Top 16 Senior claims representative Jobs in Diamond Bar, Ca

Senior Director of Billing and Regional Center Relations
CAPC, Inc. —Whittier, CA
- $73,000 - $78,000 a year
- Full-time
- Bilingual
- Background check
- Microsoft Excel
- Health insurance
- 401(k)
Quick Apply
Senior Litigation Construction Liability Claims Representative
The Travelers Companies, Inc. —Diamond Bar, CA
- $94,400 - $155,800 a year
- Hybrid work
- Customer service
- Research
- Residential
- Wellness program
- Paid holidays
6d
General Liability Senior Technical Specialist
The Travelers Companies, Inc. —Diamond Bar, CA
- $94,400 - $155,800 a year
- Hybrid work
- Residential
- High school diploma or GED
- Analysis skills
- Wellness program
- Continuing education credits
Sr. Auto Appraiser
USAA —Los Angeles, CA
- $63,590 - $121,530 a year
- Weekends as needed
- Hybrid work
- Background check
- Military
- High school diploma or GED
- Paid holidays
- Health insurance
6d
Sr. Auto Appraiser - Field
USAA —Los Angeles, CA
- $63,590 - $121,530 a year
- Weekends as needed
- Hybrid work
- Background check
- Military
- 3 years
- Paid holidays
- Health insurance
14d
Part-Time - Customer Service Representative Sr (OneCare) (Bilingual Required)
CalOptima —Orange, CA
- Weekends as needed
- Background check
- Microsoft Outlook
- Writing skills
- Tuition reimbursement
- Paid time off
2d
Sr Safety & Health Consultant
Zenith Insurance Company —Orange, CA
- $109,728.11 - $137,160.14 a year
- Full-time
- 3 years
- Master's degree
- High school diploma or GED
- Paid training
- Paid parental leave
Senior Claim Examiner I
AmTrust Financial Services, Inc. —Irvine, CA
- $49 - $54 an hour
- Full-time
- Mid-level
- 3 years
- Bachelor's degree
- Health insurance
- Dental insurance
Senior Claims Examiner - 4850
Athens Administrators —Orange, CA
- $50.29 - $55.87 an hour
- Urgently hiring
- Management
- Bachelor of Science
- Basic math
- Health savings account
- AD&D insurance
Quick Apply
Senior Claims Examiner
WESTERN GROWERS ASSURANCE TRUST —Irvine, CA
- $53,667.86 - $69,768.32 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Flexible spending account
Quick Apply
13d
Senior Workers Compensation Claims Advocate
Alliant Insurance Services —Irvine, CA
- $150,000 - $160,000 a year
- Email
- Analysis skills
- Bachelor's degree
- Experience equivalent to degree accepted
Quick Apply
Senior Claims Advocate- P&C
EPIC Brokers —Los Angeles, CA
- $110,000 - $125,000 a year
- Hybrid work
- 7 years
- Basic math
- Office
- Paid parental leave
- Paid holidays
Quick Apply
6d
Senior Customer Care Specialist, PCGS
Collectors —Santa Ana, CA
- $26 an hour
- Email
- Research
- US work authorization
- Ability to sit for extended periods
- Commuter assistance
- Paid holidays

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Senior Director of Billing and Regional Center Relations

CAPC, Inc.
Whittier, CA

Quick Apply

Job Details

Full-time
$73,000 - $78,000 a year

Benefits

Health insurance
401(k)
Tuition reimbursement
Paid time off
Vision insurance
Professional development assistance
Flexible schedule
Life insurance
Referral program
Retirement plan

Qualifications

Microsoft Excel
Financial data reconciliation
Team supervision
Accounts receivable management
Driver's License
Supervising experience
Medical billing account reconciliation
Document management systems
Excel data analysis

Full Job Description

POSITION TITLE:

Senior Director of Billing and Regional Center Relations

REPORTS TO:

Chief Executive Officer

SUPERVISORY RESPONSIBILITY:

Part-Times Billing and Quality Assurance Coordinator and other assigned revenue-cycle personnel

POSITION SUMMARY

The Senior Director of Billing and Regional Center Relations leads CAPC’s revenue-cycle operations and serves as the principal organizational liaison for Regional Center authorizations, billing, rates, vendorization, fiscal matters, and related reporting. The position protects CAPC’s revenue by ensuring that eligible services are authorized, supported, billed, reconciled, collected, and reported accurately while maintaining effective relationships across CAPC’s funding partners.

PAY SCALE: $73,000 - $78,000 Annually

Revenue-Cycle Leadership

· Own the end-to-end monthly billing cycle across Regional Centers, programs, service codes, and other assigned funding sources.

· Establish a written billing calendar, departmental cutoffs, review steps, final submission controls, backup procedures, and continuity plans.

· Validate billing against active authorizations, approved rates, unit rules, service schedules, and required supporting documentation.

· Ensure claims are submitted accurately and timely and evidence of preparation, review, approval, and submission is retained.

· Monitor unbilled services, billing holds, denials, underpayments, overpayments, aging receivables, adjustments, and write-off recommendations.

· Coordinate payment research, corrections, rebilling, recovery, and month-end reconciliation with accounting.

Authorization and Rate Management

· Maintain a centralized authorization record including individual, payer, service code, rate, unit type, effective dates, authorized units, utilization, and expiration.

· Provide service leadership with advance notice of authorizations that are expiring, insufficient, missing, or inconsistent.

· Resolve authorization, rate, and service-code discrepancies with Regional Centers and CAPC leadership.

