Vice President, Claims job El Dorado Hills California
Vice President, Claims job El Dorado Hills California
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Vice President, Claims Job

Employer Name: SpiderID: 13251383
Location: El Dorado Hills, California Date Posted: 2/22/2023
Wage: Negotiable Category: Insurance
Job Code: 170022N-2191

Job Description:
Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.


Our Company

As a not-for-profit company, our mission says it all: To ensure all Californians have access to high-quality health care at an affordable price.

Driving this mission means being an advocate for care. We have supported universal coverage since 2002 and have taken a market-leading stand on affordability by pledging to limit our net income to 2 percent, meaning we will give back all income over 2 percent to our members and the communities we serve. And since 2005, we have donated more than $200 million dollars to the Blue Shield of California Foundation.

Customer Experience

The Customer Experience division is dedicated to looking at our business from the eyes of our customer and delivering a consistent and predictable customer experience, every time. We own the operations of Blue Shield of California; Installation & Billing, Claims, Customer Care, Digital and Business Process Management.

With over 4 million members, our strategy to deliver a consistent and predictable customer experience is paramount. Our realignment of operations to an end to end enterprise view positions us effectively to establish Blue Shield as the preferred choice in health plans.


As a leading provider of healthcare and insurance, BSC prides itself on being an innovative pioneer in the health services industry. Recently, the company positioned itself to be an important player in California's effort to provide universal healthcare through our support of the Affordable Care Act and the California exchange.

The Vice President, Claims, will provide strategic direction, business planning & execution, and overall executive leadership for claims processing across all customer segments within the company.

Reporting to the Customer Care VP and working closely with Blue Shield of California-wide business partners, this position will lead optimization initiatives across the Claims organization, including the successful implementation of lean sigma throughout the organization. Key optimization parameters include automation and self-service, making continuous improvements in delivery and operating within a predictable and affordable financial model.

The successful candidate will lead the transformation of the organization by challenging current thinking and implementing current best in class claims processing. This will require a strong change leader who can assertively manage cross-functional relationships to ensure sustainability of this end-to-end process capability while ensuring customer-driven KPIs and goals are in place, with ongoing measurement, reporting, and root cause analysis.


Candidate Profile and Requirements

As a member of the Customer Care leadership team the Vice President is involved in shaping and executing the future state of the BSC customer experience. Prior experience leading process optimization through lean sigma in the health insurance operations space is essential.

The Vice President Claims must bring strong leadership, advanced consultative and relationship building skills, as well as previous experience transforming a health care claims operation, to establish and sustain strong partnerships and reputation with employers, vendors, and partners, while ensuring an excellent customer experience. In this newly created role, the Vice President must build and lead a team that truly differentiates how our customers experience Blue Shield in a way that creates consistent customer loyalty.

Specific duties include:

  • Lead the claims and corporate recovery teams to achieve designated goals and expand electronic processing and self service portals.
  • Partner with other BSC cross-functional teams to ensure services provided to our members is effective and meets the changing needs of our customers.
  • Guide the development of a long term vision, strategy and roadmap for Installation, Membership & Billing(Sign Me Up) and ensures adequate resources are available to execute
  • Act as Change Leader and assertively manage cross-functional relationships to ensure sustainability of end-to-end process capability
  • Ensure optimization of resources by resolving any duplicative improvement efforts and organization structures
  • Ensure customer-driven KPIs and goals are in place, with ongoing measurement, reporting, and root cause analysis
  • Build and maintain relationships and reputation within the industry with a high degree of integrity.
  • Provide thought leadership to the Customer Experience Leadership Team, other cross-functional leaders throughout BSC on installation and billing issues.
  • Provide effective leadership in attracting and retaining top talent to drive the business results for this business segment.
  • Travel up to 25%.

Required Experience

  • Over 10 years of strong executive leadership and relationship management skills.
  • Proven ability to lead an organization through change and high volume growth.
  • Excellent understanding of current and emerging technologies.
  • Proven success in leading and ideally, transforming, health care claims teams
  • Proven track record of delivering results that add value to the organization.
  • Superior communication skills and ability to build excellent relationships with business executive partners across the enterprise.
  • Experience in leadership positions in healthcare, financial services or similar industry is preferred


A Bachelors degree in business or related field required; advanced business degree preferred.

Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:

Contact Information:
Contact Name: Blue Shield of California Company Type:
Company: Blue Shield of California

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