Senior Manager, Claims Adjustments
L.A. Care Health PlanLos Angeles, California, United States
Posted April 20, 2026
117509 - 188015 USD
Full Time
About the Company
L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents.
Job Description
Senior Manager, Claims Adjustments manages all adjustment-related operational workflows, including provider disputes, escalated claim reviews, complex adjustments, and litigation-related claim support. Ensures that adjustment decisions are accurate, timely, consistent, and fully compliant with state, federal, and contractual requirements.
Requirements
- Bachelor's Degree
- At least 6 years of experience working in claims, provider disputes, adjustments, or related operational functions
- At least 5 years of experience in leading, supervising and/or managing staff
- Experience in Medicaid, Medicare, and Commercial managed care lines of business
- Experience in interpreting provider contracts, payment methodologies, and managed care benefit structures
- Experience managing complex claim review, root-cause evaluation, adhering to regulatory TAT requirements, and ensuring accuracy
- Experience leading teams, projects, initiatives, or cross-functional groups
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)