Claims Manager, Medicare Advantage Plan – Flexible Hybrid

UCLA Health

Claims Manager at UCLA Health managing the Medicare Advantage Plan team. Driving operational excellence in claims processes and developing quality customer service culture.

Posted 7/27/2026full-timeLos Angeles • California • 🇺🇸 United StatesMid-LevelSenior💰 $99,100 - $216,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims operations management, including knowledge of CPT and ICD-10 coding standards, while fostering a high-performing team culture focused on quality and customer service. Proficient in implementing efficient claims adjudication processes and ensuring compliance with regulatory requirements.

Highest-signal resume keywords

Claims Operations ManagementCPT Coding StandardsICD-10 Coding StandardsRegulatory ComplianceTeam Leadership

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Adjudication ProcessesPhysician Billing PracticesFacility Billing PracticesData Visualization ToolsClaims Editing SoftwareManaged Care Transaction SystemsStandard Electronic Claim FormatsPaper Claim FormatsReimbursement MethodologiesWorkflow Enhancement

Soft Skills

Problem IdentificationAnalytical AbilitiesInterpersonal SkillsCommunication SkillsTeam Empowerment

Tools & Technologies

Microsoft Office SuiteOptum CESWeb StratMcKessonOptum PPSMicroDyn3MEPIC (Tapestry Module)EZ CapFacets

Certifications & Qualifications

Certified Professional Biller (CPB)Certified Revenue Cycle Representative (CRCR)

Industry Keywords

Medicare AdvantageHIPAADMHCAB1455CMS Reporting RequirementsProvider Network ArrangementsIPA ArrangementsRevenue CodingClaims Processing EnvironmentCross-Functional Workgroups

About the role

Key responsibilities & impact

Play a vital role on our Claims leadership team, you will manage a team of claim examiners, auditors, and support staff toward operational excellence.
Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments.
Foster a positive, high-performing team culture focused on quality and exceptional customer service
Identify opportunities to enhance workflows, resolve complex claim issues, and develop practical standard operating procedures
Empower the team to navigate challenging scenarios with confidence and consistency

Requirements

What you’ll need

Bachelor’s degree in business, health care or a related field and/or equivalent work experience
Five or more years of claims operations experience in a Medicare Advantage or related environment
Three or more years of managing personnel in a claims processing environment
In-depth knowledge of physician and facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding
Understanding of provider network/IPA arrangements and reimbursement methodologies, etc.
Knowledge of standard electronic and paper claim formats
Familiarity with AMA and Centers for Medicare and Medicaid Services coding guidelines
Computer proficiency with Microsoft Office Suite and data visualization tools
Knowledge of HIPAA, DMHC, AB1455, and CMS reporting requirements
Background with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.)
Experience in implementing and managing Prospective Payment System vendor application (Optum PPS, MicroDyn, 3M, etc.). (preferred)
Expertise with one or more of the following managed care transaction systems: EPIC (Tapestry Module), EZ Cap, Facets, QNXT
Excellent problem identification, resolution, and analytical abilities
Strong communication, interpersonal, and analytical skills
Ability to develop, implement, and evaluate methods/systems to improve efficiency
Ability to lead and facilitate cross-functional workgroups
Proficiency in achieving compliance with regulatory requirements
Ability to travel/attend off-site meetings and conferences
Certified Professional Biller (CPB)
Certified Revenue Cycle Representative (CRCR)

