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 Claims Department within our MSO, ensuring accurate and compliant adjudication of professional and institutional claims.

The role provides leadership to Claims Examiners, monitors production metrics, and ensures adherence to DMHC, CMS, and DHCS requirements in a federal and California regulatory context. Hybrid office environment; strong analytical and supervisory skills required.

Qualifications

• High school diploma or equivalent required.
• Bachelor's degree preferred in Healthcare Administration, Business Administration, or related field.
• Five years managed care claims processing experience; at least two years supervisory/leadership experience.
• Experience with professional and institutional claims.

Responsibilities

• Oversee daily operations of the Claims Department within the MSO.
• Monitor claims inventory, production, and quality metrics.
• Ensure adherence to turnaround time standards and regulatory requirements.
• Provide leadership to Claims Examiners and ensure accurate, timely adjudication of claims.
• Support compliance with DMHC, CMS, and DHCS requirements where applicable.

Skills

Leadership

Staff supervision

Analytical thinking

Regulatory compliance

Communication skills

workload planning

Education

High School diploma or equivalent

Bachelor’s degree in Healthcare Administration or related field

Tools

EZ Cap

EPIC

Microsoft Office Suite

Job description

LSMA Management, Inc. seeks a Claims Manager to oversee the Claims Department within our MSO, ensuring accurate and compliant adjudication of professional and institutional claims.

The role provides leadership to Claims Examiners, monitors production metrics, and ensures adherence to DMHC, CMS, and DHCS requirements in a federal and California regulatory context. Hybrid office environment; strong analytical and supervisory skills required.