Supervisor, Claims Operations

AltaMed Health Services

. Oversee external and internal processes related to Claims Adjudication .

Posted 10/8/2026full-timeMontebello • California • United StatesMid-LevelSenior💰 $74,144 - $92,680 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Claims Adjudication processes, including data analysis, compliance monitoring, and reporting. Proficient in Medi-Cal regulations and medical terminology, with strong organizational and mathematical skills to identify and resolve claims-related issues.

Highest-signal resume keywords

Claims AdjudicationMedi-Cal RegulationsCMS-1500 and UB-04 FormsData AnalysisOrganizational Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims Data CompilationClaims TrackingError Rate MonitoringForecasting ReportsHealth Plan ReportingRoot Cause AnalysisClaims Payment Error IdentificationMathematical Skills

Soft Skills

CollaborationOrganizational Skills

Certifications & Qualifications

Associates DegreeBachelor’s DegreeHigh School Diploma

Industry Keywords

Managed Care EnvironmentMedical TerminologyDOFR InterpretationContracts Understanding

About the role

Key responsibilities & impact

Oversee external and internal processes related to Claims Adjudication
Compile and scrub claims data
Analyze, track, and trend adjudicated claims
Monitor TAT compliance, production, error rate, and forecasting reports
Prepare Health Plan monthly reporting, including ODAG and Part C
Prepare Health Plan Universes for audits
Create reports to identify potential recovery
Produce reports requested by AltaMed personnel
Identify root causes of claims payment errors
Report claims payment error causes to management
Collaborate with other departments and providers to resolve claims-related issues

Requirements

What you’ll need

Associates degree (AA/AS) or Bachelor’s degree is highly recommended
HS Diploma required
Minimum of 5 years of experience in a managed care environment
Knowledge of Medi-Cal regulations, Commercial, and Medicare rules and regulations
Knowledge of medical terminology
Understanding of CMS-1500 and UB-04 forms
Ability to read and interpret DOFRs and Contracts
Strong organizational and mathematical skills
Claims knowledge preferred

Benefits

Comp & perks

Medical, Dental and Vision insurance
403(b) Retirement savings plans with employer matching contributions
Flexible Spending Accounts
Commuter Flexible Spending
Career Advancement & Development opportunities
Paid Time Off & Holidays
Paid CME Days
Malpractice insurance and tail coverage
Tuition Reimbursement Program
Corporate Employee Discounts
Employee Referral Bonus Program
Pet Care Insurance
Discretionary bonuses or incentives may apply