Senior Manager, 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
💰 $117,509 - $188,015 per year
Job Level
About the role
- Provides daily operational leadership for enterprise claims adjudication across all lines of business.
- Responsible for ensuring timely, accurate, compliant claim processing through disciplined production management, strong operational controls, and consistent application of claims policies, benefit rules, and contractual requirements.
- Manages a team to deliver predictable throughput, high first-pass accuracy, strong auto-adjudication rates, and consistent cycle-time performance.
- Ensures operational readiness for benefit changes, system updates, regulatory modifications, and cross-functional dependencies while continuously improving process quality and reducing rework.
- Oversees the development, implementation, administration, and maintenance of the department's programs, policies, and procedures.
Requirements
- Bachelor's Degree
- At least 6 years of experience working in claims operations, 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 interpreting provider contracts, payment methodologies, and managed care benefit structures.
- Experience handling complex claim review, root-cause evaluation, adhering to regulatory TAT requirements, and ensuring accuracy.
- Experience working with Coordination of Benefits (COB) and Third-Party Liability (TPL) claims in a managed care setting.
- 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 adjudicationproduction managementoperational controlsauto-adjudicationprocess quality improvementroot-cause evaluationCoordination of Benefits (COB)Third-Party Liability (TPL)provider contract interpretationpayment methodologies
Soft skills
operational leadershipteam managementsupervisioncross-functional collaborationcommunicationproblem-solvingprocess improvementaccuracy focusadaptabilitydecision-making
Certifications
Bachelor's Degree