Director, Claims Administration
L.A. Care Health Plan
full-time
Posted on:
Location Type: Office
Location: Los Angeles • California • United States
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Salary
💰 $135,136 - $216,218 per year
Job Level
About the role
- Govern enterprise outcomes and risk controls in claims administration
- Lead end-to-end claims ecosystem including adjudication and adjustments
- Ensure compliance and accuracy across all lines of business
- Monitor production performance to meet regulatory compliance
- Develop strategic plans and influence business outcomes
- Foster a culture of accountability and continuous improvement
Requirements
- Bachelor's Degree
- 7 years of healthcare claims experience
- 5 years of experience leading or managing staff
- Experience in Medicaid, Medicare, and Commercial managed care
- Leading claims adjudication, adjustments, disputes
- Interpreting provider contracts, payment methodologies
- Managing complex claim reviews and root-cause evaluations
- Experience with regulatory audits and inquiries
Benefits
- Medical, Dental and Vision
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Wellness Program
- Volunteer Time Off (VTO)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims administrationclaims adjudicationclaims adjustmentsregulatory complianceprovider contractspayment methodologiescomplex claim reviewsroot-cause evaluationsregulatory auditsinquiries
Soft skills
leadershipstrategic planninginfluenceaccountabilitycontinuous improvement
Certifications
Bachelor's Degree