Health Insurance Operations Manager jobs in Santa Clarita, CA

Health Insurance Operations Manager manages and maintains daily health insurance operations in multiple service areas, including account installation, implementation, client support, contract administration, claim processing, and enrollment and eligibility. Handles and settles complicated customer service issues which can not be resolved by lower level staff. Being a Health Insurance Operations Manager monitors performance of each service area. Requires a bachelor's degree or its equivalent. Additionally, Health Insurance Operations Manager typically reports to senior management or Director. The Health Insurance Operations Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Health Insurance Operations Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Senior Manager or Director, PACE Health Plan Operations
  • myPlace Health
  • Los Angeles, CA FULL_TIME
  • About myPlace Health

    myPlace Health was founded in 2021 by mission-aligned healthcare leaders and organizations that are committed to drastically improving health outcomes, quality and experience for vulnerable older adults and frail seniors. We specialize in providing value-based, comprehensive care and coverage for older adults with significant needs so they can thrive in the homes they love and in the communities they cherish. 


    Our mission is simple: to enable older adults to live the independent lives they deserve. We pursue this mission through our myPlace PACE (Program of All-Inclusive Care for the Elderly) model, which provides seamless primary care, integrated health plan coverage, personalized social engagement, and customized services delivered in the participant’s preferred place.  


    myPlace Health is building a mission-driven team that shares our passion for redefining the way older adults experience care as they “age in place” in the community. This is a unique opportunity to take on one of our country’s most challenging healthcare problems and join a fast-growing, dynamic team as we prepare to scale our mission to serve more markets. 


    About this Role 

    This is an extraordinary opportunity for a mission-driven leader to play an integral role in building and leading health plan operations in a dynamic, integrated care delivery startup. This teammate will report to the Sr. Director of Health Plan Operations and will be responsible for the management and oversight of functions that include but are not limited to: TPA management/oversight (claims), utilization management, risk adjustment, and PBM oversight, and pharmacy services vendor oversight.  

     

    As one of the inaugural members of our Health Plan leadership team, this teammate will set the tone in how we maintain sound, compliant financial management practices and efficient health plan operations that enable us to scale our model effectively and responsibly. Most importantly, this teammate will be empowered to think strategically across nearly all facets and modalities of healthcare delivery in support of our effort to redefine the way older adults experience care as they age in place in their homes and communities. 


    The final leveling of this role will be Sr. Manager or Director, dependent on the selected candidates relevant past experience, competencies, and level of autonomy with which the selected candidate can operate.

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    Expectations for this Role
    • Serve as an accountable leader for PACE Health Plan Operations functions and ensure that staff are trained to perform their functions within the organization. 
    • Manage and provide oversight to our TPA, PBM, and pharmacy services vendors. 
    • Lead all Medicare Part D operations, including reporting, compliance, and audit. 
    • Develop and manage effective processes for maintaining participant Medicaid & Medicare eligibility, resolving issues and timely monitoring of data to ensure participants retain benefits for which they are eligible. 
    • Coordinate with the Finance department, Vendor & Network support and all other operations staff to support authorizations, billing, claims and appeals activities. 
    • Lead across all disciplines in the education and collaboration of Health Plan services.  
    • Establish management and oversight of enrollment and disenrollment activities to ensure adherence to regulatory requirements including the ongoing training of PACE operations team. 
    • Manage enrollment data and data systems including data transfers and the development and management of systems to meet PACE programmatic requirements with all vendor and related parties. 
    • Develop and support all workflows and policies surrounding self-pay and other private billing processes between accounting and TPA. 
    • Collaborate with analytic roles to maintain effective monitoring programs for claims processing, enrollment reconciliation, Med D, RAPS, and Encounter Data submissions.  
    • Lead utilization management operations by supporting care teams on the ground with appropriate tools and process that ensure efficient and timely decisions. 
    • Support government relations activities with respect to our health plan operations and collaborate on regulatory audits (e.g., 1/3rd financial audit, Part D audits, enrollment data verification, and other health plan related audits). 
    • Manage and support reporting required by regulatory bodies (CMS, state) and any key vendors as needed.  
    • Support the Finance and Accounting team with reinsurance activities. 
    • Oversee risk adjustment compliance and documentation integrity oversight, including but not limited to coordinating the HOS survey. 
    • Collaborate with Health Plan Analyst to design and support reporting needed by the operations teams (e.g., Quality, Risk Adjustment, Utilization). 
    • Oversee access to online systems and portals for HPO operations. 
    • Develop policies and procedures that meet applicable PACE program requirements. 
    • Stay current on regulations and policies impacting the PACE program, health plan operations, and collaborate with our compliance and quality teams to share that knowledge across the organization.  
    • All other duties assigned 


