The specialist will monitor and audit delegated claims entities to ensure compliance with regulatory and contractual standards. They will also analyze performance metrics, manage corrective action plans, and prepare reports for health plan partners and leadership.
Benefits:
401(k)
401(k) matching
Bonus based on performance
Company parties
Dental insurance
Employee discounts
Health insurance
Opportunity for advancement
Paid time off
Parental leave
Savings bank
Training & development
Vision insurance
Wellness resources
About the Role:
MedPOINT Management is looking for a detail-driven Claims Delegations Oversight Specialist to join our team in Sherman Oaks, CA. In this critical role, you'll help ensure that delegated claims operations meet regulatory and contractual standards, playing a key part in the integrity of our managed care network. If you thrive in a compliance-focused environment and have a passion for healthcare operations, we want to hear from you!
Responsibilities:
Monitor and audit delegated claims entities to ensure compliance with contractual, regulatory, and accreditation requirements
Conduct routine oversight reviews and site audits of delegated claims operations
Analyze claims data and performance metrics to identify trends, discrepancies, and areas of risk
Collaborate with delegate organizations to develop and track corrective action plans (CAPs)
Maintain accurate documentation of oversight activities, findings, and follow-up actions
Coordinate with internal departments including compliance, legal, and provider relations on delegation-related matters
Support preparation of reports for health plan partners, regulatory agencies, and leadership
Requirements:
2+ years of experience in claims processing, managed care, or healthcare compliance
Working knowledge of delegation oversight, NCQA/DMHC standards, and IPA or health plan operations
Strong analytical skills with the ability to interpret claims data and audit findings
Experience developing or managing corrective action plans (CAPs)
Proficiency in Microsoft Office Suite, particularly Excel; experience with claims management systems a plus
Excellent written and verbal communication skills for reporting and cross-functional collaboration
Highly organized, self-motivated, and able to manage multiple priorities in a deadline-driven environment
About Us:
MedPOINT Management is a leading Independent Practice Association (IPA) management company serving the greater Los Angeles area, with decades of experience supporting physician organizations and health plan partnerships. Our clients trust us for our deep expertise in managed care operations, and our employees value the collaborative, mission-driven culture we've built. At MedPOINT, you'll be part of a team that is genuinely committed to improving healthcare delivery for providers and patients alike.
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