Senior Manager Claims Job at L.A. Care | Los Angeles

Senior Manager, Claims Adjustments at L.A. Care | Los Angeles

If you have extensive healthcare claims experience and enjoy leading teams through complex operational challenges, the Senior Manager, Claims Adjustments at L.A. Care could be an opportunity worth exploring. Based in Los Angeles, California, this full-time management position focuses on the operational side of complex claim adjustments, provider disputes, escalated reviews, and related payment-integrity activities.

The role goes beyond routine claims processing. It calls for someone who can interpret payment methodologies and provider contracts, investigate complicated claim scenarios, work with compliance and legal teams, and turn operational data into practical improvements. The position also has a substantial people-management component, with responsibility for developing and guiding adjustment analysts and dispute specialists.

According to the supplied job posting, L.A. Care Health Plan is a publicly operated health plan serving Los Angeles County communities. The posting lists a salary range of $117,509 to $188,015, with a midpoint of $152,762. Actual compensation can depend on factors such as experience, education, geography, and market conditions.

For experienced healthcare claims professionals who want to move into a senior leadership position, this Senior Manager, Claims Adjustments job at L.A. Care combines claims expertise, compliance awareness, analytics, project leadership, and team development.

Job Overview

Job Detail	Information
Company	L.A. Care Health Plan
Position	Senior Manager, Claims Adjustments
Department	Core Admin Ops – Payment Integrity
Location	Los Angeles, California 90017
Employment Type	Full Time
Job Category	Management/Executive
Requisition ID	13041
Minimum Experience	6+ years in claims, provider disputes, adjustments, or related operations
Management Experience	5+ years leading, supervising, and/or managing staff
Education	Bachelor's degree or equivalent education/experience
Preferred Education	Master's degree in Business Administration or related field
Listed Salary Range	$117,509 – $188,015

The information above is based on the job details provided for this article. Applicants should verify the current posting for any changes before applying.

About L.A. Care Health Plan

L.A. Care Health Plan operates in the healthcare insurance and managed-care sector, with a particular focus on serving Los Angeles County. The organization was established in 1997 and is described in the supplied posting as an independent public agency created by the state of California.

Its work sits at the intersection of healthcare access, insurance administration, provider relationships, claims operations, and regulatory compliance. That makes operational accuracy particularly important because claims decisions can involve contracts, benefits, coding, pricing arrangements, and government program requirements.

The supplied job posting states that L.A. Care serves more than two million members. It also identifies Medicaid, Medicare, and commercial managed-care experience as relevant to this position.

For professionals considering a leadership career in healthcare operations, this environment can provide exposure to several interconnected areas rather than limiting the role to traditional claims examination.

Key Responsibilities

Lead Complex Claims Adjustments

The Senior Manager oversees non-routine adjustment activity, including escalated cases, complex pricing reviews, and benefit- or authorization-related adjustments. The objective is to ensure that difficult cases receive consistent, well-supported decisions.

Manage Provider Disputes

Provider disputes can require investigation into contracts, reimbursement arrangements, coding, payment methodology, and other factors. The role involves reviewing the underlying causes of disputes and ensuring findings are properly documented.

Maintain Regulatory Compliance

The position requires familiarity with requirements associated with organizations such as the Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and Centers for Medicare and Medicaid Services (CMS). Regulatory turnaround requirements and contractual deadlines are important considerations.

Work With Compliance and Legal

Complex claims may have compliance or legal implications. The Senior Manager works with relevant internal teams on claim-level reviews, discovery support, documentation, and adjustment packages.

Improve Operational Processes

Rather than simply resolving individual cases, the position looks for recurring problems. The manager analyzes adjustment trends, identifies root causes, and works with other departments to address upstream issues that create unnecessary rework.

Develop Reports and Dashboards

Performance information can help leadership understand adjustment volume, turnaround times, accuracy trends, and systemic issues. The role includes developing reporting that supports operational decision-making.

Lead and Develop Employees

People leadership is a major component of the position. Responsibilities include hiring, training, coaching, mentoring, scheduling, performance management, and developing employees' technical and critical-thinking capabilities.

Support Strategic Projects

The Senior Manager may lead complex initiatives involving multiple stakeholders. This includes establishing timelines, coordinating contributors, monitoring deliverables, and supporting implementation after approval.

Required Skills

Candidates considering this opportunity should be comfortable with both technical claims concepts and leadership responsibilities.

Technical Skills

Important areas include:

• Healthcare claims adjudication
• Claims adjustments and provider disputes
• Coding and pricing concepts
• Managed-care payment rules
• Provider contract interpretation
• Division of Financial Responsibility (DOFR)
• Inpatient and outpatient pricing
• Long-Term Care and ancillary-service pricing
• Medicaid, Medicare, and commercial managed care
• Regulatory requirements involving DMHC, DHCS, and CMS
• Claims reporting and operational analytics
• Budgeting and financial management

Leadership and Soft Skills

The role also requires:

• Strong analytical and decision-making ability
• Critical thinking
• Conflict resolution and mediation
• Executive-level communication
• Presentation skills
• Team building
• Coaching and mentoring
• Strategic planning
• Organization and prioritization
• Attention to detail
• Cross-functional collaboration

Because the role involves complex cases and multiple stakeholders, the ability to explain difficult issues clearly is particularly valuable.

Qualifications

The supplied posting requires a Bachelor's degree, although equivalent education and/or experience may be considered.

Applicants should have at least six years of experience working in claims, provider disputes, adjustments, or related operational functions. The position also requires at least five years of experience leading, supervising, and/or managing employees.

