Remote Senior Manager, Health Plan Claims Readiness

CareMore Health Management Services, LLC; San Francisco (CA); Remote; USD 130,000 - 195,000; Full time

Job summary

CareMore Health Management Services, LLC is seeking an experienced Senior Manager, Claims Health Plan Readiness to lead regulatory compliance, audit preparation, and payment accuracy across health plan operations. Fully remote role with standard business hours in Pacific Time.

You will direct CMS and health plan audits, translate CMS changes into scalable policies, and drive cross-functional improvements with Compliance, Finance, IT, and Operational leaders.

Qualifications

• Bachelor's degree in a related field or equivalent experience.
• 8–10+ years in healthcare claims, reimbursement, or regulatory compliance.
• 3–5+ years of leadership managing teams or programs.
• Proven CMS knowledge and audits experience.
• Experience with Medicare/Medicaid managed care and coding standards.

Responsibilities

• Develop and execute claims health plan readiness strategies.
• Lead multiple teams to support compliant claims adjudication and audits.
• Coordinate CMS and health plan audits including documentation and responses.
• Translate regulatory changes into policies and procedures.
• Drive corrective actions and process improvements in payment integrity.

Skills

Regulatory compliance

CMS audits

Leadership

Stakeholder communication

Process improvement

Education

Bachelor's degree or equivalent

Advanced degree

Tools

Facets

QNXT

EDI 837/835

Job description

CareMore Health Management Services, LLC is seeking an experienced Senior Manager, Claims Health Plan Readiness to lead regulatory compliance, audit preparation, and payment accuracy across health plan operations. Fully remote role with standard business hours in Pacific Time.

You will direct CMS and health plan audits, translate CMS changes into scalable policies, and drive cross-functional improvements with Compliance, Finance, IT, and Operational leaders.