Claims Operational Support Manager

CalOptima is a nationally recognized County Organized Health System that provides health insurance to over 300,000 Orange County, California residents through multiple product lines. Our mission is to provide our members with access to quality health care services delivered in a cost-effective and compassionate manner.

CLAIMS OPERATIONAL SUPPORT MANAGER
The Claims Operational Support Manger is responsible for the strategic and tactical implementation of CalOptima business rules and government regulations for all initiatives and projects that impact claims processes. Duties of this position include acting as a liaison with internal departments in analyzing the impact and implementation of projects, assisting in developing the strategic direction of the claims department to ensure compliance with all DMHC, DHS and CMS regulations, as well as working with the Director of Claims and Compliance for implementing AB1455 requirements.
REQUIREMENTS
This position requires the knowledge of program development, reporting and systems implementation, as well as knowledge of ICD9, CPT and HCPC codes. Knowledge of Medicare and Medi-Cal guidelines and regulations are a must. This position requires seven years experience with Medi-Cal and Medicare claims processing in a Managed Care environment that would have developed the knowledge and abilities listed above. Bachelor’s degree in healthcare or related field is a plus.

CalOptima offers an excellent work environment that includes flexible scheduling plans, a highly competitive benefits package and an organizational mission that drives our employees to excel!