Claims Operations & Compliance Lead

LSMA Management, Inc.; San Bernardino (CA); Hybrid; USD 87,000 - 98,000; Full time

Job summary

LSMA Management, Inc. is seeking a Claims Manager to oversee the daily operations of the Claims Department within our MSO ecosystem.

You will supervise Claims Examiners and ensure accurate, timely, and compliant adjudication of professional and institutional claims in line with health plan contracts and regulatory requirements. You will monitor claims inventory, production, and quality metrics, enforce turnaround time standards, and support regulatory compliance with DMHC, CMS, and DHCS as

Qualifications

• Minimum: High School diploma or equivalent required.
• Preferred: Bachelor’s degree in Healthcare Administration, Business Administration, or related field.
• Minimum: At least five years of managed care claims processing experience.
• Minimum: Two or more years of supervisory or leadership experience.
• Preferred: Certified Professional in Healthcare Quality (CPHQ)

Responsibilities

• Oversee daily operations of the Claims Department.
• Lead and supervise Claims Examiners.
• Ensure accurate, timely, and compliant adjudication of professional and institutional claims.
• Monitor claims inventory, production, and quality metrics.
• Enforce turnaround time standards and support regulatory compliance with DMHC, CMS, and DHCS.

Skills

Managed care claims processing

CPT/HCPCS/ICD-10 knowledge

Regulatory knowledge (DMHC/CMS/DHCS)

Leadership

Analytical skills

Excel

Education

High School diploma or equivalent

Bachelor’s degree in Healthcare Admin/related field

Tools

EZ Cap

EPIC

Job description

LSMA Management, Inc. is seeking a Claims Manager to oversee the daily operations of the Claims Department within our MSO ecosystem.

You will supervise Claims Examiners and ensure accurate, timely, and compliant adjudication of professional and institutional claims in line with health plan contracts and regulatory requirements. You will monitor claims inventory, production, and quality metrics, enforce turnaround time standards, and support regulatory compliance with DMHC, CMS, and DHCS as