Claims Manager

PPO Medical Claims ManagerLocation: San Fernando Valley (Onsite) Compensation: $125,000 – $140,000 + stellar benefits & generous PTO Schedule: Full-TimeAbout the OrganizationThis established healthcare benefits organization is all about supporting its members with accurate claims processing, compassionate service, and rock-solid operations. The culture is collaborative, energetic, and people-first, a place where employees feel supported, valued, and encouraged to grow.The RoleWe’re looking for an experienced Medical Claims Manager to lead an onsite team in San Fernando Valley, CA. You’ll keep operations running smoothly, develop and motivate staff, and ensure claims are handled with accuracy and care. You’ll also partner closely with a supportive, collaborative Director of Claims who empowers the team, values transparency, and truly invests in people’s growth.If you love leading teams, leveling up workflows, and working where details truly matter, all while indirectly supporting the people who help power creative projects behind the scenes, you’ll feel right at home here.What You’ll Be DoingLead the daily operations of the Claims department with clarity, confidence, and a strong sense of ownershipCoach and develop a team of 15 examiners, processors, and clerical staff, with the support of an Assistant Manager already in placeOversee monthly QNXT claims processing (~100K claims/month) and ensure accuracy for all manual adjudicationManage PPO claims exclusively (Anthem Blue Cross) within a unionized environment known for very low turnover and strong team stabilityCollaborate with senior leadership to streamline processes and drive continuous improvements; reports to the Director of Claims Work closely with vendors and internal partners to resolve escalations and optimize benefit configurationSupport appeals, audits, compliance reviews, and benefit-related investigationsServe as a key voice for the department in cross-functional meetings and initiatives Utilize and deepen payor-side experience, with exposure to full-risk and delegated modelsEnjoy potential for a future hybrid schedule after approximately one year of strong performance and onboarding integrationWho You Are (a.k.a. Our Dream Match):A seasoned leader with 7+ years managing teams in PPO medical claimsA claims expert who knows adjudication, COB, CPT, ICD-10, and medical terminology inside and outSomeone who has worked in systems like QNXT (or similar) and can navigate them confidentlyA strong communicator who loves coaching, developing people, and elevating team performanceA detail-focused problem-solver who thrives in a fast-paced environmentA professional who understands HIPAA compliance and values accuracy and confidentialityWhy You’ll Love it Here100% employer-paid medical, dental, and vision coverageGenerous PTO so you actually get time to live your lifeA stable, mission-driven organization with decades of impactA collaborative team that values accuracy, kindness, and accountabilityRetirement benefits + professional development opportunitiesA role where your leadership genuinely improves the experience of thousands of participantsIf this sounds like your kind of role, apply today and let’s make great work happen.