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

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
EZCAP experience is a plus
Master's degree or healthcare certifications

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.
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 humanresourcesdept@astranahealth.com to request an accommodation.
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.

Senior Manager – Claims

Key skills