Ultimate Staffing · 1 day ago
Healthcare Claims Manager
Los Angeles County, CA
Full-time
Onsite
Mid, Senior Level
$30/hr - $40/hr
3+ years expUltimate Staffing is seeking a Healthcare Claims Manager who will oversee the day-to-day operations of the claims department to ensure accurate and compliant processing of various healthcare claims. This role involves managing the claims processing team, ensuring regulatory compliance, and driving improvements in efficiency and member experience.
EmploymentHuman ResourcesManufacturingStaffing Agency
Hiring Manager
Grayson Harvey
Responsibilities
Manage and supervise the claims processing team, including workload distribution, performance monitoring, and training
Oversee the review, adjudication, and resolution of healthcare claims to ensure accuracy and compliance with plan benefits, policies, and regulatory requirements
Identify and resolve complex claim issues, discrepancies, or escalations
Monitor claim turnaround times (TAT) and ensure department meets service-level standards
Ensure claims processing complies with federal and state regulations, HIPAA guidelines, and internal policies
Conduct routine audits to verify accuracy and identify trends or areas for improvement
Develop and implement quality assurance protocols and corrective action plans when needed
Analyze claims data to identify patterns, inefficiencies, or cost‑containment opportunities
Recommend and implement process improvements to enhance accuracy, workflow, and productivity
Collaborate with IT and system vendors on claims system enhancements or updates
Work closely with Member Services, Provider Relations, Finance, and Eligibility teams to support issue resolution and improve service delivery
Serve as a subject‑matter expert on claims policies, benefits interpretation, and claims‑related inquiries
Support leadership with reports, departmental metrics, and claims performance insights
Provide coaching, mentorship, and development for claims staff
Participate in recruiting, hiring, and training new team members
Promote a positive, collaborative, and member‑focused team culture
Qualification
Required
3-5+ years of experience in healthcare claims processing, including HMO/PPO, self‑funded, or TPA environments
Strong knowledge of medical terminology, CPT/ICD coding, UB‑04/HCFA‑1500 forms, and benefit structures
Experience leading or supervising a team
Proficiency with claims processing systems and general healthcare administration workflows
Strong analytical and problem‑solving skills with high attention to detail
Preferred
Experience in union benefit plans, TPAs, or health & welfare funds (if applicable)
Familiarity with CMS, ERISA, and state regulatory requirements
Advanced Excel skills or experience with claims reporting tools
Company
Ultimate Staffing
Ultimate Staffing specializes in clerical, administrative, customer service, and manufacturing and production positions.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Lisa Marez
Partnership Director
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