Senior Manager, Provider Appeals & Dispute Resolution

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 135,000 - 216,000; Full time

Benefits offered by this job

Paid Time Off

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off (VTO)

Job summary

L.A. Care Health Plan seeks a Senior Manager of Provider Appeals and Dispute Resolution Management to oversee the full lifecycle of provider appeals, disputes, and complex reimbursement issues.

You will establish standardized processes, ensure regulatory compliance, and coordinate cross-functional reviews for accurate claim adjudication. You will manage staffing, develop team capabilities, and prepare executive summaries for leadership, while driving improvements to reduce friction and improve

Qualifications

• Experience managing provider appeals, payment disputes, and claim escalations in healthcare.
• Leadership experience managing staff and driving performance.
• Knowledge of contract terms, reimbursement methodologies, and regulatory requirements.
• Ability to design standardized dispute resolution processes.

Responsibilities

• Oversee end-to-end provider appeals, payment disputes, and complex reimbursement issues.
• Lead standardized intake, triage, investigation, assignment, and closure processes.
• Coordinate cross-functional reviews to align contractual and operational outcomes.
• Develop and mentor a high-performing team and prepare executive summaries.
• Monitor dispute aging and escalate unresolved cases for timely resolutions.

Skills

Root-cause analysis

Cross-functional teamwork

Contract interpretation

Reimbursement methodologies

Regulatory compliance

Leadership

Budgeting

Communication skills

Education

Bachelor's Degree

Master's Degree

Job description

L.A. Care Health Plan seeks a Senior Manager of Provider Appeals and Dispute Resolution Management to oversee the full lifecycle of provider appeals, disputes, and complex reimbursement issues.

You will establish standardized processes, ensure regulatory compliance, and coordinate cross-functional reviews for accurate claim adjudication. You will manage staffing, develop team capabilities, and prepare executive summaries for leadership, while driving improvements to reduce friction and improve