Claims Manager

The Claims Manager, under general supervision of the Claims Director, is responsible for managing the hourly staff’s daily activities, productivity and performance evaluations. This person will also assist in the audit preparation and coverage needed in the Department with DHS, DMHC, HEDIS and other organizations requiring State and Federal auditors; assist in the creation and development of the department’s policies and procedures; handle the interaction with internal and external departments and organizations, as instructed by the Claims Director. The position works closely with the Chief of Managed Care Operations, Directors of Claims and other Departments, Director of Regulatory Affairs and Compliance, Information Services Staff, Utilization Management Staff, and other LA Care Departments to carry out the functions of the department.

Must be able to demonstrate critical thinking and leadership skills to others, concerning business practices related to patient billing, claims adjudication, State and Federal regulatory requirements concerning appropriate business practices, as they relate to members, providers, collection agencies, and LA Care practices, and service needs of Medi-Cal, indigent and under-served and culturally diverse populations in the State of California.
QUALIFICATIONS & REQUIREMENTS



EDUCATION/TRAINING:

Required:
Bachelor's Degree (or equivalent) in Health Care Administration, Public Health, or related healthcare field.

Preferred:
Master's Degree (or equivalent) in Health Care Administration, Public Health, or related healthcare field.


REQUIRED EXPERIENCE:

Minimum 5 years supervisory experience managing a staff of 12-50 in a Claims Payor environment.

Minimum 7 years experience in a Health Care environment serving Medicare, Medicaid, and Commercial populations.

Minimum 5 years health plan Operations/Administration experience.


PREFERRED EXPERIENCE:

7 years supervisory experience managing a staff of 25-100 in a Claims Payor environment.

10 years experience in a Health Care environment serving Medicare, Medicaid, and Commercial populations.

7 years health plan Operations/ Administration experience.


FOREIGN LANGUAGES:

Bilingual English/Spanish is preferred.

 

FOR CONSIDERATION, PLEASE INCLUDE SALARY HISTORY & REQUIREMENT WITH RESUME.