Inland Empire Health Plans
Supervisor, Claims Processing - Medi-Cal
Inland Empire Health Plans, California, Missouri, United States, 65018
What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an
authentic experience!The Supervisor, Claims Processing – Medi-Cal provides daily oversight of claims staff, business processes, and inventory management. Ensures the claims team follows state/federal regulations and standard operating procedures. Develops best practices to optimize claim processing quality. Evaluates professional skills of team members and provides appropriate work assignments. Resolves claim payment issues and quality oversight. Assists in hiring and training new team members in their job responsibilities. Monitors individual and team performance to ensure quality and performance objectives are met. Assists in employee performance evaluation, coaching, and professional development activities to improve performance efficiency.
PerksIEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.CalPERS retirement457(b) option with a contribution matchGenerous paid time off- vacation, holidays, sickState of the art fitness center on-siteMedical Insurance with Dental and VisionPaid life insurance for employees with additional optionsShort-term, and long-term disability optionsPet care insuranceFlexible Spending Account – Health Care/ChildcareWellness programs that promote a healthy work-life balanceCareer advancement opportunities and professional developmentCompetitive salary with annual merit increaseTeam bonus opportunities
Education & ExperienceFour (4) years medical claims processing experience, at least two (2) years of experience in a supervisory capacity leading a team.Three (3) years of experience in a managed care environment.Experienced in benefit and financial matrix interpretation.Experience preferably in an HMO or Managed Care setting.High School diploma or GED required.Bachelor's degree from an accredited institution preferred.Key QualificationsA 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 Revenue Codes.Solid understanding of the DHCS, DMHC, and CMS rules and regulations governing claims adjudication practices and procedures desired.Principles and techniques of supervision and training.Knowledge of medical terminology and understanding of healthcare 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/communication skills.Must have a high degree of patience and ability to lead a large team of professionals.Start your journey towards a thriving future with IEHP and apply
TODAY !
#J-18808-Ljbffr
authentic experience!The Supervisor, Claims Processing – Medi-Cal provides daily oversight of claims staff, business processes, and inventory management. Ensures the claims team follows state/federal regulations and standard operating procedures. Develops best practices to optimize claim processing quality. Evaluates professional skills of team members and provides appropriate work assignments. Resolves claim payment issues and quality oversight. Assists in hiring and training new team members in their job responsibilities. Monitors individual and team performance to ensure quality and performance objectives are met. Assists in employee performance evaluation, coaching, and professional development activities to improve performance efficiency.
PerksIEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.CalPERS retirement457(b) option with a contribution matchGenerous paid time off- vacation, holidays, sickState of the art fitness center on-siteMedical Insurance with Dental and VisionPaid life insurance for employees with additional optionsShort-term, and long-term disability optionsPet care insuranceFlexible Spending Account – Health Care/ChildcareWellness programs that promote a healthy work-life balanceCareer advancement opportunities and professional developmentCompetitive salary with annual merit increaseTeam bonus opportunities
Education & ExperienceFour (4) years medical claims processing experience, at least two (2) years of experience in a supervisory capacity leading a team.Three (3) years of experience in a managed care environment.Experienced in benefit and financial matrix interpretation.Experience preferably in an HMO or Managed Care setting.High School diploma or GED required.Bachelor's degree from an accredited institution preferred.Key QualificationsA 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 Revenue Codes.Solid understanding of the DHCS, DMHC, and CMS rules and regulations governing claims adjudication practices and procedures desired.Principles and techniques of supervision and training.Knowledge of medical terminology and understanding of healthcare 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/communication skills.Must have a high degree of patience and ability to lead a large team of professionals.Start your journey towards a thriving future with IEHP and apply
TODAY !
#J-18808-Ljbffr