Senior Manager, Claims Operations & Analytics

Gold Coast Health Plan; California (MO); On-site; USD 142,000 - 213,000; Full time

Job summary

A health care organization is seeking a Senior Manager, Operations - Applications & Analytics to lead claims-related services. This role involves overseeing processing, auditing, and improvement initiatives while ensuring compliance and satisfaction. Candidates should have extensive experience in claims management and a solid grasp of regulatory requirements. The position offers a competitive salary range of $142,000.00 – $213,000.00 and requires strong leadership and analytical skills.

Qualifications

• 8+ years of experience managing a claims processing department, preferably in a Medi-Cal/Medicaid managed care plan.
• Excellent understanding of claims regulatory requirements.
• Adaptability in a fast-paced, diverse environment.

Responsibilities

• Lead and direct the claims management process.
• Ensure claims payment processing adheres to regulations.
• Manage staff selection, evaluation, training, and development.

Skills

Analytical ability

Problem-solving

Staff selection and development

Effective presentation

Advanced MS Office skills

Education

High School Graduate or GED

Bachelor’s Degree

Tools

Meditrac claims processing system

Optum CES

Easy Group

MHK

Job description

A health care organization is seeking a Senior Manager, Operations - Applications & Analytics to lead claims-related services. This role involves overseeing processing, auditing, and improvement initiatives while ensuring compliance and satisfaction. Candidates should have extensive experience in claims management and a solid grasp of regulatory requirements. The position offers a competitive salary range of $142,000.00 – $213,000.00 and requires strong leadership and analytical skills.