Job Description

Job Description

Job Description

Description

About the Role:
We’re looking for a Claims Operations leader who enjoys balancing people leadership with operational execution. In this role, you’ll oversee daily claims processing, drive quality and turnaround time performance, and support the onboarding of new IPAs and implementations. You’ll partner closely with internal teams, resolve escalations, and coach a team of claims professionals to deliver compliant, efficient, and accurate outcomes in a fast‑paced environment. 

Our Values: 

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Lead daily claims operations to ensure quality, accuracy, and timely processing
• Manage claims inventory and prioritize workloads to consistently meet SLAs
• Support onboarding and implementation of new IPAs and claims operations
• Drive continuous improvement initiatives to increase claims efficiency and quality
• Resolve claims processing issues and escalations across assigned teams and IPAs
• Use claims systems and reports to monitor performance and share insights with leadership
• Coach, train, and develop claims staff (including offshore teams) to meet performance expectations
• Partner with internal teams on system updates, process improvements, and compliance needs
• Handle sensitive provider/member inquiries and high‑level claim issues as needed
• Other duties as assigned

Qualifications

• Minimum of a Bachelor's degree (B.A.) from a four-year college or university; or at least four (4) years current Management or equivalent experience with an MSO or IPA Management
• Full knowledge of DMHC, DHS and CMS Regulations and Guidelines, ICD-10, CPT, RV/RBRVS codes
• Experience with contract law and Division Responsibility matrix interpretation 
• Comprehensive knowledge in the AB1455 regulations 

You're great for the role if: 

• EZCAP experience is a plus
• Master's degree or healthcare certifications

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis.  The office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
• The national target pay range for this role is $125,000 - $140,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.   

Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change. 

Job Tags

Contract work, Work at office

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