Jobs
>
Rancho Cucamonga

    Manager, Claims Processing - Rancho Cucamonga, United States - Inland Empire Health Plan

    Inland Empire Health Plan
    Inland Empire Health Plan Rancho Cucamonga, United States

    1 week ago

    Default job background
    Description

    Overview:

    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 Manager, Claims Processing - Covered California is responsible for oversight and direction of claims and auditing activities of the Covered California (CCA) vendor and personnel. This position requires excellent communication, collaboration and leadership skills and the ability to provide detailed instructions to vendor and staff while monitoring inventory and compliance metrics within the department to ensure that our provider and member needs are met in a timely manner.

    Major Functions (Duties and Responsibilities)

    1. Interface with vendor to review daily productivity/quality/inventory due to compliance.
    2. Coordinate business rules/EOC changes with vendor
    3. Collaborate with providers and senior leadership to address escalated claims issues.
    4. Work closely and attend meetings with the Senior Director and Director of Claims.
    5. Participate in regulatory audits and corrective action plans.
    6. Oversee reporting needs and request.
    7. Promote process improvements methodologies and best practices that enhance claims service with vendor.
    8. Monitor and report key performance metrics in jeopardy of compliance risk with vendor.
    9. Oversee performance monitoring and claims inventory management for Covered California claims processed by vendor.
    10. Oversee of Covered California claims adjudication and quality by vendor.
    11. Partner and collaborate with various areas and vendor for resolution on claim issues.
    12. Engage in regulatory audits and CAP remediation.
    13. Hire, train, and manage support staff, while monitoring and evaluating outcomes.
    14. Conduct performance reviews of each Team Member within IEHP guidelines.
    15. Any other duties as required to ensure the Health Plan operations are successful.

    Commitment to Quality: The IEHP Team is committed to incorporate IEHPs Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

    Additional Benefits:

    Perks

    IEHP 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 retirement
    • 457(b) option with a contribution match
    • Generous paid time off- vacation, holidays, sick
    • State of the art fitness center on-site
    • Medical Insurance with Dental and Vision
    • Paid life insurance for employees with additional options
    • Short-term, and long-term disability options
    • Pet care insurance
    • Flexible Spending Account Health Care/Childcare
    • Wellness programs that promote a healthy work-life balance
    • Career advancement opportunities and professional development
    • Competitive salary with annual merit increase
    • Team bonus opportunities
    Qualifications:

    Education & Experience

    • Five (5) years of claims processing experience, at least (3) three of which was in a management capacity
    • Three (3) years of experience in an HMO or managed care environment.
    • Experienced in benefit and interpretation, regulatory payment appeals, and claim adjudication
    • The Manager must have past Covered California or Commercial claims processing experience
    • Bachelors degree from an accredited institution required, degree preferably in Business Administration, Accounting or Healthcare from an accredited institution required

    Key Qualifications

    • Excellent communication, collaboration, and leadership skills.

    Start your journey towards a thriving future with IEHP and apply TODAY

    Pay Range:
    USD $ USD $66.27 /Hr.
  • Inland Empire Health Plan

    Manager, Claims Processing

    1 week ago

    Inland Empire Health Plan Rancho Cucamonga, United States

    Overview: · 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 Manager, Claims Processing - Covered California is responsible for o ...

  • CorVel Corporation

    Ca Claims Specialist

    2 weeks ago

    CorVel Corporation Rancho Cucamonga, United States

    The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of ...

  • Alaphia Care

    Medical Billing and Coding Specialist

    2 days ago

    Alaphia Care Rancho Cucamonga, United States

    **Job Summary**: · **Responsibilities**: · - Review and verify accuracy of billing data and revise any errors · - Prepare and submit claims to insurance companies · - Follow up on unpaid claims within standard billing cycle timeframe · - Utilize medical billing software to proces ...

  • Inland Empire Health Plan

    Auditor - Provider Recovery

    1 week ago

    Inland Empire Health Plan Rancho Cucamonga, United States

    **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** · Under the direction of the Provider Claims Resolution & Recovery Supervisor, ...

  • Sedgwick

    Claims Assistant

    6 days ago

    Sedgwick Rancho Cucamonga, United States

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...

  • Inland Empire Health Plan

    Auditor - Provider Recovery

    1 week ago

    Inland Empire Health Plan Rancho Cucamonga, United States

    Overview: · **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** · Under the direction of the Provider Claims Resolution & Recovery ...

