Utilization Management & Claims Senior Manager
$100k/y-$140k/y
Akido Labsa day ago
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OnsiteFull-timeSenior
Summary
Akido Labs is seeking a Senior Manager for Utilization Management & Claims to join their team in Chino, CA. The role involves leading and overseeing Utilization Management and Claims operations across multiple IPAs, ensuring regulatory compliance and operational excellence.
About the Role
As a Senior UM & Claims Manager, you will provide strategic oversight of all UM and delegated Claims operations, lead a team of 5–10 professionals, serve as the primary operational liaison for contracted health plans, oversee health plan audits, and monitor key performance metrics. You will also partner with executive leadership to identify process improvements and create SOPs for core workflows.
About You
Required:
- Minimum 10 years of experience in Utilization Management, Claims, Managed Care, or IPA/MSO operations.
- Exceptional organizational, analytical, and process improvement skills.
Preferred:
- Deep expertise in regulatory requirements governing UM and delegated claims functions in California.
- Experience overseeing health plan audits, delegated oversight reporting, ODAG logs, and claims timeliness reporting.
- Demonstrated experience managing teams in a multi-IPA or delegated risk environment.
- Strong knowledge of authorization workflows, medical necessity criteria, and claims adjudication processes.
- Experience serving as a primary operational contact for health plans.
- Proficiency in platforms such as EZCap, EZNet, EMR systems, reporting tools, and health plan portals.
Benefits
- Health benefits include medical, dental and vision.
- 401K.
- Life insurance.
Akido Labs
We are pioneering a reimagined healthcare system; one that bridges technology and empathy to make exceptional healthcare a basic human right. For the first time in history, technology exists to create a healthcare system that anticipates your needs, responds with precision and is always accessible to all, regardless of financial means or geography. This has been our mission since day one. We were founded in 2015 by leaders in technology, social enterprise and hospital administration. Our team is made up of some of the brightest minds in artificial intelligence, healthcare, medicine and engineering, committed to ushering in a new era in care.
Chino, CA