Sharp HealthCare · 1 day ago
Manager Claims Admin - PFS Claims Processing - Sharp Corporate - Day Shift - Full Time
San Diego, CA
Full-time
Onsite
Mid, Senior Level
$51.38/hr - $81.22/hr
3+ years expSharp HealthCare is a leading healthcare provider, and they are seeking a Manager Claims Admin to oversee the claims units for Sharp Managed Care Contracts. The role involves managing daily operations, staff training, and ensuring efficient claims processing while maintaining high accuracy and turnaround times.
Non ProfitHealthcareHealth Care
Responsibilities
Leadership Display professionalism and teamwork in promoting the Mission, Goals, and Objectives of Sharp Healthcare. Recruit, hire, motivates staff to perform at a level that consistently meets expectations. Develop, train, counsel staff, and conduct performance appraisals. (Standard: Employee turnover rate kept at or below corporate standard and complete performance appraisals in a timely manner 98% of the time
Daily Operations Manage the daily operations of the claims department maintaining claim turnaround times at 95% processed within four weeks, 95% of the time, and maintaining accuracy rates of 95% procedural and 98% financial. Develop reporting and follow through mechanisms to document departmental efficiency and productivity. Responsible for the development and implementation of continuous quality improvement and measurement of claims unit effectiveness
Training Coordinate continuing staff training and establish quality and productivity standards to be reported monthly. Provide input into claims policy and procedure manuals. Effectively communicate departmental policies to staff and other affected areas
Application Management Participates in the development and implementation of improvements in software functionality, workflow and system integration
Internal and External Customer Service Interface with Health Plans, Providers, Members, and Medical Groups to resolve issues in a professional manner that maintains consistently positive relationships. Demonstrate a positive, professional and contributory posture in all matters requiring interface with customers, both internal and external. (Standard: Consistent positive feedback from staff, peers, and external customers. Less than 2 exceptions noted per year)
Safety Demonstrate safe work practices by identifying and reporting potential safety hazards to appropriate personnel, including but not limited to the following: Assuring staff’s appropriate chair height, keyboard and screen placement, securing of electrical wiring, use of proper body mechanics, etc. Attend annual Safety Fair. (Standard: 1 exception noted per year and attends annual Safety Fair)
Qualification
Required
3 years' experience in the HMO industry to include claims, customer service, and/or health insurance management
2 years leadership experience
Bachelor's degree in business, health services, management, or relevant field; or 4 years of relevant experience in the healthcare industry may substitute for the degree
Preferred
Experience with EPIC Tapestry
Company
Sharp HealthCare
Sharp HealthCare is a not-for-profit integrated regional health care delivery system based in San Diego, Calif.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Parkinson's Foundation
2023-07-25Grant
Leadership Team
Dan Exley
Vice President of Clinical Systems
Recent News
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2026-01-07
2025-12-27
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