Make a difference in people’s lives every day. When you join UCLA Health, you’ll be working at an institution that provides leading-edge care to the people of L.A. and throughout the world. We provide our team members with the environment and support to do amazing work, because each and every one of them plays a vital role in our commitment to care.
We are seeking a detailed-oriented and experienced Claims Manager to join our Claims leadership team. In this key role, you will oversee a dedicated team of claims examiners, auditors, and support staff, and monitor the department for regulatory compliance. You will be responsible for implementing and maintaining efficient claims adjudication processes that utilize technology to automate workflows and maximize the accuracy of claim payments.
The ideal candidate will demonstrate strong leadership and communication skills, fostering collaborative relationships with colleagues and team members. You will promote high-quality customer service and identify opportunities for workflow improvements to boost effectiveness and productivity. Additionally, you will research and resolve complex claims issues and develop standard operating procedures for handling various intricate claim scenarios.
Salary Range: $92,600 – $202,200 Annually
- High School Diploma
- Bachelor’s Degree in Business Administration, Health Care or other related field preferred or equivalent work experience, preferred
- 5 years previous experience in claims operations specifically related to Medicare Advantage or managed care in a complex and diversified healthcare or health insurance company
- 3 years experience managing personnel with at least 2 years managing personnel in a claims processing environment
- Extensive knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards related to specificity, as well as Revenue and HCPCS coding
- Strong working knowledge of provider network/IPA arrangements and reimbursement methodologies and of health benefit plan concepts
- Conversant with standard electronic and paper claim formats; familiarity with American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) coding guidelines such as the National Correct Coding Initiative (NCCI) edits and their relation to clinical logic in claims adjudication
- Experience with Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization tools
- Strong knowledge of all regulatory standards such as HIPAA, DMHC, AB1455, and CMS reporting requirements
- Familiarity with claims edit software
- Ability to analyze and organize complex federal and private insurance regulations
- Strong critical thinking and the ability to apply knowledge at a broad level within a complex academic medical center is essential
- Ability to support the working hours of the department
- Ability to travel/attend off-site meetings and conferences
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VINCENT, Sr. CLS Specialist, Toxicology
MONICA
I've been blessed to touch so many lives through my serving. It's a privilege to uplift other employees with words of encouragement and a smile.
SOZIT
The first thing i noticed when i joined the team was how everyone is very welcoming and friendly with supportive management. I did not feel like an outsider.
EDGAR
Once I joined, I knew UCLA Health was THE place to be due to the growth potential and training offered
RENE
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ERA
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ELIZABETH
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JERRY
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ORLANDO
There’s a togetherness and higher level of commitment to teamwork at UCLA Health. We are several groups and teams that work together with a common goal which is to improve our patients experience.
DAVID
UCLA Health walks the walk and talks the talk! It's an incredible feeling to work for an organization that always puts the patient first. I am honored to work in full alignment with the UCLA Health Mission and Vision.
DR. ISLA GARRAWAY
UCLA has incredible resources and a team science approach. The ability to work with collaborative teams and access the amazing resources around campus is the best part about being at UCLA.
RADU
UCLA is very diverse in its personnel as well as its many research fields studied
JENNA
UCLA Health provides so many opportunities to exchange ideas, share moments and grow. I have learned a lot about team management and relationship building.
SHARON
I was looking for a job to further my career and continue to improve and learn as a therapist.
TARO
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