Claims Manager

The Claims Manager oversees end-to-end claims operations within managed care delegated functions, ensuring accurate and timely processing for Medi-Cal, Medicare, PACE, and other lines of business. This role involves leading the claims team, implementing process improvements, and collaborating with internal and external stakeholders to optimize adjudication workflows. The position requires ensuring full compliance with CMS, DHCS, and health plan guidelines while managing escalations, appeals, and grievances.