Hybrid Claims Operations Supervisor – Growth & Impact

AltaMed Health Services Corporation; Los Angeles (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-m

Job summary

AltaMed Health Services is seeking a Supervisory role for Claims Operations in Montebello, CA. The supervisor will oversee both external and internal claims processes and ensure accurate adjudication with a focus on TAT, production, error rates, and forecasting.

The position requires deep knowledge of CMS-1500/UB-04 forms and strong organizational skills. The role emphasizes collaboration with multiple departments to identify root causes and resolve claims issues, with potential discretionary

Qualifications

• Associates degree (AA/AS) or Bachelor's degree recommended.
• Must understand Medi-Cal, Commercial and Medicare rules and medical terminology.
• HS Diploma required.
• Minimum of 5 years in a managed care environment; claims knowledge preferred.
• Ability to read CMS-1500 and UB-04 forms and interpret DOFRs and contracts.
• Strong organizational and mathematical skills.

Responsibilities

• Oversee internal and external claims adjudication processes.
• Compile and scrub claims data to analyze trends and performance.
• Monitor TAT compliance, production, and error rates.
• Prepare mid-month forecasting and Health Plan monthly reports.
• Collaborate with departments and providers to resolve claims issues.

Education

Associates degree (AA/AS) or Bachelor's degree

HS Diploma

Job description

AltaMed Health Services is seeking a Supervisory role for Claims Operations in Montebello, CA. The supervisor will oversee both external and internal claims processes and ensure accurate adjudication with a focus on TAT, production, error rates, and forecasting.

The position requires deep knowledge of CMS-1500/UB-04 forms and strong organizational skills. The role emphasizes collaboration with multiple departments to identify root causes and resolve claims issues, with potential discretionary