Claims Manager - Hybrid
The University of California, San Diego
About this position
Position Description
The Managed Care Claims Manager is responsible for the overall leadership, strategic oversight, and operational performance of the claims adjudication process within the managed care division. This position ensures that claims and encounters are processed accurately, efficiently, and in full compliance with regulatory, contractual, and industry standards. The Manager oversees claim adjudication workflows, monitors operational trends, and implements process improvements to optimize quality, timeliness, and regulatory adherence. This position is also responsible for maintaining readiness for health plan audits, overseeing the team that responds to data requests and implementing audit-driven improvements as well as overseeing encounter submission and rejection resubmission of encounters to health plans.
Qualifications
Nine (9) years of related experience in medical claims processing, claim adjudication, encounter reporting, claims operations management, OR a Bachelor’s degree in a related field plus five (5) years of related experience. Related experience includes supervisory or leadership experience in a healthcare claims environment (health plan, provider group, IPA, MSO, TPA, or managed care organization). Solid knowledge of the principles, concepts, systems, processes, quality improvement plans, and best practices needed for effective and successful operations in managed care contacting. Ability train and guide employees on techniques. Knowledge of medical center, HR and UC policies and processes. Solid knowledge of applicable federal, state and local laws and regulations. Demonstrated skills in employee supervision and HR administration. Leadership skills to motivate and inspire staff to improve Managed Care services. Demonstrated ability to prioritize effectively to meet deadlines in a complex, challenging environment. Solid organizational and customer service skills to structure unit operations and lead assigned staff in an efficient and effective manner. Interpersonal skills to work collaboratively, coordinate and integrate with others throughout the organization. Maintains cooperative working relationships with professional and administrative staff, peers, multidisciplinary team members, management, and external managed care representatives. Ability to positively influence subordinates in conflict resolution, and knowledge of when to escalate conflict intervention. Strong critical thinking skills, with the ability to quickly analyze and evaluate complex and difficult problems, and sensitive situations, determine appropriate level of intervention, and develop and apply effective solutions. Solid verbal and written communication skills to explain technical Managed Care concepts, actively listen, persuade, advise, and counsel. Strong computer proficiency in all relevant hardware, software, and specialty contract databases and applications used in the department. Ability to synthesize data and utilize computerized systems to produce meaningful reports on department operations, results, and performance.
Job Location
Greenwich Drive