Finance Manager

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 120,000 - 150,000; Full time

Job summary

Imperial Health Plan of California, Inc. in Pasadena seeks a Finance Manager to oversee the Financial Analyst team and key financial operations. The role requires at least 5 years of experience, with strong MAPD knowledge and regulatory reporting expertise. You will collaborate across departments to ensure accuracy, compliance, and operational efficiency.

The position emphasizes capitation payments, DOFR compliance, and financial forecasting for multiple entities within the organization.

Qualifications

• Bachelor's degree in Finance, Accounting, or related field; Master's preferred.
• 5+ years of healthcare MAPD and risk adjustment experience.
• Strong regulatory reporting knowledge (DMHC, TDI, NAIC).

Responsibilities

• Oversee capitation payments and risk-adjustment accuracy.
• Lead regulatory reporting across DMHC, TDI, NAIC, and related bodies.
• Manage claims procedures in line with DOFR requirements.
• Develop financial projections for multiple entities.
• Provide SQL-based data analysis and reporting support.

Skills

MAPD knowledge

Financial analysis

Regulatory reporting

SQL proficiency

Communication skills

Education

Bachelor's degree in Finance/Accounting/Business

Master's degree preferred

Tools

SQL

Job description

On-Site required

Job Title

Finance Manager

Location

Pasadena, California, On-Site required

About Us

Join our dynamic team at Imperial Management Administrators Services (IMAS), a Management Service Organization (MSO) that manages a portfolio of healthcare entities, including Imperial Health Plan of California, Inc. (a 3.5-star MAPD plan), Imperial Insurance Companies (ACA), Imperial Health Holdings, A Professional Medical Group (California RBO), among others. We are dedicated to providing value-based care to members while maintaining compliance with regulatory requirements.

Job Summary

We are seeking a detail-oriented and experienced Finance Manager to oversee and manage the Financial Analyst team. The Finance Manager will be responsible for key financial operations within our organization. The ideal candidate must have at minimum 5 years of experience and strong understanding of the MAPD business model, including reconciliation of CMS premium to revenue, Division of Financial Responsibilities (DOFR) as it relates to fee-for-service claims and capitation payment processes, and regulatory reporting requirements. This role requires a combination of deep analytical skills, financial expertise, and technical proficiency to ensure accuracy, compliance, and operational efficiency.

Key Responsibilities

Capitation Payments and Risk Adjustment

• Ensure CMS H5496 capitation payments are accurately received for all enrolled members based on the application and risk adjustment factors.
• Verify the accuracy of capitation calculations by the capitation team, including IPAs (Independent Practice Associations) and PCPs (Primary Care Providers) capitation expense.
• Ensure no claims are paid for members for whom CMS did not provide capitation payments.

Regulatory Reporting And Compliance

• Manage and oversee reporting requirements for DMHC (Department of Managed Health Care), TDI (Texas Department of Insurance), NAIC (National Association of Insurance Commissioners), and other regulatory requirements, as needed.
• Prepares and tracks IPA financial solvency for all affiliated RBO's to present and distribute to management team.
• Maintain compliance with all applicable regulatory standards and reporting deadlines.

Claims

• Review the Fee-for-Service (FFS) claims ensuring adherence to Division Of Financial Responsibilities (DOFR).
• Partner with the CEO, Claims Director, Claims Recovery, and others on claims settlement.
• Oversee the Claims Recovery team and Configuration to prevent errors or discrepancies that could impact financial outcomes.

Financial Projections And Analysis

• Develop financial projections and forecasts for multiple entities within the organization.
• Analyze financial data and trends to support decision-making and strategic planning.

Technical And Analytical Support

• Utilize SQL or other coding tools to extract and analyze financial data as needed.
• Collaborate with the data team to enhance reporting accuracy and efficiency.
• Acts as a liaison to the Information Technology Department for the creation of various database queries on utilization, membership, revenue sources, etc.

Qualifications

• At minimum, Bachelor's degree in Finance, Accounting, Business Administration, or a related field (Master's degree preferred).
• Extensive experience (at minimum 5 years) in the healthcare industry, specifically with MAPD plans and risk adjustment processes.
• Proficiency in regulatory reporting (DMHC, TDI, NAIC, etc.).
• Strong knowledge of capitation and FFS claims processing.
• Technical proficiency with SQL or other coding languages for data analysis.
• Exceptional analytical, organizational, and problem-solving skills.
• Excellent communication and collaboration abilities.

Preferred Skills

• Experience working in an MSO or with managed entities like Imperial Health Plan of California, Inc.
• Familiarity with CMS guidelines.
• Strong understanding of financial processes correlated to MAPD business models.