Posted: 01/14/20252025-01-142025-02-15Employment Type:Contract To HireJob Category:Accounting & FinanceJob Number: 627593Is job remote?: NoCountry: United States
Job Description
Job Title: Claims Director of Provider Disputes and Resolution
Contract -to-Hire
Onsite - Montebello, CA 90640 Must-Have:
Bachelor’s degree or equivalent.
6+ years of progressive leadership experience in managed care health care claims.
Thorough knowledge of managed care regulations and compliance.
Proficiency in Microsoft Office (Word, Excel, PowerPoint).
Knowledge of healthcare reimbursement, billing procedures, CPT and ICD-10 coding, and medical terminology.
Pluses:
Experience with managed care service providers.
Strong computer skills.
Job Summary: The Claims Director oversees all aspects of claims operations related to provider disputes, projects, and refund recoveries, ensuring regulatory compliance and company objectives. This role involves leading and supporting units, managing performance, quality improvements, and operational accuracy, and participating in various forums and initiatives to support claims integrity. Essential Functions:
Oversee provider claim disputes and projects.
Manage refund recoveries.
Ensure compliance with current rules, regulations, and industry standards.
Develop and maintain relationships with managed care service providers.
Collaborate with business units to resolve claims quality issues.
Implement plans to improve claims processes.
Participate in special projects and audits.
Define and support claims department processes and workflows.
Serve as a subject matter expert on managed care contracts and payment rules.
Lead teams to improve claims data quality and payment accuracy.
Direct staff activities and performance.
Ensure compliance with health plan claims delegation requirements.
Manage member and provider inquiries.
Support payment methodology interpretation.
Develop automation processes to improve payment accuracy and efficiency.
Lead tracking and reporting efforts.
Recommend quality assurance improvements.
Maintain department policies and procedures.
Present findings to management.
Establish credibility with all levels of management.
The staffing industry has seen an increase in people falsely representing themselves as recruiters to gather personal information from job seekers. For your safety, do not provide sensitive data to anyone you have not spoken with thoroughly, never provide banking information during the application process and always double check the email address of the recruiter to ensure it’s from @planet-pro.com - and not a domain with an alternative extension like .net, .org or .jobs. Candidate safety is a top priority at Planet Professional.
Planet Professional and The Planet Group of Companies are equal opportunity employers. It is our practice not to discriminate against any employee or applicant based on any criteria, condition or basis protected by laws or regulations in the locations where we do business. All qualified applicants are encouraged to apply. We celebrate diversity and are committed to providing an environment of mutual respect. We believe that diversity, equity and inclusion enable us to better meet our mission and values while serving our clients across the globe. If you have a disability or handicap and would like us to accommodate you in any reasonable way, please inform your recruiter, or contact us, so that we can discuss the appropriate alternatives available.
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About Montebello, CA
Ready to embark on a career journey in the vibrant city of Montebello, California? This diverse and thriving community offers a plethora of job opportunities across various industries, from healthcare to technology and beyond. Located in Los Angeles County, Montebello boasts a rich cultural heritage, stunning views of the San Gabriel Mountains, and easy access to popular attractions like the Commerce Casino and the Shops at Montebello. Indulge in the local cuisine, enjoy performances at the Montebello Barnyard Zoo or take a stroll through Grant Rea Park. Find your next career move in this dynamic city, where endless possibilities await. Explore our job listings today and discover the exciting opportunities Montebello has to offer!
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