Sr. Manager - Claims

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Lead daily claims operations to ensure quality, accuracy, and timely processing
• Manage claims inventory and prioritize workloads to consistently meet SLAs
• Support onboarding and implementation of new IPAs and claims operations
• Drive continuous improvement initiatives to increase claims efficiency and quality
• Resolve claims processing issues and escalations across assigned teams and IPAs
• Use claims systems and reports to monitor performance and share insights with leadership
• Coach, train, and develop claims staff (including offshore teams) to meet performance expectations
• Partner with internal teams on system updates, process improvements, and compliance needs
• Handle sensitive provider/member inquiries and high‑level claim issues as needed
• Other duties as assigned

Qualifications

• Minimum of a Bachelor's degree (B.A.) from a four-year college or university; or at least four (4) years current Management or equivalent experience with an MSO or IPA Management
• Full knowledge of DMHC, DHS and CMS Regulations and Guidelines, ICD-10, CPT, RV/RBRVS codes
• Experience with contract law and Division Responsibility matrix interpretation 
• Comprehensive knowledge in the AB1455 regulations 

• EZCAP experience is a plus
• Master's degree or healthcare certifications

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis.  The office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
• The national target pay range for this role is $125,000 - $140,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.