Asian Health Services

Operations

• Support day-to-day health plan administration functions across claims, enrollment, provider operations, and care coordination workflows
• Assist in developing and maintaining SOPs, escalation pathways, and performance tracking processes
• Monitor operational workflows and flag issues for timely resolution
• Coordinate with delegated TPA and vendor partners on claims adjudication and payment workflows
• Track pended and paid claims and support operational issue resolution
• Manage participant enrollment and disenrollment workflows, including CMS and DHCS submission tracking
• Support provider network operations including provider data maintenance, credentialing coordination, and access management
• Coordinate centralized referral workflows and external appointment scheduling processes
• Support operational readiness activities for CMS and DHCS requirements
• Partner with Finance, Compliance, Quality, and Clinical Operations on shared workflows and escalations

Health Plan Operations Manager