Strategic Claims Integrity & Recovery Supervisor

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 77,000 - 124,000; Full time

Benefits offered by this job

Paid Time Off

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off

Job summary

L.A. Care Health Plan is seeking a Supervisor of Claims Integrity & Recovery Services to lead a team focused on identifying, preventing, and recovering improper claim payments. The role oversees pre- and post-payment reviews, overpayment recovery, and outreach to providers/members.

Responsibilities include ensuring timely, accurate, and compliant operations aligned with contracts and regulations, and mentoring staff while driving efficiency across the department.

Qualifications

• Bachelor's Degree in Related Field or equivalent experience.
• At least 3 years of experience processing health plan claims recoveries.
• At least 1 year in leading a process, program, or staff.
• Experience with recovery tools/case management platforms and claims systems.
• CPC designation is required.

Responsibilities

• Oversee review of claim payments to detect overpayments and pricing errors.
• Manage recovery activities: offsets, recoupments, refunds, and dispute coordination.
• Ensure compliance with CMS, state/federal requirements, and internal policies.
• Track KPIs and drive process improvements to improve recovery yield.
• Collaborate with cross-functional teams on complex cases and clinical reviews.

Skills

Prioritization

Multi-tasking

Analytical skills

MS Office

Communication

Recovery posting

SOP development

Staff mentoring

Decision making

Education

Bachelor's Degree

Tools

Facets

QNXT

HealthRules

EPIC Tapestry

Job description

L.A. Care Health Plan is seeking a Supervisor of Claims Integrity & Recovery Services to lead a team focused on identifying, preventing, and recovering improper claim payments. The role oversees pre- and post-payment reviews, overpayment recovery, and outreach to providers/members.

Responsibilities include ensuring timely, accurate, and compliant operations aligned with contracts and regulations, and mentoring staff while driving efficiency across the department.