

Capitation and Claims Senior Manager POST NUMBER: 455159
Key Responsibilities
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Manage the monthly capitation process, quality reviews, provider payments, reconciliation, and compliance with contracts.
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Interpret new and existing contractual agreements, focusing on global, full, and shared risk arrangements, risk pools, and incentive programs.
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Maintain and oversee configuration of capitation and shared risk modules; ensure system accuracy and support system implementations (ERP and healthcare admin systems).
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Lead accounting operations for capitation and claims, including month-end close, reconciliations, P&L analysis, Balance Sheet integrity, GAAP compliance, and audit deliverables.
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Prepare financial schedules supporting regulatory filings, CMS/DHCS bids, and audits.
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Provide variance analysis and financial insights to Network Management, Value-Based Care, Actuarial, and other departments.
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Oversee provider capitation reports, respond to inquiries, and support provider education on arrangements.
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Supervise and develop team members, provide training, coach performance, and drive engagement.
Requirements
Education:
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Bachelor’s degree in Finance, Accounting, Business, or related field required.
Experience:
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7 years progressive finance/accounting management.
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5 years in managed care finance/accounting (capitation & claims).
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Strong knowledge of eligibility, capitation models, IBNR, provider risk pools, incentive programs.
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ERP experience (Oracle preferred); healthcare core admin systems (capitation module).
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Healthcare insurance, integrated healthcare system, or provider network experience preferred.
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Medicare Advantage exposure preferred.
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Experience with new system implementations highly valued.
Skills:
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Strong technical accounting knowledge.
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Deep understanding of healthcare capitation/claims operations.
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Advanced financial analysis and reporting skills.
Vaco by Highspring values a diverse workplace and strongly encourages women, people of color, LGBTQ+ individuals, people with disabilities, members of ethnic minorities, foreign-born residents, and veterans to apply.
EEO Notice
Vaco by Highspring is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race (including but not limited to traits historically associated with race such as hair texture and hair style), color, sex (includes pregnancy or related conditions), religion or creed, national origin, citizenship, age, disability, status as a veteran, union membership, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, political affiliation, or any other protected characteristics as required by federal, state or local law.
Vaco by Highspring and its parents, affiliates, and subsidiaries are committed to the full inclusion of all qualified individuals. As part of this commitment, Vaco by Highspring and its parents, affiliates, and subsidiaries will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact HR@vaco.com .
Vaco by Highspring also wants all applicants to know their rights that workplace discrimination is illegal.
By submitting to this position, you agree that you will be giving Vaco by Highspring the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco by Highspring about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco by Highspring agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal.
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Vaco by Highspring and its parents, affiliates, and subsidiaries (“we,” “our,” or “Vaco by Highspring”) respects your privacy and are committed to providing transparent notice of our policies.
- California residents may access Vaco by Highspring HR Notice at Collection for California Applicants and Employees here.
- Virginia residents may access our state specific policies here.
- Residents of all other states may access our policies here.
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Pay Transparency Notice
Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to:
- the individual’s skill sets, experience and training;
- licensure and certification requirements;
- office location and other geographic considerations;
- other business and organizational needs.
With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses.