Remote Senior Manager of Healthcare Claims (Must Reside in CA, NV, AZ, or TX)

Remote Senior Claims Auditing Manager HealthCare Support is seeking a Senior Claims Auditing Manager to be part of a physician-centric, technology-powered healthcare management company in Monterey Park, CA!

Compensation

• $125K - $140K annually (depending on experience)

Shift: Monday through Friday, standard business hours (PST)

Benefits

• Medical, dental, and vision coverage
• Complimentary access health plan option to employees
• Paid time off
• 401(k) match
• Employee Stock Purchase Plan

Daily Responsibilities

• The Senior Claims Manager, Claims Delegation Oversight, is responsible for leading and overseeing all delegated claims audit activities, including audits conducted by external health plan partners and regulatory agencies. This role drives the development and execution of departmental strategies, manages the overall audit program, and focuses on optimizing audit processes. They will leverage data and technology to enhance claims quality while reducing operational costs.

Qualifications

• Bachelor’s degree (BA/BS) or equivalent combination of education and experience
• 3+ years of claims administration experience within an IPA or MSO environment
• 3+ years of experience supporting or overseeing delegation audits
• 3+ years of people leadership experience, including coaching and performance management
• Hands-on claims auditing experience, including root cause analysis and corrective action management
• Have advanced knowledge of CMS, DHCS, DMHC, Medicare, Medi-Cal, and Medicaid regulations impacting claims adjudication
• Strong understanding of claims payment methodologies (e.g., RBRVS, DRG/AP-DRG, APC, Medicare/Medi-Cal fee schedules)

Interested in this opportunity? Click Apply Now for immediate consideration, or reach out to our Recruiter, Melanie Williams with any questions:

• Call: (407) 346-0844
• Email:[email protected]
• Schedule a Call:calendly.com/mw4

Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law. Apply tot his job Apply To this Job