Senior Claims Manager – Health Plan Operations

Local 1014 Medical Plan; El Monte (CA); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

100% covered benefits for employee and

Dependent coverage

IRA contributions (7%–9%)

Paid time off: 2 weeks vacation, 10 S,

Office hours Mon–Fri 8:30 AM–4:30 PM

Job summary

Local 1014 Medical Plan in Los Angeles County, El Monte, CA, seeks a Claims Manager to lead a diverse claims team in a fast-paced, on-site environment.

The role focuses on regulatory compliance, process improvements, and effective customer service for plan members and providers. The ideal candidate has extensive claims leadership experience in health plans and strong collaboration with stakeholders.

Qualifications

• Minimum of four years of managing claims personnel in health insurance or managed care.
• Minimum 10 years of claims processing/adjudication experience.
• Proficiency with EDI and paper claim lifecycles in health insurance.
• Baseline knowledge of HIPAA and ERISA regulations.
• Experience with Basys and WGS systems preferred.
• Strong leadership and communication abilities.
• Ability to manage staff performance and conduct.
• Detail-oriented with excellent time management.

Responsibilities

• Lead a team of MSRs, adjusters, and auditors to meet regulatory and service standards.
• Oversee call flow, workflows, productivity, and member feedback; drive improvements.
• Handle escalated complaints as a technical expert.
• Manage personnel tasks: timecards, PTO, evaluations, discipline, hiring/terminations.
• Identify system/workflow improvements and implement best practices.
• Develop and deliver staff training and corrective action plans.
• Collaborate with Board, Trustees, and other stakeholders.
• Assist in implementing new Health Trust service offerings.

Skills

Leadership

Customer service

Regulatory compliance

Communication

Team management

Problem solving

Time management

Staff development

Education

Bachelor's degree preferred

Equivalent qualifying experience

Tools

Basys

WGS claim system

Taft-Hartley knowledge

Job description

Local 1014 Medical Plan in Los Angeles County, El Monte, CA, seeks a Claims Manager to lead a diverse claims team in a fast-paced, on-site environment.

The role focuses on regulatory compliance, process improvements, and effective customer service for plan members and providers. The ideal candidate has extensive claims leadership experience in health plans and strong collaboration with stakeholders.