Job Description
Department(s): Claims Administration
Reports to: Manager Claims
FLSA status: Non-Exempt
Salary Grade: L - $77,000 - $127,094
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Thursday, November 02, 2023 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
About CalOptima Health
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!
About the Position
The Supervisor Claims (Operational Support-Analytics) will manage the day-to-day operations of the operational support staff, which includes the Analytics team. The incumbent will be responsible for managing projects for Claims Administration, User Acceptance Testing (UAT) and exception reporting. The incumbent will follow regulatory and internal guidelines in conjunction with CalOptima Health's policies and procedures as they apply to claims operational support for Medi-Cal and Medicare, OneCare and Programs of All-Inclusive Care for the Elderly (PACE).
Duties & Responsibilities:

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Trains and supervises all operational support staff to ensure adherence to the Medi-Cal and Medicare regulatory and processing guidelines.
• Identifies learning opportunities for staff (e.g., analysis, software, tools and provider education).
• Maintains presence at workshops related to claims guidelines to allocate and guide staff.
• Assigns projects and determines priorities of work done by staff.
• Ensures prompt communication with staff, schedules bi-weekly team meetings to review any updates or claims issues and conducts one-on-one meetings with staff to review progress regarding success factors (e.g., teamwork, quality, timely deliverables, etc.).
• Sets or recommends work performance standards.
• Reviews work procedures, recommends changes and/or changes procedures to be more time and cost efficient.
• Assists in the hiring process and makes recommendations for hire.
• Works with manager to complete annual employee performance reviews.
• Conducts employee counseling and corrective interviews with the assistance of Human Resources, as needed.
• Completes other projects and duties as assigned.

Experience & Education:

• Bachelor's degree in Business Administration, Health Care Administration or related field required.
• 3 years of experience in a managed care environment in technical areas of medical claims administration required.
• 1 year of progressive leadership experience, including the direct supervision of staff, in operational aspects of key functional areas in claims support required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Experience leading or participating in workgroups.
• Experience with analytics including but not limited to, UAT, postproduction analysis and reporting.

Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting.

• Work environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.

About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
Job Location: Orange, California
Position Type:
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4410
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