Summary Claims Delegation Oversight Specialist is responsible for providing support for Claims Operations as it pertains to compliance and delegation oversight functions. The Claims Delegation Oversight Coordinator will coordinate and communicate between the Claims Team and other departments, assist and ensure Claims requests are completed timely and orderly. This teammate will report under the Supervisor of Claims Delegation Oversight.

Duties and Responsibilities:

Assist in health plan audit preparation, submission requests, preliminary and corrective action plan submissions. Oversight for submissions of claims universe, selections, audit documentation, preliminary and corrective actions. Delegate health plan communication to teams and ensuring deadlines are met. Collaborate with internal SMEs from functional areas Demonstrate claims systems for health audit live validations. Support Claims team in developing root cause analysis and potential solutions to corrective action plans (CAPs) requested from auditors/clients Attend health plan audits and Compliance Claims meetings. Collaborate with the Claims Support team to ensure timely and accurate submissions. Understand Claims Operations function and assist with ADHOC Claims requests Support delegation onboarding Communicate externally when necessary Take meeting minutes Adhere to organization policies and procedures

Minimum Job Requirements:

Must have a high school diploma or equivalent. Strong familiarity with California State and CMS healthcare regulations & Claims experience 2-3 years experience working in Claims operations with a focus on compliance/operations Prior experience with government programs (Medicaid and Medicare), regulatory and compliance standards Knowledge and experience in Claims Operations, operational, and compliance areas for Medicare, Medi-Cal, and Commercial lines of business Proficiency in Microsoft Office (Word, Excel, PowerPoint, Visio, OneNote) Minimum one year experience in

Claims Delegation Knowledge, Skills, and Abilities Required:

Strong organizational skills A willingness to learn Ability to be flexible in high volume settings Strong written and verbal communication skills

Critical Thinking Salary Range:

$74,880 - $80,000 annually