  • Inland Empire Health Plan

    IT Specialist Ii

    5 hours ago

    Inland Empire Health Plan Rancho Cucamonga, United States

    **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 IT Specialist II - EDI will work with the client implementation team to ...

  • Inland Empire Health Plan

    IT Specialist Ii

    5 hours ago

    Inland Empire Health Plan Rancho Cucamonga, United States

    Overview: · **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 IT Specialist II - EDI will work with the client implementat ...

  • Lowe's

    Branch Operations Supervisor

    5 days ago

    Lowe's Rancho Cucamonga, United States

    Essential Functions: · Operational Excellence · - Monitors the flow of inventory in the facility frequently throughout the day, making adjustments to team assignments as needed. · - Identifies and resolves equipment issues · - Identifies and assists in implementing process improv ...

  • Bradshaw Home

    Accounts Receivable Specialist

    2 weeks ago

    Bradshaw Home Rancho Cucamonga, United States

    Welcome to Bradshaw Home, where innovation meets everyday living. As a leading force in the housewares and kitchenware industry, we take pride in crafting products that elevate the ordinary into the extraordinary. At Bradshaw Home, we believe in the power of thoughtful design and ...

  • Kaiser Permanente

    Design & Delivery Consultant Iv

    2 weeks ago

    Kaiser Permanente Rancho Cucamonga, United States

    **Job Summary**: · **Essential Responsibilities**: · - Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. ...

  • Bradshaw Home

    Accounts Receivable Coordinator

    2 weeks ago

    Bradshaw Home Rancho Cucamonga, United States

    Welcome to Bradshaw Home, where innovation meets everyday living. As a leading force in the housewares and kitchenware industry, we take pride in crafting products that elevate the ordinary into the extraordinary. At Bradshaw Home, we believe in the power of thoughtful design and ...

  • FD Thomas

    Project Manager Assistant

    2 weeks ago

    FD Thomas Rancho Cucamonga, United States

    _Ready to live and work in the city known as the "Inland Empire" where you can take in the scenic landscape at an altitude known as nature's paradise? What about a fun and challenging outdoor adventure in Cucamonga Canyon _ · Whatever your heart desires, you will find yourself wo ...

  • Estes Express Lines

    Terminal Manager

    1 day ago

    Estes Express Lines Rancho Cucamonga, United States

    **Job Summary**: · - Lead, guide and direct terminal employees to include setting targets, monitoring performance, providing coaching, counseling and development. Accountable for the management of an efficient, clean and safe LTL operation · - Responsible for all hiring, training ...

  • Ascension

    Assistant Medical Claims Processing Urology

    2 weeks ago

    Ascension Orange Park, United States Full time

    Details · Department: Medical Claims Processing Urology · Schedule: Day Shift Monday - Friday 8:00am - 5:00pm · Facility: Ascension St. Vincent's Medical Group · Location: Jacksonville, FL · Listening to you, caring for you · When you join our team, you join a true work ...

  • Doctor's choice pharmacy

    Pharmacy Technician

    5 hours ago

    Doctor's choice pharmacy Upland, United States

    Job Overview: · We are seeking a skilled and dedicated Pharmacy Technician Bilingual (English/spanish) to join our team. As a Pharmacy Technician, you will play a crucial role in assisting pharmacists in providing quality patient care. Your responsibilities will include preparing ...

  • 1st Commercial Realty Group Inc.

    Commercial Property Manager

    2 weeks ago

    1st Commercial Realty Group Inc. Upland, United States

    Full-time · Dental, Life, Medical, Vision, Simple IRA, Employee Education Program, Professional Development · $84,970.00-$94,437.00 · The Property Manager is responsible for the overall operations of a portfolio of properties and directing the assistant property manager and the A ...

  • Sedgwick

    Claims Assistant

    1 week ago

    Sedgwick Ontario, United States

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...

  • Barrett Daffin Frappier Turner & Engel, LLP

    Part Time Entry Level Lawyer/attorney

    1 week ago

    Barrett Daffin Frappier Turner & Engel, LLP Ontario, United States Part time

    **Must be licensed in the State of California.** · Must be able to go into the local office in Ontario, California. · Responsible for performing legal services involved with pre/post foreclosure sales, including, loss mitigation, probate, deceased debtor issues, reviewing title p ...

  • Vinnova Inc

    General Accountant

    2 weeks ago

    Vinnova Inc Ontario, United States

    **Responsibilities**: · - Responsible for ensuring accuracy with all the financial accounts, preparing financial reports and managing entries with QuickBooks accounting system. · - Responsible for preparing, coding and posting AP invoices and client AR invoices · - Posting receip ...