Claims Manager

3 weeks ago

California, United States AMI Network Full time

PPO Medical Claims Manager Schedule: Full Time Base Pay Range $125,000.00/yr - $140,000.00/yr About the Organization This established healthcare benefits organization is all about supporting its members with accurate claims processing, compassionate service, and rock-solid operations. The culture is collaborative, energetic, and people-first, a place where employees feel supported, valued, and encouraged to grow. The Role We’re looking for an experienced Medical Claims Manager to lead an onsite team in San Fernando Valley, CA. You’ll keep operations running smoothly, develop and motivate staff, and ensure claims are handled with accuracy and care. You’ll also partner closely with a supportive, collaborative Director of Claims who empowers the team, values transparency, and truly invests in people’s growth. What You’ll Be Doing Lead the daily operations of the Claims department with clarity, confidence, and a sense of ownership Coach and develop a team of 15 examiners, processors, and clerical staff, with the support of an Assistant Manager already in place Oversee monthly QNXT claims processing (~100k claims/month) and ensure accuracy for all manual adjudication Manage PPO claims exclusively (Anthem Blue Cross) within a unionized environment known for very low turnover and strong team stability Collaborate with senior leadership to streamline processes and drive continuous improvements; reports to the Director of Claims Work closely with vendors and internal partners to resolve escalations and optimize benefit configuration Support appeals, audits, compliance reviews, and benefit-related investigations Serve as a key voice for the department in cross-functional meetings and initiatives Utilize and deepen payor-side experience, with exposure to full-risk and delegated models Enjoy potential for a future hybrid schedule after approximately one year of strong performance and onboarding integration Who You Are (a.k.a. Our Dream Match) A seasoned leader with 7+ years managing teams in PPO medical claims A claims expert who knows adjudication, COB, CPT, ICD‑10, and medical terminology inside and out Someone who has worked in systems like QNXT (or similar) and can navigate them confidently A strong communicator who loves coaching, developing people, and elevating team performance A detail-focused problem-solver who thrives in a fast-paced environment A professional who understands HIPAA compliance and values accuracy and confidentiality Why You’ll Love It Here 100% employer‑paid medical, dental, and vision coverage Generous PTO so you actually get time to live your life A stable, mission‑driven organization with decades of impact A collaborative team that values accuracy, kindness, and accountability Retirement benefits plus professional development opportunities A role where your leadership genuinely improves the experience of thousands of participants If this sounds like your kind of role, apply today and let’s make great work happen. Seniority level: Mid‑Senior level | Employment type: Full‑time | Job function: Quality Assurance | Industries: Insurance #J-18808-Ljbffr

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