$78,500–$163,600 Per Year
Adjudication, Business Administration, Centers for Medicare and Medicaid Services (CMS), Claims Management, Claims Processing, Coaching, Communication Skills, Content Management Systems (CMS), Cross-Functional, Documentation, Health Plan, Healthcare Administration, Healthcare Management, Industry Standards, Leadership, Maintain Compliance, Managed Care, Medicare, Operational Improvement, Operational Strategy, Operational Support, Operations, Operations Planning, People Management, Performance Management, Problem Solving Skills, Quality Metrics, Quality Monitoring, Reconciliation, Regulations, Regulatory Requirements, Reimbursement, System Test, Time Management, Trend Analysis
Claims Resolution and Reconciliation Supervisor - - 30537 - UCLA Health
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Claims Resolution and Reconciliation Supervisor
General Information
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Work Location: Los Angeles, CA, USA
Onsite or Remote
Flexible Hybrid
Work Schedule
Monday - Friday, 7:00am - 3:30pm PST
Posted Date
05/13/2026
Salary Range: $78500 - 163600 Annually
Employment Type
2 - Staff: Career
Duration
indefinite
Job #
30451
Primary Duties and Responsibilities
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The Claims Resolution and Reconciliation Supervisor oversees daily claims resolution operations, ensuring timely, accurate, and compliant processing of complex claims adjustments, provider disputes, appeals, and grievances. This role provides direct supervision to staff, supports operational performance, and ensures compliance with Department of Managed Health Care (DMHC) and Centers for Medicare & Medicaid Services (CMS) requirements, industry standards, and organizational standards.
Key Responsibilities
- Supervise Claims Adjustment Specialists and Provider Dispute Resolution Analysts, including workload distribution, training, coaching, and performance management.
- Oversee daily claims operations to ensure accurate and timely resolution of complex claims adjustments, disputes, and escalated issues.
- Monitor productivity, quality, and inventory metrics to support operational goals and identify trends or areas for improvement.
- Ensure compliance with CMS, DMHC, and internal claims processing policies and procedures.
- Review and approve complex or high-dollar claims within established authority levels.
- Develop and maintain operational reports, workflows, desk procedures, and supporting documentation.
- Support audits, system testing, and implementation activities related to claims operations.
- Collaborate with cross-functional teams to resolve systemic claims issues and improve operational efficiency.
Salary Range: $78,500 - $163,600/Annually
Job Qualifications
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All items are required:
- Bachelor's degree in Business Administration, Healthcare Administration, or related field, and/or equivalent combination of education and experience.
- Minimum 5 or more years of related experience or training in medical claims processing within a managed care or health plan environment
- Minimum of 2 or more years of experience supervising or leading claims processing staff
- Applies knowledge of revenue cycle operations, claims adjudication, and reimbursement methodologies
- Interprets and applies DMHC and CMS Medicare Advantage regulatory requirements
- Monitors productivity, quality, and inventory metrics to support unit performance
- Provides guidance on complex claims adjustments and provider dispute resolution
- Utilizes claims systems and reporting tools to support operational oversight
- Communicates effectively with staff, leadership, and internal stakeholders
- Manages competing priorities in a high-volume operational environment
- Supports audit activities and regulatory inquiries related to claims processing
- Experience training, mentoring, and coaching staff
- Proficiency with claims processing systems and standard office applications
As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.
Current/former UC employees are subject to a personnel file review.
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