Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)
UCLA HealthAbout the role
General Information
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Primary Duties and Responsibilities
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Play a vital role on our Claims leadership team, you will manage a team of claim examiners, auditors, and support staff toward operational excellence. The Claims Manager of the Medicare Advantage Plan will:
- 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
Salary Range: $95,400 - $208,300/annually
Note: This position is flexible-hybrid.
Job Qualifications
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We’re seeking a self-motivated, service-driven leader with:
Required:
- 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 c
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