Claims Supervisor will be responsible for assisting Claims Manager in overseeing the Claims Department. Responsibilities include, but not limited to: • Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including: Contractual agreement rates Health Plan procedures Medicare and Medi-cal reimbursement Claims processing guidelines Providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, process, and adjusting claims Authorizes the appropriate payment or refer claims for further review Respond and resolve providers' and health plans' inquires in a timely manner Provide support to Configuration to ensure accuracy Coordinate with Compliance department to process claims accordingly to Health Plan requirements. Support Compliance department in Health Plan audits Help identify issues from audit findings and develop action plans to resolve Supervise and monitor Claims staff production and guide them for improvements Provide additional training to Claims staff for efficient processing as needed Ensure check runs are ready according to schedule Attend meetings as required Report to Claims Manager Other duties as needed Qualifications: Bachelor's degree in related field Minimum of one year in a managerial position Must have at least 5 years of applicable healthcare claims adjudication experience within a managed care industry Must be familiar with ICD-10, HCPCS, CPT coding, APC, ASC, and DRG pricing. Must be familiar with facility (UB-04) and professional (CMS-1500) claim billing practices. Must have good written and communication skills. Must have managerial and risk management skills Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment. Computer literacy required, including proficient use of Microsoft Word, Excel, Outlook, and EZ-CAP. Typing skills of at least 40 wpm. Exempt and on-site position. Benefits: Medical Insurance Dental Insurance Vision Insurance Paid Time Off 401K Matching
09/06/2025
Full time
Claims Supervisor will be responsible for assisting Claims Manager in overseeing the Claims Department. Responsibilities include, but not limited to: • Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including: Contractual agreement rates Health Plan procedures Medicare and Medi-cal reimbursement Claims processing guidelines Providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, process, and adjusting claims Authorizes the appropriate payment or refer claims for further review Respond and resolve providers' and health plans' inquires in a timely manner Provide support to Configuration to ensure accuracy Coordinate with Compliance department to process claims accordingly to Health Plan requirements. Support Compliance department in Health Plan audits Help identify issues from audit findings and develop action plans to resolve Supervise and monitor Claims staff production and guide them for improvements Provide additional training to Claims staff for efficient processing as needed Ensure check runs are ready according to schedule Attend meetings as required Report to Claims Manager Other duties as needed Qualifications: Bachelor's degree in related field Minimum of one year in a managerial position Must have at least 5 years of applicable healthcare claims adjudication experience within a managed care industry Must be familiar with ICD-10, HCPCS, CPT coding, APC, ASC, and DRG pricing. Must be familiar with facility (UB-04) and professional (CMS-1500) claim billing practices. Must have good written and communication skills. Must have managerial and risk management skills Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment. Computer literacy required, including proficient use of Microsoft Word, Excel, Outlook, and EZ-CAP. Typing skills of at least 40 wpm. Exempt and on-site position. Benefits: Medical Insurance Dental Insurance Vision Insurance Paid Time Off 401K Matching
HR Specialist The HR Specialist is responsible for many aspects of Human Resources responsibilities, including payroll duties, benefits, compliance, and general office matters. Responsibilities include but not limited to: Coordinate with SEVP on HR matters Onboard new hires ensuring all pre-employment screenings have cleared Be up-to-date on labor laws and update onboarding paperwork as needed Create and maintain employee folders Create employee badges and update time system Process employee terminations and report to COBRA department Assign mandatory HR trainings as needed Complete EDD forms such as Benefit Audit, Unemployment, and Disability Assist in yearly Form 5500 audit File yearly reporting such as CA Pay Data, EEO-1, and ESR Handle employment verifications Handle withholding orders and garnishments Review year-end census for 401K Review ESR mid-year report and provide new enrollments Track FMLA/CFRA Track PTO balances Draft formal letters as needed Post jobs on hiring sites Screen resumes and schedule interviews as requested Handle Open Enrollments during renewals (health benefits) and submit enrollment forms timely Review timesheets biweekly and process payroll Provide payroll reporting and cash requirements to Accounting/Finance Follow-up on outstanding items and maintain deadlines Schedule meetings in Outlook Prepare agenda for meetings Attend meetings File contracts Prepare expense reports Create monthly charges Prepare interoffice mail as needed Interact and assist other managers as needed Maintain office inventory Report building maintenance issues Prepare staff lunches as requested Operate standard office equipment Perform other duties as assigned Qualifications: Bachelor's degree preferred Minimum of four years' experience in a HR administrative role or comparable experience Experience in workforce management Experience processing payroll through Paychex Some accounting knowledge, but accounting experience is preferred Excellent writing skills Excellent communication skills Excellent organization skills and detail-oriented Excellent time management Ability to work independently and as a team Computer savvy including working with Microsoft Office Ability to be confidential and professional Benefits Medical Insurance Dental Insurance Vision Insurance Life Insurance Paid Time Off 401K Matching Reports to SEVP Full-Time (in-Office)
09/05/2025
Full time
HR Specialist The HR Specialist is responsible for many aspects of Human Resources responsibilities, including payroll duties, benefits, compliance, and general office matters. Responsibilities include but not limited to: Coordinate with SEVP on HR matters Onboard new hires ensuring all pre-employment screenings have cleared Be up-to-date on labor laws and update onboarding paperwork as needed Create and maintain employee folders Create employee badges and update time system Process employee terminations and report to COBRA department Assign mandatory HR trainings as needed Complete EDD forms such as Benefit Audit, Unemployment, and Disability Assist in yearly Form 5500 audit File yearly reporting such as CA Pay Data, EEO-1, and ESR Handle employment verifications Handle withholding orders and garnishments Review year-end census for 401K Review ESR mid-year report and provide new enrollments Track FMLA/CFRA Track PTO balances Draft formal letters as needed Post jobs on hiring sites Screen resumes and schedule interviews as requested Handle Open Enrollments during renewals (health benefits) and submit enrollment forms timely Review timesheets biweekly and process payroll Provide payroll reporting and cash requirements to Accounting/Finance Follow-up on outstanding items and maintain deadlines Schedule meetings in Outlook Prepare agenda for meetings Attend meetings File contracts Prepare expense reports Create monthly charges Prepare interoffice mail as needed Interact and assist other managers as needed Maintain office inventory Report building maintenance issues Prepare staff lunches as requested Operate standard office equipment Perform other duties as assigned Qualifications: Bachelor's degree preferred Minimum of four years' experience in a HR administrative role or comparable experience Experience in workforce management Experience processing payroll through Paychex Some accounting knowledge, but accounting experience is preferred Excellent writing skills Excellent communication skills Excellent organization skills and detail-oriented Excellent time management Ability to work independently and as a team Computer savvy including working with Microsoft Office Ability to be confidential and professional Benefits Medical Insurance Dental Insurance Vision Insurance Life Insurance Paid Time Off 401K Matching Reports to SEVP Full-Time (in-Office)