Claims Operations Lead – Managed Care

AltaMed; Montebello (CA); Presencial; USD 74.000 - 93.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, Dental and Vision insurance

403(b) Retirement savings with company

Flexible Spending Accounts

Paid Time Off & Holidays

Tuition Reimbursement

Descripción de la vacante

AltaMed in Montebello, CA is seeking a Claims Operations Supervisor to oversee internal and external claims adjudication processes. You will compile and scrub data, track TAT, production, and error rates, and generate mid-month and health plan reports to support forecasting and audits.

The role requires reading CMS-1500 and UB-04, knowledge of Medi‑Cal, Medicare and commercial rules, plus 5+ years in a managed care environment.

Formación

• AA/AS or Bachelor's degree recommended
• Must understand Medi-Cal, Commercial, and Medicare rules
• HS Diploma required
• Minimum 5 years in a managed care environment
• Ability to read CMS-1500 and UB-04 forms and interpret DOFRs/Contracts
• Strong organizational and mathematical skills

Responsabilidades

• Oversee internal and external claims adjudication processes
• Compile and scrub claims data to analyze and forecast performance
• Produce mid-month forecasts and health plan reports for audits and reviews
• Identify root causes of payment errors and collaborate with other departments for resolution

Conocimientos

Organizational skills

Analytical skills

CMS-1500 & UB-04 reading

Attention to detail

Educación

Associate or higher degree

HS Diploma required

Descripción del empleo

AltaMed in Montebello, CA is seeking a Claims Operations Supervisor to oversee internal and external claims adjudication processes. You will compile and scrub data, track TAT, production, and error rates, and generate mid-month and health plan reports to support forecasting and audits.

The role requires reading CMS-1500 and UB-04, knowledge of Medi‑Cal, Medicare and commercial rules, plus 5+ years in a managed care environment.