Supervisor, Claims Processing - Medi-Cal

Inland Empire Health Plans; California (MO); On-site; USD 80,000 - 110,000; Full time

Job summary

Inland Empire Health Plans seeks a Supervisor for Claims Processing to ensure compliance, optimize operations, and lead a dedicated team in a dynamic healthcare environment. Ideal candidates will have a strong background in claims processing and supervisory experience, bringing analytical and organizational skills to enhance team performance.

Benefits

CalPERS retirement

457(b) option with a contribution match

Generous paid time off

State of the art fitness center on-site

Medical Insurance with Dental and Vision

Short-term and long-term disability options

Flexible Spending Account – Health Care/Childcare

Wellness programs promoting work-life balance

Career advancement opportunities

Team bonus opportunities

Qualifications

• Four years medical claims processing experience with two years in supervisory capacity.
• Three years experience in managed care.
• Knowledge of CMS, DHMC, DHCS regulations.

Responsibilities

• Oversee daily operations of claims staff and ensure compliance with regulations.
• Resolve claim payment issues and assist in training new employees.
• Monitor team performance and facilitate employee evaluations.

Skills

Analytical skills

Communication skills

Project management

Writing skills

Education

High School diploma or GED

Bachelor's degree preferred

Job description

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to anauthentic experience!

The Supervisor, Claims Processing – Medi-Cal provides daily oversight of claims staff, business processes and inventory management. Ensures the claims team follows state/federal regulations and standard operating procedures. Develops best practices to optimize claim processing quality. Evaluates professional skills of team members and provide appropriate work assignments. Resolve claim payment issues and quality oversight. Assist in hiring and training new team members in their job responsibilities. Monitors individual and team performance to ensure quality and performance objectives are met. Assist in employee performance evaluation, coaching and professional development activities to improve performance efficiency.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

• CalPERS retirement
• 457(b) option with a contribution match
• Generous paid time off- vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account – Health Care/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities

Education & Requirements

• Four (4) years medical claims processing experience, at least two (2) years of experience in a supervisory capacity leading a team
• Three (3) years of experience in a managed care environment
• Experienced in benefit and financial matrix interpretation
• High School diploma or GED required
  • Bachelor's degree from an accredited institution preferred

Key Qualifications

• Experience preferably in an HMO or Managed Care setting
• Medicare, Commercial and/or Medi-Cal experience preferred
• Prior experience in a lead role or customer service environment is a plus
• A thorough understanding of claims industry and customer service standards
• Knowledge in CMS, DHMC and DHCS regulatory guidelines including AB1455
• Extensive knowledge of ICD-9, ICD-10, CPT, and Revenue Codes
• Solid understanding of the DHCS, DMHC and CMS rules and regulations governing claims adjudication practices and procedures desired
• Principles and techniques of supervision and training
• Knowledge of medical terminology and understanding of healthcare claims
• Analytical skills with emphasis on time management, data base maintenance, spreadsheet manipulation, and problem solving
• Strong writing, organizational, project management, and communication skills proficiency required
• Excellent interpersonal/communication skills
• Must have a high degree of patience and ability to lead a large team of professionals

Start your journey towards a thriving future with IEHP and apply TODAY!