Claims Manager - Figherfighter's Health Plan L.A. County Firefighter Local 1014 Health Plan El Monte, CA Job Details Full-time $140,000 - $150,000 a year 4 hours ago Benefits Wellness program Dental insurance 401(k) Paid time off Employee assistance program Vision insurance 401(k) matching Prescription drug insurance Qualifications Staff performance monitoring Appeals Insurance products customer support Microsoft Excel Microsoft Outlook EDI Managing teams in a customer support role Health insurance policy knowledge Regulatory compliance in claims processing Coding for hospital billing Health insurance customer support HIPAA Frontline customer support management Healthcare practice team management Team development Bachelor's degree Data entry Health information regulatory compliance Medical insurance appeals management Managing insurance claims teams Clinical confidentiality policies Technical Proficiency Full Job Description Claims Manager Local 1014, the self-funded ERISA Trust dedicated to serving the well-being of the Los Angeles County Fire Fighters and their families, is seeking a service driven Claims Manager. The ideal candidate should have management experience in a call center environment, aiding in improving the efficiency of the Claims Department, and guide Claim Adjusters processing complex hospital, and facility claims independently and with confidence. The position is on-site in El Monte, CA. Position Overview As a member of the Health Trust management team, the Claims Manager is responsible for overseeing the Assistant Claims Manager, two Auditors, and an 18-person claims team, with day-to-day focus on call center and member services handling of incoming calls from plan members and providers. Essential Job Functions Manage a team of member services representatives (MSRs), adjusters, and auditors, focused on consistently meeting regulatory requirements while demonstrating the standards and values of Local 1014 in their interaction with plan members, external business partners, and other areas within Local 1014. Oversee call flow, work processes, claim resolution productivity, and member feedback. Facilitate team training, process improvements, or documentation updates to ensure member service goals and audit objectives are met promptly. Act as a technical expert in handling complaints and other escalated issues from internal and external sources. Monitor all tasks related to personnel management, including but not limited to: timecard management, PTO approval, performance evaluations, goal setting, compliance with Local 1014's Work Rules and Codes of Conduct, counseling/discipline, and hiring/termination. Proactively identify potential system or workflow improvements that may enhance accuracy, productivity, and timeliness of service; implement industry best practices. Identify staff training needs, develop training materials as needed, and implement corrective action plans. Collaborate well with all levels of personnel within Local 1014, including the Board and Trustees. Assist in the implementation of new Health Trust service offerings. Required Knowledge/Skills/Abilities/Experience Minimum of five years of Claims Management experience in a health insurance or managed care environment, or equivalent education/experience. Minimum 10 years of claims processing/adjudication with knowledge of healthcare benefits, benefit administration, and health care delivery from either a payer or provider perspective. Minimum of three years of experience managing personnel, with at least two years managing personnel in a claims processing environment. Working knowledge of EDI and paper claim lifecycles and how they relate to health insurance industry practices and standards. Proficiency using a claims transactional system for data entry and claims processing. Proficiency in Basys and WGS claim systems (or Taft-Hartley or multiemployer trust funds experience) strongly preferred. Thorough knowledge of regulatory requirements for handling of claims and appeals, and protection of privacy, such as HIPAA and ERISA. Extensive knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, and revenue and HCPCS coding. High proficiency in Microsoft Office programs — Excel, Outlook, and Word. Excellent leadership, interpersonal, and team-building skills. Superior verbal and written communication skills. Strong analytical ability and problem-resolution skills. Ability to establish and maintain positive and effective work relationships with people from many different disciplines with varying degrees of technical and clinical expertise, including coworkers, plan members, providers, and external business partners. Effective management of staff performance. Strong service orientation and ability to maintain professional composure when dealing with confrontation or complaints. Effective time management and organizational skills. Ability to work independently and handle multiple priorities simultaneously. Detail-oriented. Education Bachelor's degree preferred, but not required with equivalent qualifying experience. Preferred Certifications AHIP designations such as HIA (Health Insurance Associate), PAHM (Professional, Academy for Healthcare Management), or ACS (Associate, Customer Service) AAPC or AHIMA coding certification (CPC, CCS, or equivalent) Familiarity with

ERISA/HIPAA

compliance training or certification is a plus Compensation & Total Rewards (all start day 1 of employment)

Salary:

$140,000-$150,000 100% covered benefits for employee and dependents Local 1014 contributes 7%-9% of annual income to an IRA (not deducted from your paycheck) 2 weeks accrued vacation, 10 sick days 13 holidays, Office Hours Mon-Fri, 8:30 AM-4:30 PM (some weekends may be required) Full-time, Exempt Equal Employment Opportunity Statement Local 1014 is an equal opportunity employer. We are committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, veteran status, or any other characteristic protected by applicable federal, state, or local law. This commitment applies to all aspects of employment, including recruitment, hiring, training, promotion, compensation, and termination.

Pay:

$140,000.00 - $150,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Paid time off Prescription drug insurance Vision insurance Wellness program Application Question(s): Please list any active industry certifications or licenses you hold (e.g., CPC, CCS, AHIP, CA Adjuster License) Are you able to commute to El Monte, CA, daily?

Experience:

Processing/Adjudicating Healthcare Claims:

8 years (Required)

Claims Managmenet :

4 years (Preferred)

Call Center Management:

2 years (Preferred) Self-funded ERISA plans orTaft-Hartley trusts: 2 years (Preferred)

Work Location:

In person