PPO Medical Claims Manager

Motion Picture Industry Pension & Health Plans (MPI)-posted 23 days ago
$125,000 - $145,000/Yr
Full-time • Manager
Onsite • Los Angeles, CA
251-500 employees
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MPI is seeking an experienced Medical Claims Manager to lead our Claims team in Studio City, CA. This onsite leadership role is responsible for overseeing day-to-day claims operations, ensuring accurate and timely processing, compliance, and staff development. The ideal candidate brings a strong background in PPO medical insurance claims management, with proven expertise in systems such as QNXT (or similar claim platforms), CPT/ICD-10 coding, coordination of benefits, and HIPAA compliance. You will play a key role in shaping department workflows, mentoring claims staff, and partnering with leadership to support MPI’s mission of delivering exceptional service to our participants.

  • Lead daily operations of the claims department, including staffing, workflow, production, and team support.
  • Manage and coach a team of claims examiners, processors, and clerical staff.
  • Oversee QNXT claims processing inventory for manually adjudicated claims and ensure system accuracy.
  • Collaborate with the Director of Medical Claims to set department goals, improve processes, and implement system enhancements.
  • Monitor compliance with HIPAA, privacy regulations, and industry standards.
  • Partner with vendors (such as Anthem) and internal teams to recommend benefit configurations and resolve escalated issues.
  • Support appeals, benefits-related inquiries, and regulatory audits.
  • Develop and present reports for senior leadership and the Board of Directors.
  • Represent the Claims department in cross-functional meetings.
  • Bachelor’s degree or equivalent combination of education and experience.
  • Minimum 7 years of people management experience leading a team who process and adjudicate PPO medical claims for a payer, including hiring, training, and staff development.
  • 5–7 years of experience with PPO medical claims Payer systems, benefit configuration, and claims adjudication requirements (7+ years preferred).
  • 3+ years’ experience with QNXT or a comparable claims system.
  • Strong knowledge of CPT, ICD-10, COB, and medical terminology.
  • Advanced proficiency in Microsoft Office Suite (Excel, Word, Outlook).
  • 7+ years’ experience with HIPAA and privacy compliance.
  • Excellent communication skills, with strong analytical and problem-solving abilities.
  • Ability to thrive in a fast-paced environment with strict attention to detail.
  • Flexibility to work extended hours as required.
  • Ability to interact with all levels of employees including entry level staff and. senior management
  • MPI offers a comprehensive benefits package, including free medical, dental, and vision coverage, generous paid time off, retirement benefits, and professional development opportunities.
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