Manager, Claims Research and Remediation
L.A. Care Health Plan
full-time
Posted on:
Location Type: Office
Location: Los Angeles • California • United States
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Salary
💰 $102,183 - $163,492 per year
About the role
- Manages L.A. Care’s specialized “Tiger Team” responsible for investigating, reconstructing, quantifying, and remediating the most complex and high-risk claims issues across the enterprise.
- Ensures that investigations are comprehensive, evidence-based, and defensible, and that remediation actions are accurate, auditable, and sustainable.
- Drives L.A. Care’s most critical investigative and corrective work.
- Partners with Legal to support litigation research, discovery preparation, and exposure modeling.
- Oversees multi-layered remediation for retroactive benefit changes, contract corrections, reimbursement updates, or operational/system defects.
- Ensures remediation execution is compliant, accurate, documented, and coordinated with cross-functional key stakeholders.
- Provides operational insights and documentation required for regulators, external auditors, and legal proceedings.
Requirements
- At least 5 years of experience working in claims research, auditing, payment integrity, provider disputes, adjustments, or complex claims operational functions.
- At least 3 years of leading, supervising /managing staff.
- Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.
- Experience leading teams, projects, initiatives, or cross-functional groups.
- Experience in Medicaid, Medicare, and Commercial managed care lines of business.
- Deep experience interpreting provider contracts, payment methodologies, and managed care benefit structures.
- Demonstrated experience with high complexity claims review and RCA.
- Experience interacting with Legal, Compliance, or regulators.
- Strong experience with claims system logic, configuration dependencies, provider contracts, and benefit structures.
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 researchauditingpayment integrityprovider disputesadjustmentscomplex claims operational functionshigh complexity claims reviewroot cause analysis (RCA)claims system logicconfiguration dependencies
Soft skills
leadershipsupervisionteam managementcross-functional collaborationoperational insightsdocumentationcommunication
Certifications
L.A. Care Management Certificate Training Program