We’re a nonprofit, regional healthcare network with two hospitals, numerous outpatient medical offices, a multi-specialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer and emergency services. Our leadership is dedicated to putting patients first—a cornerstone of our mission, vision and values—as we deliver top-quality healthcare.

From our extensive facilities in Whittier, California and Downey, California, PIH Health serves more than two million residents in Los Angeles and Orange Counties and throughout the San Gabriel Valley.

The CLAIMS SUPERVISOR reports to the Director of Claims and is responsible for overseeing and managing the claims examiners, and is responsible for processing claims to ensure accurate and timely claims payment.   The Claims Supervisor understands the types of provider contracting arrangements, and all other fee schedules to support the accurate payment of claims.  The Supervisor  will provide leadership in performance management, identification of performance management of metrics, and one on one mentoring, coaching and ongoing training. The Supervisor will monitor internal controls to ensure proper adjudicatin and payment of claims based on Regulatory guidelines.  The Claims Supervisor is responsible for day to day management of claims inventory, monitoring the production and quality of the staff, mentoring, training, team building and maintaing examiners statistics and will all ensure that all examiners are adhering to guidelines and all organization policies.

This role assists the Director of Claims in operations.

Required Skills

• Working  knowledge of medical terminology & RVS/CPT/RBRVS/ICD-10 codes
• Experienced with complex provider contract payment methodologies including but not limited to case-rates and stop-loss.
• Excellent communication, problem solving, and decision-making skills coupled with the ability to work successfully in a team environment.
• Ability to take initiative in analyzing problems, developing solutions and taking necessary action.

Required Experience

REQUIRED:

• Must have a minimum five (5) years of experience as a senior claims examiner in claims adjudication with knowledge of at least one of the following: membership, benefits, provider contracts & pricing, medical reviews, referral authorizations and code review and fee schedules.
• Knowledge of regulatory requirements (CMS . DMHC and DHS)
• High School Diploma or G.E.D. is required.

PREFERRED:

• Associate or Bachelor’s Degree

Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package.  We are an equal opportunity employer and seek diversity in our workforce.   EOE M/F/D/V

• Working  knowledge of medical terminology & RVS/CPT/RBRVS/ICD-10 codes
• Experienced with complex provider contract payment methodologies including but not limited to case-rates and stop-loss.
• Excellent communication, problem solving, and decision-making skills coupled with the ability to work successfully in a team environment.
• Ability to take initiative in analyzing problems, developing solutions and taking necessary action.