Sr. Manager Claims
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Job Location:
Monterey Park, NM - USA
Yearly Salary:
$ 125000 - 140000
Posted on:
9 days ago
Vacancies:
1 Vacancy
Job Summary
About the Role:
Were looking for a Claims Operations leader who enjoys balancing people leadership with operational this role youll oversee daily claims processing drive quality and turnaround time performance and support the onboarding of new IPAs and implementations. Youll partner closely with internal teams resolve escalations and coach a team of claims professionals to deliver compliant efficient and accurate outcomes in a fastpaced environment.
Our Values:
Were looking for a Claims Operations leader who enjoys balancing people leadership with operational this role youll oversee daily claims processing drive quality and turnaround time performance and support the onboarding of new IPAs and implementations. Youll partner closely with internal teams resolve escalations and coach a team of claims professionals to deliver compliant efficient and accurate outcomes in a fastpaced environment.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What Youll Do
- Lead daily claims operations to ensure quality accuracy and timely processing
- Manage claims inventory and prioritize workloads to consistently meet SLAs
- Support onboarding and implementation of new IPAs and claims operations
- Drive continuous improvement initiatives to increase claims efficiency and quality
- Resolve claims processing issues and escalations across assigned teams and IPAs
- Use claims systems and reports to monitor performance and share insights with leadership
- Coach train and develop claims staff (including offshore teams) to meet performance expectations
- Partner with internal teams on system updates process improvements and compliance needs
- Handle sensitive provider/member inquiries and highlevel claim issues as needed
- Other duties as assigned
Qualifications
- Minimum of a Bachelors degree (B.A.) from a four-year college or university; or four (4) years current Management or equivalent experience with an MSO or IPA Management
- Full knowledge of DMHC DHS and CMS Regulations and Guidelines ICD-10 CPT RV/RBRVS codes
- Experience with contract law and Division Responsibility matrix interpretation
- Comprehensive knowledge in the AB1455 regulations
Youre great for the role if:
- EZCAP experience is a plus
- Masters degree or healthcare certifications
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park CA 91754.
- The national target pay range for this role is $125000 - $140000. Actual compensation will be determined based on geographic location (current or future) experience and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race religion color national origin gender (including pregnancy childbirth or related medical conditions) sexual orientation gender identity gender expression age status as a protected veteran status as an individual with a disability or other applicable legally protected characteristics. All employment is decided on the basis of qualifications merit and business need. If you require assistance in applying for open positions due to a disability please email us at to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Required Experience:
Manager
