Top 165 Insurance manager Jobs in Brisbane, Ca

MSO CLAIMS MANAGER
NORTH EAST MEDICAL SERVICES —Burlingame, CA
- $112,247.20 - $128,752.00 a year
- Full-time
- 5 years
- Analysis skills
- Children
- Health insurance
- Dental insurance
Account Manager
MetLife —San Francisco, CA
- $90,000 - $101,000 a year
- Email
- Mid-level
- 3 years
- High school diploma or GED
- Paid holidays
- Disability insurance
Insurance Case Manager
Ethos Life —San Francisco, CA
- $90,000 - $120,000 a year
- Full-time
- Remote
- Research
- Mid-level
- SQL
- Life insurance
6d
Account Manager - State Farm Agent Team Member
Brandon Yim - State Farm Agent —Burlingame, CA
- $80,000 - $90,000 a year
- Full-time
- Mid-level
- Office
- Leadership
- Paid holidays
- Health insurance
Quick Apply
Manager, Claims Operations
San Francisco Health Plan —San Francisco, CA
- $140,000 - $150,000 a year
- Full-time
- Hybrid work
- Fair chance
- Experience equivalent to degree accepted
- Senior level
- Paid holidays
- Health insurance
Quick Apply
Manager, Claims Compliance
Uber —San Francisco, CA
- $117,000 - $162,000 a year
- Full-time
- Office
- 3 years
- Presentation skills
- 401(k)
Senior Manager, Insurance Customer Operations
Ethos Life —San Francisco, CA
- $110,000 - $130,000 a year
- Full-time
- Remote
- SQL
- Bachelor's degree
- Mentoring
- Life insurance
4d
Insurance Manager
Grubmarket, Inc. —South San Francisco, CA
- $120,000 - $160,000 a year
- Microsoft Outlook
- 5 years
- Finance
Quick Apply
Finance Manager
Victory Honda of San Bruno —San Bruno, CA
- Full-time
- Dealership
- Computer literacy
- Basic math
- Paid holidays
- Health insurance
Quick Apply
Premier Relationship Manager
East West Bank —Daly City, CA
- $80,500 - $135,000 a year
- Full-time
- Mid-level
- Office
- Analysis skills
- Opportunities for advancement
Senior Account Manager- People Solutions
Lockton, Inc. —San Francisco, CA
- $103,000 - $123,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Research
- Wellness program
- Paid parental leave
Account Manager, Employee Benefits
Heffernan Insurance Brokers —San Francisco, CA
- $90,000 - $100,000 a year
- Full-time
- Hybrid work
- Mid-level
- 3 years
- High school diploma or GED
Quick Apply
Strategic Account Manager
Ethos Life —San Francisco, CA
- $124,000 - $220,000 a year
- Full-time
- Remote
- 5 years
- Travel
- Fair chance
- Life insurance
Account Manager, Commercial Lines
Heffernan Insurance Brokers —San Mateo, CA
- $90,000 - $110,000 a year
- Full-time
- Hybrid work
- Mid-level
- 3 years
- High school diploma or GED
Quick Apply
Senior Manager | Sales Reinvention | Insurance
Accenture —San Francisco, CA
- $122,700 - $317,200 a year
- Full-time
- 5 years
- US work authorization
- Military encouraged
- Paid holidays
- Disability insurance
P&C Insurance (Personal & Commercial) Transformation Manager
Accenture —San Francisco, CA
- $87,400 - $293,800 a year
- Full-time
- 5 years
- Analysis skills
- Bachelor's degree
- Paid holidays
- Disability insurance
Account Manager II, Personal Lines
HUB International —San Francisco, CA
- Online Application
- Microsoft Outlook
- Writing skills
- Mid-level
- Health savings account
- Disability insurance
Senior Insurance Risk Manager
Aurora —San Francisco, CA
- $147,000 - $236,000 a year
- Full-time
- Hybrid work
- Office
- Finance
- 8 years
Quick Apply
Private Client Advisor Team Manager
Marsh McLennan Agency —San Francisco, CA
- $89,500 - $166,900 a year
- Full-time
- Hybrid work
- 5 years
- Mid-level
- Travel
- Health insurance
- 401(k)
CMSAF - Dealer Relationship Manager
JPMorganChase —San Francisco, CA
- $93,100 - $145,000 a year
- Full-time
- Dealership
- Bachelor of Science
- Mid-level
- Health insurance
- Tuition reimbursement

