Claims Operations Supervisor

. Monitor and review Claims production staff work for training needs and compliance with quality and production standards .

Posted 10/7/2026full-timeMonterey Park • California • United StatesMid-LevelSenior💰 $78,000 - $91,000 per yearWebsite

Key responsibilities & impact

Monitor and review Claims production staff work for training needs and compliance with quality and production standards
Provide performance feedback and identify developmental opportunities
Monitor claims production and transaction reports; identify error trends and implement controls to reduce incorrect adjudication
Coordinate potential recovery efforts with Company Accounting and physician education opportunities with Company Physician Services
Collaborate with departments to achieve claims quality goals
Ensure legal, regulatory, and policy requirements are met
Manage and update claims production policies, workflows, and processes
Analyze claims quality adjudication results and identify training opportunities
Coordinate testing of provider contracts, health plan benefits/DOFR, and system rules configuration
Ensure accurate reporting and timely submission of quarterly PDR timeliness reports
Prepare, coordinate, and facilitate external PDR and adjustment audits
Develop and monitor corrective action plans from audit findings
Implement controls to minimize claims overpayments and identify physician education opportunities
Supervise direct reports, including assigning work, evaluations, training, development, corrective actions, and hiring/termination recommendations
Mentor team members in technical and functional areas
Achieve departmental goals related to claims inventory, turnaround times, quality scores, production standards, and financial accuracy
Perform other duties as assigned

What you’ll need

Bachelor’s degree in a relevant field (or an equivalent combination of education and progressively responsible experience)
At least 5 years of medical claims experience with a Medical Group, IPA, MSO, or Health Plan
At least 2 years of lead, supervisory, or people leadership experience preferred
Experience must be in healthcare claims; workers’ compensation, life insurance, or auto insurance experience does not count toward the minimum requirement
Advanced knowledge and hands-on experience with healthcare coding conventions, including ICD-10, CPT, and HCPCS
Thorough knowledge of medical claim processing procedures and systems, including auditing, claim protocols, industry standards, and CMS regulations related to claims payment and compliance
Advanced knowledge of claims processing system configuration and architecture sufficient to troubleshoot complex claims transaction issues

Comp & perks