The Role
Oversee daily claims processing, manage claims inventory, drive improvements for efficiency, resolve claims issues, and coach claims staff.
Summary Generated by Built In
About the Role:
We’re looking for a Claims Operations leader who enjoys balancing people leadership with operational execution. In this role, you’ll oversee daily claims processing, drive quality and turnaround time performance, and support the onboarding of new IPAs and implementations. You’ll partner closely with internal teams, resolve escalations, and coach a team of claims professionals to deliver compliant, efficient, and accurate outcomes in a fast‑paced environment.
Our Values:
We’re looking for a Claims Operations leader who enjoys balancing people leadership with operational execution. In this role, you’ll oversee daily claims processing, drive quality and turnaround time performance, and support the onboarding of new IPAs and implementations. You’ll partner closely with internal teams, resolve escalations, and coach a team of claims professionals to deliver compliant, efficient, and accurate outcomes in a fast‑paced environment.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
- Lead daily claims operations to ensure quality, accuracy, and timely processing
- Manage claims inventory and prioritize workloads to consistently meet SLAs
- Support onboarding and implementation of new IPAs and claims operations
- Drive continuous improvement initiatives to increase claims efficiency and quality
- Resolve claims processing issues and escalations across assigned teams and IPAs
- Use claims systems and reports to monitor performance and share insights with leadership
- Coach, train, and develop claims staff (including offshore teams) to meet performance expectations
- Partner with internal teams on system updates, process improvements, and compliance needs
- Handle sensitive provider/member inquiries and high‑level claim issues as needed
- Other duties as assigned
Qualifications
- Minimum of a Bachelor's degree (B.A.) from a four-year college or university; or four (4) years current Management or equivalent experience with an MSO or IPA Management
- Full knowledge of DMHC, DHS and CMS Regulations and Guidelines, ICD-10, CPT, RV/RBRVS codes
- Experience with contract law and Division Responsibility matrix interpretation
- Comprehensive knowledge in the AB1455 regulations
You're great for the role if:
- EZCAP experience is a plus
- Master's degree or healthcare certifications
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
- The national target pay range for this role is $125,000 - $140,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
About
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Skills Required
- Bachelor's degree or equivalent experience
- Full knowledge of DMHC, DHS and CMS Regulations and Guidelines
- ICD-10, CPT, RV/RBRVS codes experience
- Experience with contract law
- Comprehensive knowledge in AB1455 regulations
- EZCAP experience
- Master's degree or healthcare certifications
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The Company
What We Do
Astrana Health is a physician-centric, technology-powered healthcare company that operates an integrated delivery platform. It enables providers to participate in value-based care arrangements, helping them deliver accessible, high-quality, and cost-effective care to patients. The company provides care coordination services to patients, primary care physicians, specialists, and health plans, leveraging proprietary technology to streamline operations and improve patient outcomes across local communities.
