Claims Leadership and Operations Manager
6 days ago
L.A. Care Health Plan, the nation's largest publicly operated health plan, is seeking a skilled Claims Supervisor to join our team.
Job Summary
The successful candidate will work closely with the Claims Manager to oversee daily operations, ensuring high-quality performance and compliance with state and federal regulations.
This role requires managing new program implementations, system updates, and maintaining expertise in national and state-wide standards for claims processes.
The ideal candidate will have a strong background in claims examination, preferably with experience working with medical facility claims and high-dollar claims.
In addition to technical skills, this role demands exceptional leadership, communication, and coaching abilities to build effective teams and drive results.
Key Responsibilities
- Supervise and develop procedures to achieve quality goals and production levels within the department.
- Maintain accurate tracking and trending of metrics associated with claims adjudication.
- Prepare and present written and verbal reports on complex problem areas and recommend corrective actions.
- Provide guidance and training to staff, including mentoring and cross-training.
- Ensure compliance with company policies, laws, and regulations.
Requirements
- Bachelor's Degree in Business or Healthcare Related Field (equivalency accepted).
- At least 3 years of experience as a claims examiner, preferably with medical facility claims and high-dollar claims.
- 2+ years of supervisory/management experience, with equivalency through L.A. Care Management Certificate Training Program.
- Extensive experience in handling claims appeals, communicating with external providers, and working with Provider Dispute Resolution (PDRs).
- Strong understanding of healthcare code sets, familiarity with DRG pricing, and proficiency in Microsoft Word and Excel.
About Us
L.A. Care Health Plan offers a competitive salary range: $77,265 - $100,445 per year, depending on qualifications and experience. We provide a comprehensive benefits package, including paid time off, tuition reimbursement, retirement plans, medical, dental, and vision insurance, wellness programs, and volunteer time off.
We strive to create a diverse and inclusive work environment where employees feel valued and empowered to contribute their best. If you're passionate about delivering high-quality patient care and committed to excellence, we encourage you to apply for this exciting opportunity.
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