability to design and implement standardized processes, governance models, and operational controls
Strong skills with claims platforms and analytics/reporting tools
Proficient with Microsoft Office and data/reporting tools
High level of organization, planning, prioritization and attention to detail
Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization
Demonstrated ability to make sound and timely decisions
Demonstrated ability to adapt to changing situations and adjust strategies accordingly
Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change
Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment
Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations
Preferred
Master's Degree in Business Administration or Related Field
Experience in government-sponsored programs and large regional plans
Experience with vendor management
Lean Six Sigma Green Belt
Lean Six Sigma Black Belt
Benefits
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
Company
L.A. Care Health Plan
L.A. Care’s mission is to provide access to quality health care for L.A.
1001-5000 employees
H1B Sponsorship
L.A. Care Health Plan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (1)
2023 (1)
2021 (3)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Melanie Rainer
Chief Strategy and Transformation Officer
Recent News
2026-01-17
MarketScreener
2025-08-27
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