This job has closed.

IEHP · 2 weeks ago

Supervisor, Claims Processing - Covered California

Rancho Cucamonga, CA

Full-time

Hybrid

Mid, Senior Level

$72K/yr - $93K/yr

4+ years exp

IEHP is committed to healing and inspiring the human spirit, and they are seeking a Supervisor for Claims Processing in Covered California. This role provides oversight of claims staff and ensures compliance with regulations while developing best practices to optimize claim processing quality.

Health CareHealth DiagnosticsHospital

Comp. & Benefits

Responsibilities

Provides daily oversight of claims staff, business processes and inventory management

Ensures that the claims team follows state/federal regulations and standard operating procedures

Develops best practices to optimize claim processing quality

Evaluates professional skills of team members and provides appropriate work assignments

Resolves claim payment issues and quality oversight

Qualification

Claims processing experienceSupervisory experienceManaged care experienceICD-9/ICD-10CMS regulationsAnalytical skillsCommunication skillsOrganizational skillsInterpersonal skillsProject management skills

Required

Minimum of four (4) years of medical claims processing experience, of which at least two (2) years of experience in a supervisory capacity leading a team

This should also be inclusive of three (3) years of experience in a managed care environment

The person in this role should also be experienced in benefit and financial matrix interpretation

Experience in an HMO or Managed Care setting

Medicare, Commercial and/or Medi-Cal experience preferred

Prior experience in a lead role or customer service environment is a plus

High School diploma or GED required

A thorough understanding of claims industry and customer service standards

Knowledge in CMS, DHMC and DHCS regulatory guidelines including AB1455

Extensive knowledge of ICD-9, ICD-10, CPT, and Revenue Codes

Solid understanding of the DHCS, DMHC and CMS rules and regulations governing claims adjudication practices and procedures desired

Knowledge in Commercial and Exchange policy and procedures

Principles and techniques of supervision and training

Knowledge of medical terminology and understanding of healthcare claims

Analytical skills with emphasis on time management, database maintenance, spreadsheet manipulation, and problem solving

Strong writing, organizational, project management, and communication skills proficiency required

Excellent interpersonal and communication skills

Must have a high degree of patience and ability to lead a large team of professionals

Preferred

Bachelor's degree from an accredited institution preferred

Benefits

Telecommute schedule

State of the art fitness center on-site

Medical Insurance with Dental and Vision

Life, short-term, and long-term disability options

Career advancement opportunities and professional development

Wellness programs that promote a healthy work-life balance

Flexible Spending Account – Health Care/Childcare

CalPERS retirement

457(b) option with a contribution match

Paid life insurance for employees

Pet care insurance

Company

IEHP

Glassdoor3.8

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans, the largest not-for-profit Medicare-Medicaid public health plan in the country, and for the fourth year in a row, certified as A Great Place To Work®.

Founded in 1995

Rancho Cucamonga, California, USA

1001-5000 employees