    Attributes of an Ideal Candidate
    • Passion and mission orientation for serving high-risk seniors and frail older adults 
    • Previous experience leading health plan operations functions for a PACE, Medicare Advantage, and/or Medicaid managed care health plan 
    • Strong understanding of health plan and healthcare provider financial funds flows and regulatory requirements, ideally in a PACE, Medicare Advantage (MAPD), or Medicare Prescription Drug Plan (PDP) organization 
    • Thrives in a relatively undefined, “zero to one” environment – unafraid to “roll up your sleeves” and drive a wide-ranging set of projects, processes,and deliverables 
    • Demonstrated past ability to champion continuous improvement to processes and systems across functions as the size and complexity of our business grows. 
    • Exhibit leadership presence and approachability in your ability to communicate confidently and persuasively to all audiences, including external stakeholders. 
    • Build, mentor, and manage teams supporting the various Health Plan functions.  
    • Preferred 5 years of related experience in a similar role and education concentration (e.g., certification, Bachelor’s, or Master’s) in a related field (e.g., business/MBA, accounting/CPA, finance/MS, economics, math, healthcare administration/MHA, etc.). 
    • An independent worker who can run down problems with relatively little direction, knows when and how to escalate effectively.  
    • Expert proficiency in both MS Excel and PowerPoint required. 


    Location
    • Hybrid based out of Los Angeles; we anticipate this role will be onsite up to 2 days/month
    • Remote with ability to travel 20%-40% based on business need. 
    • Relocation benefits offered if willing to reside in the Los Angeles metro area. 


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    $110,000 - $150,000 a year
    myPlace Health offers a robust compensation package for this role that includes cash compensation and other total rewards. Base pay is based on several factors including but not limited to education, relevant work and industry experience, certifications, and location of the role. Onsite roles include appropriate geographic adjustments, while remote roles are typically priced off national pay data.
     
    This role is eligible for the following:
    Performance-based cash bonus.
     
    401k with Employer match
     
    Your choice of 6 medical plans, with premium coverage of up to 80% for employees and 75% for all dependents
     
    Dental, vision, health savings account, flexible spending accounts, short- and long-term disability coverages
     
    PTO starting at 20 days per year; plus 12 paid holidays per year, and 2 floating holidays per year
     
    Generous CME/CEU budget and time off, and professional development opportunities
     
    One-time stipend towards setting up your home office (for remote or hybrid roles)
     
    Family friendly policies, including paid new parent leave!
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    Your Application

    Please submit your resume/CV and a short message that explains why you are interested in this role..


    Our Commitment to Diversity, Equity and Inclusion

    At myPlace Health, we value the diversity of our team members, and we are committed to building a culture of inclusion and belonging.  We pride ourselves to be an equal opportunity employer.  People seeking employment at myPlace Health are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.


    COVID-19 Vaccination Policy

    At myPlace Health, we provide safe and high-quality care to our participants. To achieve this, we have implemented a strongly recommended vaccination policy to keep both our team members and participants safe as an essential requirement of this role. Medical and religious exemptions can be granted based upon review of proper documentation. We adhere to all federal, state, and local regulations by obtaining necessary proof of vaccination prior to employment.


    Beware of Scams and Fraud

    Please beware of scams that solicit interviews or promote jobs for opportunities that are not listed on our website or are not directly related to a job you applied for yourself. Please be advised that myPlace Health will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option: https://reportfraud.ftc.gov/#/..

