Hybrid Claims Operations Supervisor

Astrana Health Management; Monterey Park, Northern (CA, KY); Hybrid; USD 78,000 - 91,000; Full time

Job summary

Astrana Health is seeking a Supervisor – Claims Operations to lead the claims production team, ensuring accurate, timely adjudication and ongoing staff development.

This hybrid role based in Monterey Park, CA, partners with Accounting, Physician Services and QA to reduce errors, address overpayments, and ensure compliance with all regulatory standards. Proactive leadership and process improvements are essential for success.

Qualifications

• Bachelor's degree or equivalent experience in a relevant field.
• At least 5 years of medical claims experience with a Medical Group, IPA, MSO, or Health Plan.
• At least 2 years of lead/supervisory experience.
• Advanced knowledge of ICD-10, CPT, HCPCS and claims processing procedures.

Responsibilities

• Lead and monitor claims production staff to ensure quality and training needs.
• Identify error trends and implement controls to minimize incorrect adjudication.
• Coordinate with Accounting and Physician Services on recovery and education opportunities.
• Ensure compliance with regulatory requirements and policy changes.
• Manage policies, workflows, and processes; analyze adjudication results for training.
• Oversee audits and CAPs; track progress and apply corrective actions.
• Report quarterly PDR timeliness; collaborate on cross-department controls.
• Mentor team members and participate in hiring/discipline as needed.

Skills

Healthcare claims knowledge

Coding conventions (ICD-10, CPT, HCPCS

Claims processing systems

Leadership experience

Education

Bachelor's degree in a relevant field

Job description

Astrana Health is seeking a Supervisor – Claims Operations to lead the claims production team, ensuring accurate, timely adjudication and ongoing staff development.

This hybrid role based in Monterey Park, CA, partners with Accounting, Physician Services and QA to reduce errors, address overpayments, and ensure compliance with all regulatory standards. Proactive leadership and process improvements are essential for success.