Claims Operations Lead, Managed Care Compliance

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

Job summary

LSMA Management Inc seeks a Claims Manager to oversee the daily operations of the Claims Department within the MSO, guiding Examiners and ensuring accurate, timely adjudication of professional and institutional claims.

The role focuses on monitoring inventory, production, and quality metrics, maintaining regulatory compliance with DMHC, CMS, and DHCS requirements, and supporting delegated managed care operations.

Qualifications

• Minimum: High School diploma or equivalent required.
• Preferred: Bachelor's degree in Healthcare Administration or related field.
• Experience with managed care claims processing and supervisory roles preferred.

Responsibilities

• Oversee daily operations of the Claims Department to ensure accuracy and compliance.
• Monitor claims inventory, production, and quality metrics.
• Ensure adherence to turnaround times and regulatory requirements (DMHC, CMS, DHCS).
• Provide leadership to Claims Examiners and support audits.

Skills

Claims processing expertise

Regulatory compliance

Leadership

Analytics

Communication skills

Excel / Microsoft Office

Policy documentation

Education

High School diploma or equivalent

Bachelor’s degree in Healthcare Administration or related field

Tools

EZ Cap

EPIC

CMS

DMHC

DHCS

Job description

LSMA Management Inc seeks a Claims Manager to oversee the daily operations of the Claims Department within the MSO, guiding Examiners and ensuring accurate, timely adjudication of professional and institutional claims.

The role focuses on monitoring inventory, production, and quality metrics, maintaining regulatory compliance with DMHC, CMS, and DHCS requirements, and supporting delegated managed care operations.