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MSO CLAIMS MANAGER

NORTH EAST MEDICAL SERVICES -
Burlingame, CA

Apply Now

Job Details

Full-time
$112,247.20 - $128,752.00 a year

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance

Qualifications

Medicare
Managed care organization experience
CMS
Regulatory compliance in claims processing
Medical claims processing software
CMS regulatory compliance
Medicare regulations
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid regulations
Analytics

Full Job Description

The Claims Manager is responsible for overseeing the end-to-end claims operations within the MSO managed care delegated functions. This role provides guidance on healthcare claims adjudication and payment processing for Medi-Cal, Medicare, PACE, and other lines of business based on member Evidence of Coverages (EOC) and CMS/DHCS guidelines, ensures that claims are processed accurately, timely, and in compliance with regulatory requirements and contractual obligations. The Claims Manager will lead the claims team, implement process improvements, and collaborate with internal and external stakeholders to optimize claims adjudication workflows.

This role requires high-level of decision-making and problem-solving skills in relates to claims operations, compliance, and process improvements. Deep understanding of Medi-Cal, Medicare Advantage, PACE, CMS, and DHCS regulations; ensuring full compliance across the department. Ability to manage multiple priorities, oversee department workflows, and optimize resource allocation. Responsible to design training programs for claims teams and leads initiatives to enhance team expertise. Excellent communication skills to interact with leadership, payers, providers, auditors, and MSO internal departments.

ESSENTIAL JOB FUNCTIONS:

Oversee managed care claims processing, ensuring compliance with CMS, DHCS, and health plan guidelines.
Monitor claims adjudication, ensuring accuracy, timeliness, and regulatory adherence.
Develop and implement policies and procedures to improve claims processing efficiency.
Work with IT and system vendors to optimize claims processing systems and troubleshoot issues.
Lead and mentor the claims team, including Claims Supervisors and processors, ensuring high performance and engagement.
Conduct regular performance evaluations, design training programs, provide training, and develop staff competencies.
Establish and monitor productivity metrics to enhance team efficiency.
Serve as the primary liaison with health plans, providers, auditors, and third-party administrators to resolve claims issues and disputes.
Manage escalations, appeals, and grievances related to claims processing.
Coordinate with provider relations to address claims denials and payment disputes.
Identify areas for process improvement and implement best practices to enhance claims adjudication.
Analyze claims data, trends, and key performance indicators to drive operational enhancements.
Prepare reports for senior management on claims performance, backlog, and issue resolution.
Direct supervision of a department involving responsibility for results in terms of costs, methods and personnel. Responsible for carrying out supervisory/managerial responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing and hiring of employees; planning, assigning, scheduling, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Performs other job duties as required by manager/supervisor.

QUALIFICATIONS:

Bachelor's degree in business, healthcare administration, or related field is preferred; Associate’s degree may be considered with relevant, equivalent work experience.
Experience: Minimum of 5 years in managed care claims and compliance field, with at least 3 years in a managerial role within an IPA, health plan, medical group, or TPA.
Knowledge of: Medi-Cal and MA claims processing, CMS and DHCS regulations, capitated vs. fee-for-service (FFS) models, claims adjudication systems (e.g., EZ-CAP, HealthEdge, Tapestry, or similar).
Skills: Strong analytical, problem-solving, and leadership skills. Proficiency in Excel, reporting tools, and claims systems.

LANGUAGE:

Must be able to fluently speak, read and write English.
Fluency in other languages are an asset.

STATUS:

This is an FLSA Exempt position.
This is not an OSHA high-risk position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

Apply Now

Refine Your Search

insurance manager jobs in brisbane, ca

MSO CLAIMS MANAGER

Account Manager

Insurance Case Manager

Account Manager - State Farm Agent Team Member

Manager, Claims Operations

Manager, Claims Compliance

Senior Manager, Insurance Customer Operations

Insurance Manager

Finance Manager

Premier Relationship Manager

Senior Account Manager- People Solutions

Account Manager, Employee Benefits

Strategic Account Manager

Account Manager, Commercial Lines

Senior Manager | Sales Reinvention | Insurance

P&C Insurance (Personal & Commercial) Transformation Manager

Account Manager II, Personal Lines

Senior Insurance Risk Manager

Private Client Advisor Team Manager

CMSAF - Dealer Relationship Manager

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