California Licensed Claims Manager
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Job Summary
Leading regulatory compliance and audit readiness initiatives, the full-time remote California Licensed Claims Manager will oversee claims operations, manage audit preparations, and enhance payment accuracy while collaborating with cross-functional teams.
Key Responsibilities
- Develop and execute claims health plan readiness strategies focused on regulatory compliance and audit readiness
- Lead teams in compliant claims adjudication and coordinate health plan and CMS audit preparations
- Direct the analysis and resolution of systemic claims issues and implement corrective actions to improve performance
Required Qualifications
- Bachelor's degree in a related field or equivalent relevant experience
- 8-10+ years of progressive healthcare claims, adjudication, or regulatory compliance experience
- 3-5+ years of leadership experience managing teams or complex operational programs
- Extensive knowledge of CMS requirements and health plan regulatory compliance
- Demonstrated experience leading claims-related health plan and CMS audits
Complete Job Description
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