What are the responsibilities and job description for the Medical Claims Manager position at CMF?
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. They may work remotely 90% of the time, but must attend meetings when required.
3. 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: Minimum 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 $100,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
Ability to Commute:
- Corona, CA 92879 (Required)
Ability to Relocate:
- Corona, CA 92879: Relocate before starting work (Required)
Work Location: In person
Salary : $100,000