Sr. Manager - Claims

Astrana Health, Inc.•Monterey Park, CA

112d•$125,000 - $140,000•Hybrid

About The Position

We’re looking for a Claims Operations leader who enjoys balancing people leadership with operational execution. In this role, you’ll oversee daily claims processing, drive quality and turnaround time performance, and support the onboarding of new IPAs and implementations. You’ll partner closely with internal teams, resolve escalations, and coach a team of claims professionals to deliver compliant, efficient, and accurate outcomes in a fast‑paced environment.

Requirements

Minimum of a Bachelor's degree (B.A.) from a four-year college or university; or at least four (4) years current Management or equivalent experience with an MSO or IPA Management
Full knowledge of DMHC, DHS and CMS Regulations and Guidelines, ICD-10, CPT, RV/RBRVS codes
Experience with contract law and Division Responsibility matrix interpretation
Comprehensive knowledge in the AB1455 regulations

Nice To Haves

EZCAP experience is a plus
Master's degree or healthcare certifications

Responsibilities

Lead daily claims operations to ensure quality, accuracy, and timely processing
Manage claims inventory and prioritize workloads to consistently meet SLAs
Support onboarding and implementation of new IPAs and claims operations
Drive continuous improvement initiatives to increase claims efficiency and quality
Resolve claims processing issues and escalations across assigned teams and IPAs
Use claims systems and reports to monitor performance and share insights with leadership
Coach, train, and develop claims staff (including offshore teams) to meet performance expectations
Partner with internal teams on system updates, process improvements, and compliance needs
Handle sensitive provider/member inquiries and high‑level claim issues as needed
Other duties as assigned