California Claims Operations Manager

Job Summary

A company is looking for a Claims Operations Manager to lead the Claims Operations Unit within the Claims Department.

Key Responsibilities

• Manage and lead the Claims Operations Unit, providing guidance on claims operations functions
• Oversee planning, implementation, and compliance of claims operations activities
• Manage the Provider Dispute Resolution lifecycle and mentor assigned staff

Required Qualifications, Training, and Education

• Bachelor's degree in Business, Healthcare Administration, Public Health, or a related field
• Minimum of six years of experience in a healthcare or managed care environment, with three years in a supervisory role
• Strong understanding of claims processing functions and regulatory requirements
• Experience with operational improvement activities and workflow design
• Ability to train, mentor, and evaluate staff effectively