Claims Operations Manager - Health Plans

Sharp HealthCare; San Diego (CA); On-site; USD 70,000 - 112,000; Full time

Job summary

Sharp HealthCare seeks a capable leader to manage its claims units for managed care contracts, ensuring prompt, accurate processing across Sharp Rees-Stealy, Sharp Community Medical Group, and other services. The role demands strong HMO operations knowledge, 3+ years in claims or related fields, and at least 2 years in leadership.

The candidate will oversee daily operations, drive performance, train staff, and coordinate with health plans and providers to maintain high service standards while

Qualifications

• 3 years' experience in the HMO industry including claims, customer service, and/or health insurance management.
• 2 years leadership experience.

Responsibilities

• Lead and manage the daily operations of the claims unit.
• Promote efficient processing and timely claim turnaround.
• Coordinate staff training and performance assessments.
• Assist in application management and system improvements.
• Interface with health plans, providers, members, and medical groups to resolve issues.
• Maintain safety practices and regulatory compliance.

Skills

HMO industry experience

Leadership

Customer service

Education

Bachelor's degree in business/health services/management

Tools

EPIC Tapestry

Job description

Sharp HealthCare seeks a capable leader to manage its claims units for managed care contracts, ensuring prompt, accurate processing across Sharp Rees-Stealy, Sharp Community Medical Group, and other services. The role demands strong HMO operations knowledge, 3+ years in claims or related fields, and at least 2 years in leadership.

The candidate will oversee daily operations, drive performance, train staff, and coordinate with health plans and providers to maintain high service standards while