Utilization Management & Claims Senior Manager

Akido Labs; Chino (CA); On-site; USD 100,000 - 140,000; Full time

Benefits offered by this job

Health benefits including medical, dental and vision

401K

Life insurance

Job summary

A healthcare technology company is looking for a Senior UM & Claims Manager in Chino, CA, to oversee Utilization Management and Claims operations. You will manage a team and ensure regulatory compliance while working with health plans. Ideal candidates have over 10 years of experience in the field. The role offers competitive health benefits, a 401K, and a salary range of $100,000 - $140,000. Join us in improving healthcare for all.

Qualifications

• Minimum 10 years of experience in Utilization Management or Claims operations.
• Deep expertise in regulatory requirements governing UM and claims functions.
• Experience in managing teams in a multi-IPA environment.

Responsibilities

• Provide strategic oversight of all UM and Claims operations.
• Lead and manage a team of 5–10 UM and Claims professionals.
• Serve as the operational liaison for contracted health plans.
• Oversee health plan audits and maintain compliance.

Skills

Utilization Management

Claims Management

Regulatory Compliance

Leadership

Process Improvement

Tools

EZCap

EZNet

EMR systems

Crystal Reports

Job description

Akido builds AI-powered doctors. Akido is the first AI-native care provider, combining cutting‑edge technology with a nationwide medical network to address America’s physician shortage and make exceptional healthcare universal. Its AI empowers doctors to deliver faster, more accurate, and more compassionate care. Serving 500K+ patients across California, Rhode Island, and New York, Akido offers primary and specialty care in 26 specialties—from serving unhoused communities in Los Angeles to ride‑share drivers in New York. Founded in 2015 (YC W15), Akido is expanding its risk‑bearing care models and scaling ScopeAI, its breakthrough clinical AI platform. Read more about Akido’s $60M Series B. More info at Akidolabs.com.

The Opportunity

We are seeking a Senior UM & Claims Manager to lead and oversee Utilization Management and Claims operations across multiple IPAs supported by our MSO in Southern California. Reporting to the Head of AI Operations (COO of the MSO), this role is critical to ensuring regulatory compliance, operational excellence, and strong health plan relationships. You will serve as the primary operational point of contact for contracted health plans while leading a team of 5–10 professionals across UM and Claims. You will work in partnership with the AI Operations team to implement creative automations and efficiency initiatives. This is an opportunity to build scalable, high-performing workflows and drive measurable improvements in compliance, timeliness, and financial performance.

What you’ll do

• Provide strategic oversight of all UM and delegated Claims operations across multiple IPAs, ensuring regulatory compliance and operational efficiency
• Lead, mentor, and manage a team of 5–10 UM and Claims professionals, setting performance standards and ensuring accountability
• Serve as the primary operational liaison for contracted health plans, responding to inquiries, performance concerns, reporting requirements, and escalations
• Oversee all health plan audits (UM and Claims), coordinating preparation efforts and ensuring readiness, accuracy, and timely submission of materials
• Ensure adherence to regulatory timelines for authorizations, claims adjudication, payment processing, and reporting (ODAG logs, timeliness reports, UMC/UMCIS reports)
• Monitor and improve key performance metrics including denial rates, claims timeliness, audit outcomes, and documentation accuracy
• Oversee authorization workflows, queue management, escalation processes, and medical necessity review frameworks
• Direct delegated claims operations including intake, adjudication oversight, check runs, reporting, and corrective action implementation
• Maintain and update UM and Claims policies and procedures in alignment with regulatory and health plan requirements
• Partner with executive leadership to identify process improvements, system enhancements, and automation opportunities to scale MSO operations
• Create and maintain SOP's for all core workflows

Who you are

• Minimum 10 years of experience in Utilization Management, Claims, Managed Care, or IPA/MSO operations
• Deep expertise in regulatory requirements governing UM and delegated claims functions in California (preferred)
• Experience overseeing health plan audits, delegated oversight reporting, ODAG logs, and claims timeliness reporting (preferred)
• Demonstrated experience managing teams in a multi-IPA or delegated risk environment (preferred)
• Strong knowledge of authorization workflows, medical necessity criteria, and claims adjudication processes (preferred)
• Experience serving as a primary operational contact for health plans (preferred)
• Proficiency in platforms such as EZCap, EZNet, EMR systems, reporting tools (e.g., Crystal Reports), and health plan portals (preferred)
• Exceptional organizational, analytical, and process improvement skills
• Strong leadership presence with the ability to drive accountability and cross-functional collaboration
• Comfortable working onsite in Chino, CA

Benefits

• Health benefits include medical, dental and vision
• 401K
• Life insurance

Salary range: $100,000 USD - $140,000 USD

Akido Labs, Inc. is an equal opportunity employer, and we encourage qualified applicants of every background, ability, and life experience to contact us about appropriate employment opportunities.