Senior Manager, Claims Adjustments

Job Summary

Join our team in Los Angeles, CA, as a full-time Senior Manager overseeing claims adjustments. This role involves managing complex workflows, ensuring compliance, and leading a team to drive performance. Strong expertise in claims processes and regulatory standards is essential.

Key Responsibilities

• Manage operational workflows for non-routine claim adjustments, ensuring accuracy and compliance.
• Lead a team of analysts and specialists, fostering a culture of accuracy and continuous improvement.
• Collaborate with cross-functional departments to resolve adjustment-related dependencies.
• Develop reports and dashboards to track adjustment trends and performance.
• Provide operational support for complex provider inquiries and legal reviews.

Qualifications

• Bachelor's Degree or equivalent education/experience.
• At least 6 years of experience in claims, provider disputes, or related functions.
• Minimum 5 years in a leadership role managing staff.
• Experience with Medicaid, Medicare, and Commercial managed care lines.
• Strong analytical and decision-making skills for complex scenarios.