The Claims Operational Manager is responsible for planning, developing, implementing, overseeing, training, and maintaining all areas needed to run the Claims Department in compliance with Health Plan Standards. Oversees and maintains a positive working relationship between MSO and its contracted IPAs and is responsive to the IPAs' Claim Department needs. Ensures claim department functions are staffed appropriately and that departmental processes are completed promptly and accurately for all contracted IPAs.

Minimum Job Requirements:

Knowledge :

In-depth knowledge of managed care laws and regulations; understanding of Medi-Cal, Medicare, and Commercial health plan principles; Specifically, Claims Compliance and Operations. Knowledge of contract rate structure, DOFRs, and benefits; possesses outstanding written and verbal skills; Computer literate.

Experience :

Must have a minimum of 5 years of professional experience in managed care claims operations, with at least 3 years of mid- to upper-level supervisory experience in a health care setting preferred.

Education :

Bachelor's degree in an associated health care field or equivalent experience.

Hours:

M-F from 8:00-5:00 pm

Job Type:

Full-time Pay:

From $85,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Paid time off Vision insurance Ability to

Commute:

Corona, CA 92879 (Required) Ability to

Relocate:

Corona, CA 92879: Relocate before starting work (Required)

Work Location:

In person