PPO Medical Claims Manager
4 days ago
For more than 70 years, the Motion Picture Industry Pension & Health Plans (MPI) has proudly served the entertainment community by supporting the financial and healthcare well-being of the people who bring stories to life - from set crews to post-production pros.
We're not just analysts and benefit specialists; we're problem-solvers, collaborators, and stewards of trust. Our teams are guided by a simple mission: to improve the lives of those who work in the entertainment industry through accuracy, accountability, and care.
MPI is recognized as a Great Place to Work® Certified employer and recipient of the World at Work Seal of Distinction because we believe people do their best work when they're respected, supported, and inspired.
Role Overview:
MPI is seeking an experienced Medical Claims Manager to lead our Claims team in Studio City, CA. This onsite leadership role is responsible for overseeing day-to-day claims operations, ensuring accurate and timely processing, compliance, and staff development.
The ideal candidate brings a strong background in PPO medical insurance claims management, with proven expertise in systems such as QNXT (or similar claim platforms), CPT/ICD-10 coding, coordination of benefits, and HIPAA compliance. You will play a key role in shaping department workflows, mentoring claims staff, and partnering with leadership to support MPI's mission of delivering exceptional service to our participants.
Qualified candidates, please submit your current resume with a cover letter and your compensation requirements for consideration.
Submissions will be reviewed; only candidates most closely matching the requirements of the position will be contacted.
What You Will Need:
- Bachelor's degree or equivalent combination of education and experience.
- Minimum 7 years of people management experience leading a team who process and adjudicate PPO medical claims for a payer, including hiring, training, and staff development.
- 5-7 years of experience with PPO medical claims Payer systems, benefit configuration, and claims adjudication requirements (7+ years preferred).
- 3+ years' experience with QNXT or a comparable claims system.
- Strong knowledge of CPT, ICD-10, COB, and medical terminology.
- Advanced proficiency in Microsoft Office Suite (Excel, Word, Outlook).
- 7+ years' experience with HIPAA and privacy compliance.
- Excellent communication skills, with strong analytical and problem-solving abilities.
- Ability to thrive in a fast-paced environment with strict attention to detail.
- Flexibility to work extended hours as required.
- Ability to interact with all levels of employees including entry level staff and. senior management
- Lead daily operations of the claims department, including staffing, workflow, production, and team support.
- Manage and coach a team of claims examiners, processors, and clerical staff.
- Oversee QNXT claims processing inventory for manually adjudicated claims and ensure system accuracy.
- Collaborate with the Director of Medical Claims to set department goals, improve processes, and implement system enhancements.
- Monitor compliance with HIPAA, privacy regulations, and industry standards.
- Partner with vendors (such as Anthem) and internal teams to recommend benefit configurations and resolve escalated issues.
- Support appeals, benefits-related inquiries, and regulatory audits.
- Develop and present reports for senior leadership and the Board of Directors.
- Represent the Claims department in cross-functional meetings.
Compensation & Benefits:
The anticipated annual salary range for this position is $125,000 - $145,000. The actual base salary offered will depend on a variety of factors, including without limitation, the qualifications of the individual applicant for the position, years of relevant experience, level of education attained, certifications or other professional licenses held. MPI offers a comprehensive benefits package, including free medical, dental, and vision coverage, generous paid time off, retirement benefits, and professional development opportunities.
MPI requires employees to be vaccinated against Covid-19 with exceptions as required by law.
Motion Picture Industry Pension & Health Plans (MPI) is an equal opportunity employer and does not discriminate against any applicant or employee on the basis of race, religion, color, national origin, ancestry, sex, sexual orientation, gender identity, age over 40, marital status, veteran status, mental or physical disability, pregnancy, genetic information, or any other basis prohibited by law. Any applicant who, because of disability, requires accommodation or assistance in completing this application or at any time during the application process should contact the Human Resources Department. MPI also provides reasonable accommodations to disabled employees consistent with its obligations under applicable law.
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