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General Information

Work Location: Los Angeles, USA
Onsite or Remote
Flexible Hybrid
Work Schedule
Monday-Friday, 8:00am-5:00pm PST
Posted Date
02/25/2025
Salary Range: $83800 - 179400 Annually
Employment Type
2 - Staff: Career
Duration
Indefinite
Job #
21945

Primary Duties and Responsibilities

As a key leader within Medicare Advantage Operations, the Senior Manager will be responsible for overseeing the strategic management and operational execution of Appeals and Grievances, Claims Processing, and Payment Integrity functions. In this role, you will ensure the efficient and compliant operation of all Medicare Advantage activities, aligning with CMS regulations and internal organizational standards. You will:

• Ensure timely, accurate, and compliant operations in accordance with CMS, DMHC, and internal standards.

• Collaborate with cross-functional teams to identify opportunities for operational improvements and process optimization.

• Lead new initiatives and projects aimed at improving efficiency and enhancing service delivery.

• Develop and implement best practices to improve team performance and regulatory compliance.

• Monitor key operational metrics, including inventory, aging, timeliness, and accuracy, to maintain high standards of performance.


Salary Range: $83,800 - $179,400/annually

Job Qualifications

We’re seeking a self-directed individual with:

• A Bachelor’s degree in business administration, healthcare administration or related field, preferred

• 7 to 10 years of experience in a Medicare or Managed Care environment with responsibility for overseeing operations in appeals & grievances, claims processing, and/or payment integrity, highly desired

• 5 or more years of management or progressive leadership experience in Medicare or Managed Care Operations, required

• Management or progressive leadership experience in Appeals and Grievances, Claims, and Payment Integrity, a plus

• 5 or more years of experience with Medicare Advantage Health Plan operations, highly desired

• Knowledge of Centers for Medicare & Medicaid Services (CMS) and the Department of Health Care Services (DHCS) jurisdictions

• Proven experience overseeing operations and vendor performance.

• Advanced proficiency in Microsoft Office Suite, particularly Excel (pivot tables, VLOOKUP), Word, and PowerPoint.

• Familiarity with SQL, data visualization tools, and healthcare-related software (e.g., claims processing systems, Tapestry, etc.), preferred

• Strong oral and written communication skills with the ability to articulate complex healthcare operations and technical processes to diverse audiences, required



As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.