Senior Manager, Complex Claims & Adjustments

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 117,509 - 188,015; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Job summary

A leading health insurance provider in Los Angeles is seeking a Senior Manager for Claims Adjustments. This role involves managing operational workflows, ensuring compliance, and leading a team of analysts. The ideal candidate has extensive experience in claims management, regulatory requirements, and a strong grasp of coding and payment mechanisms. Benefits include PTO, tuition reimbursement, and retirement plans. Join us to impact the health coverage of low-income communities in Los Angeles.

Responsibilities

• Manage all adjustment-related operational workflows, including provider disputes and escalated claim reviews.
• Lead a team of adjustment analysts ensuring accuracy and compliance with requirements.
• Develop and maintain departmental programs, policies, and procedures.

Skills

Adjudication

Analytical skills

People skills

Attention to detail

Decision-making

Budget management

Education

Bachelor's Degree

Master's Degree in Business Administration or Related Field

Job description

A leading health insurance provider in Los Angeles is seeking a Senior Manager for Claims Adjustments. This role involves managing operational workflows, ensuring compliance, and leading a team of analysts. The ideal candidate has extensive experience in claims management, regulatory requirements, and a strong grasp of coding and payment mechanisms. Benefits include PTO, tuition reimbursement, and retirement plans. Join us to impact the health coverage of low-income communities in Los Angeles.