UM/Claims Senior Manager

Strategic oversight of UM and delegated Claims across multiple IPAs, ensuring compliance. Lead and mentor a 5–10 person UM/Claims team, setting standards and accountability. Serve as primary liaison for contracted health plans: inquiries, reporting, escalations.

Oversee health plan audits, coordination, accuracy, timely submission. Ensure regulatory timelines for authorizations, adjudication, payment, and reporting. Monitor KPI metrics: denial rates, timeliness, audits, documentation.

10+ years in Utilization Management, Claims, Managed Care or IPA/MSO operations.

California regulatory UM and delegated claims expertise (preferred). Experience leading health plan audits, ODAG logs, and timeliness reporting (preferred). Experience managing teams in multi-IPA or delegated risk environments (preferred).

Authorization workflows, medical necessity criteria, and claims adjudication (preferred). On-site in Chino, CA (preferred).

Stock options package Medical, dental and vision coverage 401K Long-term disability Unlimited PTO Life insurance Paid Leave Program