Claims Operations Manager

• Manage and lead the Claims Operations Unit, providing guidance on claims operations functions and departmental operations.
• Oversee the full Provider Dispute Resolution (PDR) lifecycle to ensure accurate, timely, and compliant dispute resolution.
• Manage, supervise, mentor, and train assigned staff.

This role ensures accurate and timely payment to healthcare providers, directly supporting access to quality care for members in underserved communities across Central California.

• 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, including three years of supervisory or management experience in Medi-Cal and Medicare claims operations.
• Strong understanding of end-to-end claims and PDR operations, with ability to use data and tools to spot trends and identify automation opportunities.
• Knowledge of Medi-Cal, Medicare, medical terminology, billing practices, coding standards, audit processes, and compliance requirements.

Compensation: Zone 1 Pay Range: $118,000 - $148,000; Zone 2 Pay Range: $110,000 - $140,000. Benefits include Medical, Dental and Vision Plans, Ample Paid Time Off, 12 Paid Holidays per year, 401(a) Retirement Plan, 457 Deferred Compensation Plan, Robust Health and Wellness Program, and Onsite EV Charging Stations.