· Prevent billing that exceeds authorizations, lacks support, uses an incorrect rate, or otherwise fails established requirements.

· Maintain current guidance and source documentation for rates, billing rules, payer changes, and submission procedures.

Regional Center Relations and Growth

· Serve as CAPC’s lead contact for Regional Center fiscal, vendorization, rate-setting, billing, contract, and administrative matters.

· Coordinate with the VP of Services on programmatic relationships with service coordinators and other service personnel.

· Support expansion into additional Regional Center service areas, including vendorization, new service codes, rates, location requirements, and payer readiness.

· Maintain a relationship and issue log showing commitments, owners, due dates, and unresolved matters.

· Escalate significant payer, authorization, collection, or compliance concerns to the CEO.

Analysis and Reporting

· Prepare monthly revenue and utilization reporting by Regional Center, program, team, service code, and other meaningful dimensions.

· Produce the Regional Center revenue breakdown for CAPC’s monthly Board financial dashboard.

· Explain significant fluctuations in billing, collections, utilization, authorizations, and unbilled services.

· Develop revenue projections using active authorizations, service capacity, utilization, rates, and collection history.

· Identify operational causes of lost or delayed revenue and recommend corrective action.

Controls, Audit, and Team Leadership

· Maintain complete billing, authorization, remittance, reconciliation, and audit-support records according to applicable requirements.

· Supervise the Billing and Quality Assurance Coordinator while preserving the Coordinator’s direct escalation access to the CEO for suspected unsupported billing, falsification, retaliation, or unresolved material compliance concerns.

· Ensure Billing personnel do not create, backdate, or improperly modify service-delivery records.

· Place unsupported or questionable items on billing hold and refer material concerns to the CEO.

· Develop written procedures, train assigned staff, establish performance expectations, and maintain adequate cross-training.

· Provide billing-readiness and authorization training to service leaders and administrative personnel.

Decision-Making Authority

· Approve routine billing corrections and submissions after required control steps are complete.

· Place claims on hold when authorization, documentation, rate, or integrity concerns exist.

· Communicate directly with Regional Center fiscal and vendorization representatives on behalf of CAPC.

· Assign work and evaluate supervised billing personnel.

· Recommend write-offs, staffing, systems, payer strategies, and corrective actions; final approval remains subject to CAPC policy.

· May no create missing service documentation, approve unsupported billing, execute contracts, or waive material requirements

Key Working Relationships

· CEO; VP of Services; VP of Operations; VP of Development; accounting team.

· Billing and Quality Assurance Coordinator; Service Directors, Case Managers, schedulers, and other assigned billing personnel.

· Regional Center fiscal, vendorization, rate, contract, and service-coordination representatives.

Performance Indicators

· At least 98% of eligible services billed by the established monthly deadline.

· Unbilled eligible services maintained below 2%, excluding documented payer or authorization delays outside CAPC’s control.

· Monthly billing-to-remittance-to-accounting reconciliation completed on schedule.

· Authorization expirations identified at least 30–60 days in advance.

· Denials, underpayments, and material variances researched within five business days.

· No billing knowingly submitted without active authorization and sufficient supporting documentation.

· Regional Center dashboard delivered with the monthly financial package.

· Reduction in preventable write-offs, late claims, recurring errors, and delayed collections.

QUALIFICATIONS

Required

· Bachelor’s degree in accounting, business, healthcare administration, nonprofit management, or a related field; substantial directly related experience may be considered

· Five years of billing, revenue-cycle, accounts receivable, payer, or funding-source administration experience.

· Supervisory, team-lead, or significant project-lead experience.

· Demonstrated ability to reconcile complex data and explain financial and operational variances.

· Advanced Excel skills and proficiency with billing, reporting, and document-management systems.

· Strong integrity, discretion, attention to detail, and written communication.

Preferred

Regional Center billing, vendorization, rate, or authorization experience.
Experience in intellectual and developmental disability services or another government-funded human-services setting.
Experience building dashboards, billing controls, procedures, and audit-ready records
Bilingual ability relevant to CAPC’s service area.

Core Competencies

· Revenue-cycle ownership and analytical discipline.

· Relationship building with funding partners.

· Control-minded judgment and ethical decision-making.

· Clear cross-functional communication and issue resolution.

· Deadline management, accuracy, and continuous improvement.

Other Requirements and Working Conditions

· Ability to work onsite as required for records, collaboration, audit support, and operational continuity.

· Ability to work limited additional hours around approved billing deadlines when necessary.

· Valid California driver’s license and insurability when travel is an essential assigned duty.

· Successful completion of applicable background and organizational requirements.

· Reasonable accommodations will be considered in accordance with applicable law.

Pay: $73,000.00 - $78,000.00 per year

Benefits:

401(k)
Flexible schedule
Health insurance
Life insurance
Paid time off
Professional development assistance
Referral program
Retirement plan
Tuition reimbursement
Vision insurance

Work Location: In person

Quick Apply

Refine Your Search

senior claims representative jobs in diamond bar, ca

Senior Director of Billing and Regional Center Relations

Senior Litigation Construction Liability Claims Representative

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Sr. Auto Appraiser - Field

Part-Time - Customer Service Representative Sr (OneCare) (Bilingual Required)

Sr Safety & Health Consultant

Senior Claim Examiner I

Senior Claims Examiner - 4850

Senior Claims Examiner

Senior Workers Compensation Claims Advocate

Senior Claims Advocate- P&C

Senior Customer Care Specialist, PCGS

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