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.
The Claims Resolution and Reconciliation Supervisor oversees daily claims resolution operations, ensuring timely, accurate, and compliant processing of complex claims adjustments, provider disputes, appeals, and grievances. This role provides direct supervision to staff, supports operational performance, and ensures compliance with Department of Managed Health Care (DMHC) and Centers for Medicare & Medicaid Services (CMS) requirements, industry standards, and organizational standards.
Key Responsibilities
- Supervise Claims Adjustment Specialists and Provider Dispute Resolution Analysts, including workload distribution, training, coaching, and performance management.
- Oversee daily claims operations to ensure accurate and timely resolution of complex claims adjustments, disputes, and escalated issues.
- Monitor productivity, quality, and inventory metrics to support operational goals and identify trends or areas for improvement.
- Ensure compliance with CMS, DMHC, and internal claims processing policies and procedures.
- Review and approve complex or high-dollar claims within established authority levels.
- Develop and maintain operational reports, workflows, desk procedures, and supporting documentation.
- Support audits, system testing, and implementation activities related to claims operations.
- Collaborate with cross-functional teams to resolve systemic claims issues and improve operational efficiency.
- Bachelor’s degree in Business Administration, Healthcare Administration, or related field, and/or equivalent combination of education and experience.
- Minimum 5 or more years of related experience or training in medical claims processing within a managed care or health plan environment
- Minimum of 2 or more years of experience supervising or leading claims processing staff
- Applies knowledge of revenue cycle operations, claims adjudication, and reimbursement methodologies
- Interprets and applies DMHC and CMS Medicare Advantage regulatory requirements
- Monitors productivity, quality, and inventory metrics to support unit performance
- Provides guidance on complex claims adjustments and provider dispute resolution
- Utilizes claims systems and reporting tools to support operational oversight
- Communicates effectively with staff, leadership, and internal stakeholders
- Manages competing priorities in a high-volume operational environment
- Supports audit activities and regulatory inquiries related to claims processing
- Experience training, mentoring, and coaching staff
- Proficiency with claims processing systems and standard office applications
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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.
KATHERINE
UCLA Health is a supportive, collaborative, and purposeful environment where leadership is invested in your growth and creating real opportunities. And knowing that what we do matters gives a real sense of purpose.
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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Awards & recognition
