Medical Claims Processing Lead

Providence Health & Services; Mission Hills (CA); On-site; USD 54,000 - 84,000; Full time

Benefits offered by this job

401(k) plan

Health insurance

Paid time off

Job summary

Providence Health & Services is seeking a Lead Claims Supervisor in Mission Hills, CA to supervise staff and oversee daily operations of the Claims Processing and UM Denial Letter Units. The role ensures AB1455 compliance and CMS guideline adherence within the department.

The position emphasizes leadership in a health-care claims environment, with a focus on accuracy, policy compliance, and effective team coordination in a complex payer landscape.

Qualifications

• 3 years experience in a leadership role within medical claims related field
• 5 years experience in medical/institutional claims examining within a medical group/IPA setting claim processing experience
• 2 years experience in a medical/institutional claims customer services unit within a health plan medical group or IPA setting

Responsibilities

• Supervise staff and oversee day-to-day operations of the Claims Processing and UM Denial Letter Units.
• Provide reporting to ensure compliance with AB1455 and CMS guidelines and department policies.
• Uphold and enforce department policies and procedures.

Skills

Leadership in claims

Claims processing

Customer service

Tools

Access

Teleform

IDX

Job description

Providence Health & Services is seeking a Lead Claims Supervisor in Mission Hills, CA to supervise staff and oversee daily operations of the Claims Processing and UM Denial Letter Units. The role ensures AB1455 compliance and CMS guideline adherence within the department.

The position emphasizes leadership in a health-care claims environment, with a focus on accuracy, policy compliance, and effective team coordination in a complex payer landscape.