  • 10 Days Ago

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Commercial Insurance Account Manager
  • The Point Insurance Services
  • Downey, CA FULL_TIME
  • Job DescriptionThe Point Insurance is a bilingual (Spanish/English) agency that has been around over 20 years. Our mission is to show our clients the value of insurance. We believe in providing the cl...
  • 11 Days Ago

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Auto Insurance Manager
  • Fiesta Auto Insurance (spanish speakers)
  • San Fernando, CA PART_TIME,FULL_TIME
  • Fiesta Auto Insurance has the fastest growing Insurance and Tax Preparation Offices in the Country. We have over 100 locations in California and over 150 throughout the United States and growing.Our I...
  • 2 Days Ago

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Quality Operations Manager
  • Clipboard Health
  • Los Angeles, CA FULL_TIME
  • About the Role: We are seeking a highly skilled and experienced Quality Operations Manager to oversee and optimize our quality management systems and processes. The successful candidate will be respon...
  • 11 Days Ago

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Operations Project Manager
  • SuperCare Health
  • City of Industry, CA FULL_TIME
  • HYBRID WORK: 70% Telecommuting, 10% Industry, CA / 10% Downey, CA / 10% Other Locations Who We Are: SuperCare Health (SCH) is the foremost post-acute, in-home healthcare provider in the Western U.S., ...
  • 12 Days Ago

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Operations Project Manager
  • SuperCare Health
  • Downey, CA FULL_TIME
  • HYBRID WORK: 70% Telecommuting, 10% Industry, CA / 10% Downey, CA / 10% Other Locations Who We Are: SuperCare Health (SCH) is the foremost post-acute, in-home healthcare provider in the Western U.S., ...
  • 14 Days Ago

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0 Health Insurance Operations Manager jobs found in Santa Clarita, CA area

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Commercial Lines Underwriter
  • Burns & Wilcox
  • Woodland Hills, CA
  • : When someone needs insurance coverage for the unique, the unusual, or the unconventional, they come to Burns & Wilcox....
  • 3/28/2024 12:00:00 AM

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Workers Compensation Claims Assistant I - Glendale
  • Intercare Insurance
  • Glendale, CA
  • Workers Compensation Claims Assistant I Job Details Job Type Full-time Description Summary: Reports directly to the unit...
  • 3/28/2024 12:00:00 AM

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Insurance Sales Agent
  • The Carballo Agency
  • Pasadena, CA
  • Job Description Job Description The Carballo Agency (www.thecarballoagency.com) is an insurance brokerage contracted wit...
  • 3/28/2024 12:00:00 AM

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Sr. Compliance Analyst - Testing and Monitoring (Remote)
  • Manufacturers Bank
  • Los Angeles, CA
  • About the Organization Manufacturers Bank was formed by a group of banking entrepreneurs in June 1962. Our scope is to s...
  • 3/28/2024 12:00:00 AM

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Management Trainee
  • Enterprise Holdings
  • Valencia, CA
  • Overview: Start your career with Enterprise! Were hiring immediately for our respected Management Training Program. Whet...
  • 3/28/2024 12:00:00 AM

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Manager, Strategy
  • Sunkist Growers Inc
  • Valencia, CA
  • The Manager of Strategy is responsible for supporting the development of the strategic plan and providing recommendation...
  • 3/28/2024 12:00:00 AM

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People & Culture Compliance Analyst
  • AeroVironment
  • Simi Valley, CA
  • Summary The People & Culture Compliance Analyst is responsible for assisting in the development, implementation, and adm...
  • 3/24/2024 12:00:00 AM

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Workers' Compensation Claims Supervisor (Woodland Hills)
  • ICW Group
  • Woodland Hills, CA
  • Are you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hi...
  • 3/24/2024 12:00:00 AM

Santa Clarita, according to the United States Census Bureau, has an area of 62.16 square miles (161.0 km2), of which 62.10 square miles (160.8 km2) is land and 0.06 square miles (0.16 km2) (0.099%) is water. Santa Clarita is near the San Fernando fault zone and was affected by the 1971 San Fernando earthquake, also known as the Sylmar quake. The city was also affected by the 1994 Northridge earthquake, and many commercial and residential buildings were devastated by its aftermath, including the nearby Newhall Pass, the Valencia Town Center, and Six Flags Magic Mountain. Magic Mountain's 38-st...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Health Insurance Operations Manager jobs
$120,481 to $163,796
Santa Clarita, California area prices
were up 3.2% from a year ago

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