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account UCLA Health Website LinkedIn All Job Openings 10,000+ employees Founded 1955 🏥 Healthcare 📚 Education 🔬 Science Healthcare
Education
Science UCLA Health is an integrated academic health system anchored by the UCLA School of Medicine that delivers patient care, medical education, and clinical research across Southern California. With more than 290 locations including hospitals, specialty clinics, and immediate/primary care sites, UCLA Health provides a wide range of services—cancer care, transplant, neuroscience, orthopedics, heart and vascular, pediatrics, women's health, psychiatry and more—while offering virtual care, clinical trials, and patient resources such as myUCLAhealth. The organization emphasizes advanced technology, research-driven treatments, community engagement, and top-ranked hospital patient care outcomes. Claims Manager, Medicare Advantage Plan – Flexible Hybrid 🔥 14 minutes ago 🏢🏡 Los Angeles – Hybrid 💵 $99.1k - $216.5k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 👔 Manager Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Play a vital role on our Claims leadership team, you will manage a team of claim examiners, auditors, and support staff toward operational excellence.
Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments.
Foster a positive, high-performing team culture focused on quality and exceptional customer service
Identify opportunities to enhance workflows, resolve complex claim issues, and develop practical standard operating procedures
Empower the team to navigate challenging scenarios with confidence and consistency 🎯 Requirements
Bachelor’s degree in business, health care or a related field and/or equivalent work experience
Five or more years of claims operations experience in a Medicare Advantage or related environment
Three or more years of managing personnel in a claims processing environment
In-depth knowledge of physician and facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding
Understanding of provider network/IPA arrangements and reimbursement methodologies, etc.
Knowledge of standard electronic and paper claim formats
Familiarity with AMA and Centers for Medicare and Medicaid Services coding guidelines
Computer proficiency with Microsoft Office Suite and data visualization tools
Knowledge of HIPAA, DMHC, AB1455, and CMS reporting requirements
Background with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.)
Experience in implementing and managing Prospective Payment System vendor application (Optum PPS, MicroDyn, 3M, etc.). (preferred)
Expertise with one or more of the following managed care transaction systems: EPIC (Tapestry Module), EZ Cap, Facets, QNXT
Excellent problem identification, resolution, and analytical abilities
Strong communication, interpersonal, and analytical skills
Ability to develop, implement, and evaluate methods/systems to improve efficiency
Ability to lead and facilitate cross-functional workgroups
Proficiency in achieving compliance with regulatory requirements
Ability to travel/attend off-site meetings and conferences
Certified Professional Biller (CPB)
Certified Revenue Cycle Representative (CRCR) Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs District Manager 🕒 2 days ago PVH Corp. 10,000+ employees 📣 Marketing 🏭 Manufacturing 📦 Logistics Website LinkedIn All Job Openings District Manager for Calvin Klein managing retail operations in Southern California. Leading store teams to achieve sales targets and ensuring brand standards are met across multiple locations. 🏢🏡 Los Angeles – Hybrid 💵 $125.1k - $169.3k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 👔 Manager Construction Manager II 🕒 6 days ago CLMI Group 1 - 10 💼 Consulting 🏗️ Construction 🏠 Real Estate Website LinkedIn All Job Openings Construction Manager managing public works construction projects in Los Angeles. Leading teams and mentoring staff while ensuring best practices in construction management. 🏢🏡 Los Angeles – Hybrid 💵 $152k - $162k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 👔 Manager Construction Manager 🕒 6 days ago CLMI Group 1 - 10 💼 Consulting 🏗️ Construction 🏠 Real Estate Website LinkedIn All Job Openings Construction Manager I overseeing construction management practices and staff development for infrastructure projects in Los Angeles. Collaborating with various stakeholders to ensure project efficiency and adherence to standards. 🏢🏡 Los Angeles – Hybrid 💵 $140k - $148k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 👔 Manager Portfolio Manager – Asset Based Lending 🕒 July 16 U.S. Bank 10,000+ employees 💼 Consulting 🛡️ Insurance 📦 Logistics Website LinkedIn All Job Openings ABL Portfolio Manager partnering with Relationship Managers to manage credit relationships at U.S. Bank. Focusing on revenue growth, compliance, and risk management in a dynamic team environment. 🏢🏡 Los Angeles – Hybrid 💵 $139.2k - $163.8k / year ⏰ Full Time 🟠 Senior 🔴 Lead 👔 Manager District Manager – OnStar & Loyalty 🕒 July 14 General Motors 10,000+ employees 🚘 Automotive 🏭 Manufacturing 🚗 Transport Website LinkedIn All Job Openings District Manager for OnStar driving dealership relationships and maximizing platform use. Ensuring customer safety and loyalty through technological advocacy across California. 🏢🏡 Los Angeles – Hybrid 💰 $500M Grant on 2024-07 ⏰ Full Time 🟢 Junior 🟡 Mid-level 👔 Manager 🦅 H1B Visa Sponsor View More Manager Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course OpenClaw job finder Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs