Hybrid Claims Operations Lead

Astrana Health, Inc.; Monterey Park (CA); Hybrid; USD 78,000 - 91,000; Full time

Benefits offered by this job

Hybrid work model

Competitive compensation

Job summary

Astrana Health in Monterey Park, CA is seeking a Supervisor – Claims Operations to lead a Claims production team, ensuring accurate adjudication and compliant processing while developing staff.

You will monitor performance, address error trends, coordinate with Accounting and Physician Services, and ensure timely, quality reporting and audits. The role offers a hybrid work model and a compensation range of $78,000 to $91,000 per year.

Qualifications

• 5+ years of medical claims experience with a health plan or MSSO.
• Experience leading or supervising a claims team is preferred.
• Advanced knowledge of ICD-10, CPT, HCPCS and claims processing systems.

Responsibilities

• Lead and mentor Claims production staff, providing feedback and development opportunities.
• Monitor claims production and identify error trends, implementing controls to reduce incorrect adjudication.
• Collaborate with Accounting and Physician Services on recovery efforts and education opportunities.
• Ensure compliance with state, federal, and health plan requirements and update procedures as needed.
• Oversee policy updates, workflows, and quarterly PDR reporting and audits.

Skills

Staff leadership

Healthcare claims

Quality assurance

Coaching

Education

Bachelor's degree

Job description

Astrana Health in Monterey Park, CA is seeking a Supervisor – Claims Operations to lead a Claims production team, ensuring accurate adjudication and compliant processing while developing staff.

You will monitor performance, address error trends, coordinate with Accounting and Physician Services, and ensure timely, quality reporting and audits. The role offers a hybrid work model and a compensation range of $78,000 to $91,000 per year.