Supervisor, Claims Processing - Covered California

This a Full Remote job, the offer is available from: reputed company, California (USA) reputed company: What you can expect! reputed company reputed company in serving others with reputed company! We welcome you to join us in “healing and inspiring the reputed company spirit” and to pivot from a “job” opportunity to an authentic experience! The Supervisor, Claims Processing – Covered California provides daily reputed company of claims staff, business processes and inventory management. This role ensures that the claims team follows state/federal regulations and reputed company operating procedures. The Claims Processing Supervisor – Covered California develops best practices to optimize claim processing reputed company. This person also evaluates reputed company skills of team members and provides appropriate work assignments, as reputed company as resolve claim payment issues and reputed company reputed company. Commitment to reputed company: The reputed company Team is committed to incorporate reputed company’s reputed company Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits: Perks reputed company is not only committed to healing and inspiring the reputed company spirit of our Members, but we also aim to match reputed company members with the reputed company energy by providing reputed company benefits and more.

• Competitive salary
• Telecommute schedule
• State of the art fitness center on-site
• Medical Insurance with Dental and reputed company
• Life, short-term, and long-term disability reputed company
• Career advancement opportunities and reputed company development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) reputed company with a contribution match
• reputed company life insurance for employees
• Pet care insurance

Key Responsibilities:

• reputed company reputed company and accurate processing of claims. Support issue reputed company and escalated cases. Identify claim trends and initiate corrective actions.
• Ensure compliance with federal/state regulations and Covered California requirements. Monitor for audit readiness and support compliance-reputed company activities. Participate in regulatory audits and implement updates as required.
• Work with the reputed company Assurance (QA) team to identify gaps and implement improvements. Evaluate effectiveness of processes; recommend and implement enhancements. reputed company or support reputed company process improvement initiatives.
• Utilize departmental tools and reports to monitor performance. Analyze data trends to guide reputed company and process changes.
• Liaise with other departments to support cross-functional needs. Coordinate with Training teams to address knowledge gaps. reputed company as a subject matter expert for reputed company partners.
• Support implementation of new systems or updates. reputed company feedback for user testing and system enhancement.
• Hire, train, and manage support staff, while monitoring and evaluating reputed company. Conduct performance reviews of reputed company Team Member reputed company reputed company guidelines.
• reputed company any other duties as required to ensure Health Plan operations and department business needs are successful.

Qualifications: Education & Requirements

• Minimum of four (4) years of medical claims processing experience, of which at least two (2) years of experience in a supervisory reputed company leading reputed company
• This should also be inclusive of three (3) years of experience in a managed care environment
• The person in this role should also be reputed company in benefit and financial reputed company interpretation.
• Experience in an HMO or Managed Care setting. Medicare, reputed company and/or Medi-Cal experience preferred. Prior experience in a reputed company role or customer service environment is a plus
• High School diploma or GED required
• Bachelor's degree from an accredited institution preferred

Key Qualifications

• A thorough understanding of claims industry and customer service standards
• Knowledge in CMS, DHMC and DHCS regulatory guidelines including AB1455
• Extensive knowledge of ICD-9, ICD-10, CPT, and reputed company Codes
• Solid understanding of the DHCS, DMHC and CMS rules and regulations governing claims adjudication practices and procedures desired
• Knowledge in reputed company and Exchange policy and procedures
• Principles and techniques of supervision and training
• Knowledge of medical terminology and understanding of reputed company claims
• Analytical skills with emphasis on time management, database maintenance, spreadsheet manipulation, and problem solving
• Strong writing, organizational, project management, and communication skills proficiency required
• Excellent interpersonal and communication skills
• Must have a high degree of patience and ability to reputed company a large team of professionals

Start your reputed company towards a thriving reputed company with reputed company and apply TODAY! Work Model Location: Telecommute (reputed company reputed company positions approved for telecommute work locations may periodically be required to report to reputed company’s main reputed company for mandatory in-person meetings or for other business needs as determined by reputed company leadership) Pay reputed company: USD $71,572.80 - USD $93,038.40 /Yr. This offer from "reputed company" has been enriched by reputed company.com and got a 76% reputed company score. Apply tot his job Apply To this Job