Senior Claims Operations Supervisor

AltaMed Health Services Corp; Montebello (CA); On-site; USD 74,000 - 93,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Plan

FSA

Commuter Benefits

Career Development

Paid Time Off

CME Days

Malpractice Tail Coverage

Tuition Reimbursement

Employee Discounts

Referral Bonus

Pet Insurance

Job summary

AltaMed Health Services Corp in California is seeking a Claims Operations Supervisor to oversee both external and internal claims adjudication processes. You will compile and scrub data to analyze trends, monitor TAT, production, and error rates, and generate forecasting and monthly health plan reports.

You will identify root causes of payment errors and partner with other departments and providers to resolve issues, ensuring accurate, timely claims handling across the organization.

Qualifications

• Associates degree (AA/AS) or Bachelor’s degree is highly recommended.
• Must be knowledgeable of Medi-Cal regulations, Commercial, and Medicare rules and regulations and medical terminology.
• HS Diploma required.
• Minimum of 5 years of experience in a managed care environment, claims knowledge preferred.
• Must have an understanding to read CMS-1500 and UB-04 forms and be able to read and interpret DOFRs and Contracts.
• Must have strong organizational and mathematical skills.

Responsibilities

• Oversee external and internal processes related to Claims Adjudication.
• Compile and scrub claims data to analyze, track, and trend adjudicated claims.
• Monitor TAT, production, error rate, mid-month forecasting reports, and health plan reporting.
• Identify root causes of payment errors and report to management.
• Collaborate with other departments and providers to resolve claims issues.

Skills

Medi-Cal regulations knowledge

Commercial and Medicare rules

Medical terminology

Strong organizational skills

Strong mathematical skills

Education

Associates or Bachelor’s degree

Job description

AltaMed Health Services Corp in California is seeking a Claims Operations Supervisor to oversee both external and internal claims adjudication processes. You will compile and scrub data to analyze trends, monitor TAT, production, and error rates, and generate forecasting and monthly health plan reports.

You will identify root causes of payment errors and partner with other departments and providers to resolve issues, ensuring accurate, timely claims handling across the organization.