Senior Manager, Claims Adjustments
L.A. Care Health Plan
full-time
Posted on:
Location Type: Office
Location: Los Angeles • California • United States
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Salary
💰 $117,509 - $188,015 per year
Job Level
About the role
- Manages all adjustment-related operational workflows, including provider disputes, escalated claim reviews, complex adjustments, and litigation-related claim support.
- Ensures that adjustment decisions are accurate, timely, consistent, and fully compliant with state, federal, and contractual requirements.
- Functions as the operational leader for all claim adjustments that exceed routine examiner responsibilities and require higher-level investigation or coordination.
- Leads a team of adjustment analysts and dispute specialists, building a culture of accuracy, documentation discipline, transparency, and initiative-taking issue identification.
- Oversees the development, implementation, administration, and maintenance of the department's programs, policies, and procedures.
Requirements
- At least 6 years of experience working in claims, provider disputes, adjustments, or related operational functions.
- At least 5 years of experience in leading, supervising and/or managing staff.
- Experience in Medicaid, Medicare, and Commercial managed care lines of business.
- Experience in interpreting provider contracts, payment methodologies, and managed care benefit structures.
- Experience managing complex claim review, root-cause evaluation, adhering to regulatory TAT requirements, and ensuring accuracy.
- Experience leading teams, projects, initiatives, or cross-functional groups.
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- 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 managementprovider disputesadjustmentscomplex claim reviewroot-cause evaluationpayment methodologiesmanaged care benefit structuresregulatory TAT requirements
Soft skills
leadershipsupervisionteam managementaccuracydocumentation disciplinetransparencyinitiative-takingissue identification