Claims Operations Leader - Remote, Impact & Growth

Astrana Health; Monterey Park (CA); On-site; USD 125,000 - 140,000; Full time

Job summary

Astrana Health in the United States is seeking a Claims Operations leader to oversee daily processing, manage workloads, and drive improvements in quality and speed. You will coach a team of claims professionals, including offshore members, to deliver accurate and compliant outcomes in a fast-paced environment.

The role requires strong regulatory knowledge (DMHC/DHS/CMS), experience with IPAs, and a proven ability to meet SLAs while collaborating with cross-functional teams.

Qualifications

• Bachelor's degree from a four-year college or university, or at least four years of current management or equivalent experience with an MSO or IPA Management.
• Full knowledge of DMHC, DHS and CMS Regulations and Guidelines, ICD-10, CPT, RV/RBRVS codes.
• Experience with contract law and Division Responsibility matrix interpretation.
• Comprehensive knowledge in AB1455 regulations.

Responsibilities

• Lead daily claims operations to ensure quality, accuracy, and timely processing
• Manage claims inventory and prioritize workloads to consistently meet SLAs
• Support onboarding and implementation of new IPAs and claims operations
• Drive continuous improvement initiatives to increase claims efficiency and quality
• Resolve claims processing issues and escalations across assigned teams and IPAs
• Use claims systems and reports to monitor performance and share insights with leadership
• Coach, train, and develop claims staff (including offshore teams) to meet performance expectations
• Partner with internal teams on system updates, process improvements, and compliance needs
• Handle sensitive provider/member inquiries and high-level claim issues as needed
• Other duties as assigned

Skills

Leadership

Claims processing

SLA management

Coaching

Regulatory knowledge

Education

Bachelor's degree

MSO IPA management

Tools

Claims systems

Reporting tools

Job description

Astrana Health in the United States is seeking a Claims Operations leader to oversee daily processing, manage workloads, and drive improvements in quality and speed. You will coach a team of claims professionals, including offshore members, to deliver accurate and compliant outcomes in a fast-paced environment.

The role requires strong regulatory knowledge (DMHC/DHS/CMS), experience with IPAs, and a proven ability to meet SLAs while collaborating with cross-functional teams.