Experience across Medicaid, Medicare, and commercial managed-care lines is required. Candidates should also understand provider contracts, payment methodologies, managed-care benefit structures, complex claim reviews, root-cause analysis, and regulatory turnaround requirements.

A master's degree in business administration or a related field is listed as preferred. Experience supporting regulatory audits, legal reviews, or corrective-action plans is also preferred.

Salary, Benefits and Perks

The supplied job posting lists the following salary range:

$117,509 minimum – $152,762 midpoint – $188,015 maximum

The posting notes that actual pay may vary according to factors including geography, experience, education, and market conditions.

L.A. Care's posting also identifies a range of benefits, including:

• Paid Time Off (PTO)
• Tuition reimbursement
• Retirement plans
• Medical, dental, and vision coverage
• Wellness program
• Volunteer Time Off (VTO)

Benefits and eligibility can depend on employment terms and applicable policies, so candidates should review the official careers information for the most current details.

Why Consider This Opportunity?

Senior-Level Career Development

This is a management/executive position rather than an individual claims-processing role. Experienced professionals can potentially use the position to expand their leadership responsibilities across claims operations and payment integrity.

Broad Healthcare Exposure

The role touches claims, provider relationships, contracts, pricing, compliance, legal support, analytics, and managed care. That combination can provide valuable exposure to different sides of healthcare administration.

Analytical Problem Solving

Professionals who enjoy investigating why claims issues occur may find the emphasis on root-cause analysis and operational improvement particularly relevant.

Cross-Functional Leadership

The position works across departments and requires communication with senior and executive management. This can strengthen stakeholder-management and strategic communication skills.

Team Development

For managers who enjoy coaching people, the role offers responsibility for developing employees and building a team culture centered on accuracy, accountability, and continuous improvement.

Hiring Process

The exact selection process can change and should not be assumed from the job posting. Generally, candidates for a senior management position may experience several stages:

1. Online application – Submit an application through the employer's official careers platform.
2. Resume screening – Recruiters or hiring teams review experience against the role's requirements.
3. Initial interview – Candidates may discuss their background, leadership experience, and interest in the position.
4. Additional interviews – Senior roles may involve conversations with hiring managers or other stakeholders.
5. Role-specific evaluation – Depending on the employer, candidates may be asked to discuss complex claims, leadership situations, or operational problems.
6. References and offer – A successful candidate may proceed through applicable checks before receiving an employment offer.

These are general hiring stages, not a guaranteed L.A. Care process.

How to Apply

Interested candidates should apply through the official L.A. Care careers website rather than relying on third-party application forms.

Official Apply Link:
https://jobs.lacare.org/job/Los-Angeles-Senior-Manager%2C-Claims-Adjustments-CA-90017/1383847200/

Before submitting an application, review the current posting carefully and make sure your resume clearly demonstrates relevant claims, managed-care, leadership, analytical, and regulatory experience.

Frequently Asked Questions

1. Who can apply for the Senior Manager, Claims Adjustments position?

Professionals who meet the education, claims experience, management experience, and technical requirements listed in the current posting can consider applying.

2. Is prior claims experience required?

Yes. The supplied posting requires at least six years of experience in claims, provider disputes, adjustments, or related operational functions.

3. Is management experience required?

Yes. At least five years of experience leading, supervising, and/or managing staff is listed as a requirement.

4. What degree is required?

A bachelor's degree is required, although the posting states that equivalent education and/or experience may be considered. A master's degree in business administration or a related field is preferred.

5. What is the salary for this position?

The listed range is $117,509 to $188,015, with a midpoint of $152,762. Compensation may vary based on several factors.

6. Is remote work available?

The supplied job information identifies the position as being in Los Angeles, California, but does not provide enough information to confirm a remote or hybrid arrangement. Applicants should check the current official listing for the latest work-location policy.

7. What healthcare experience is useful?

Experience with Medicaid, Medicare, and commercial managed care is required. Knowledge of claims adjudication, provider contracts, payment methodologies, coding, pricing, and regulatory requirements is also important.

8. What skills are most important?

Analytical thinking, leadership, claims expertise, communication, conflict resolution, regulatory knowledge, strategic planning, and attention to detail are among the major skills associated with the position.

9. Are benefits included?

The posting lists PTO, tuition reimbursement, retirement plans, medical, dental and vision coverage, a wellness program, and volunteer time off. Eligibility should be confirmed in the current official benefits information.

10. Where should candidates apply?

Candidates should use the official L.A. Care careers listing provided above and verify that the job is still accepting applications before applying.

11. Is relocation assistance available?

The supplied job information does not confirm relocation assistance. Candidates should ask the employer or check the current official posting for applicable relocation policies.

Related Job Suggestions

If this position matches your background, you may also want to search for:

• Senior Healthcare Claims Manager
• Claims Operations Manager
• Payment Integrity Manager
• Provider Disputes Manager
• Healthcare Claims Director
• Claims Adjustments Manager
• Managed Care Operations Manager
• Healthcare Payment Integrity Director

Final Thoughts

The Senior Manager, Claims Adjustments at L.A. Care is aimed at experienced healthcare operations professionals who can combine claims expertise with people leadership and strategic problem solving. The position involves more than resolving individual adjustment cases; it connects complex claims work with compliance, provider relationships, reporting, legal support, financial considerations, and continuous process improvement.

For qualified candidates, the role may be particularly relevant if you are ready to move from hands-on claims or operational management into a broader leadership position. Because requirements and employment details can change, always review the current official listing before submitting your application.

If your experience aligns with the requirements, visit the official L.A. Care careers page and apply through the employer's application system.