Claims Ops Supervisor - Hybrid HealthCare Analytics Leader

AltaMed Health Services; Montebello (CA); Hybrid; USD 74,000 - 93,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

403(b) Retirement plan with employer

Paid Time Off

holidays

Tuition Reimbursement

Employee Discounts

Referral Bonus

Pet Care Insurance

Job summary

AltaMed Health Services is seeking a Supervisor, Claims Operations for the Montebello, CA location. The role oversees both external and internal claims adjudication processes and data integrity, ensuring timely performance and accurate reporting.

The position requires strong organizational and mathematical skills, 5+ years in managed care, and familiarity with CMS-1500 and UB-04 forms. Hybrid work arrangement offered with competitive compensation.

Qualifications

• Must understand Medi-Cal, Commercial, and Medicare regulations and medical terminology.
• Minimum 5 years in a managed care environment; claims knowledge preferred.
• Ability to read CMS-1500 and UB-04 forms and interpret DOFRs and contracts.

Responsibilities

• Oversee external and internal claims adjudication processes and data scrubbing.
• Analyze, track, and trend adjudicated claims to monitor TAT, production, and error rates.
• Prepare mid-month forecasts and plan for monthly health plan reporting and audits.

Skills

Strong organizational skills

Mathematical proficiency

Education

AA/AS degree

Bachelor's degree recommended

Job description

AltaMed Health Services is seeking a Supervisor, Claims Operations for the Montebello, CA location. The role oversees both external and internal claims adjudication processes and data integrity, ensuring timely performance and accurate reporting.

The position requires strong organizational and mathematical skills, 5+ years in managed care, and familiarity with CMS-1500 and UB-04 forms. Hybrid work arrangement offered with competitive compensation.