Manager, Claims Compliance

Salary Range: $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Manager, Claims Compliance is responsible for ensuring Core Administrative Operations meet federal, state, and contractual regulatory requirements. This position oversees regulatory interpretation, operational compliance monitoring, corrective action oversight, and the development and delivery of operational training across all claims-related functions. The Manager establishes and maintains documentation standards, partners with operational leaders to evaluate compliance risk, and develops training and readiness programs that ensure staff consistently understand rules, follow procedures, and meet regulatory expectations. The Manager serves as the primary compliance liaison for Core Administrative Operations, ensuring that regulatory requirements are embedded into workflows, policies, and training. This position partners closely with the key stakeholders to ensure alignment between compliance oversight, audit findings, training programs, corrective action planning, and quality outcomes. The Manager leads a team responsible for training development, operational compliance validation, regulatory change management, policy governance, and operational readiness. The Manager fosters a culture of compliance, accuracy, clarity, and continuous learning across the Core Administrative Operations ecosystem. The Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. Participates and make recommendations on the department's strategic planning and/or long-term decision-making. Duties Ensures that Core Administrative Operations has a strong and sustainable compliance foundation. Interprets regulatory guidance, identifies compliance risks, develops training that operationalizes regulatory changes, and builds documentation that ensures accuracy and audit readiness. Strengthens operational integrity, improves adherence to state/federal requirements, and equips staff with the knowledge and tools needed to process claims accurately and consistently through cross-functional collaboration, transparent communication, and structured oversight. Monitors compliance with regulatory agencies, NCQA, and contractual requirements related to claims processing, adjustments, disputes, configuration, and payment accuracy. Interprets new and updated regulations, determines operational impacts, and guides leaders in implementing compliant workflows across key stake holders. Oversees compliance monitoring and internal validation activities, ensuring critical regulations (TATs, notices, interest, benefit/payment rules, documentation) are consistently met. Serves as subject-matter expert on regulatory and contractual requirements affecting claims and related administrative functions. Partners with the key stakeholders to ensure compliance findings are integrated into testing programs, CAP validation, and quality standards. Designs, implements, and oversees comprehensive operational training programs across cross functional teams. Develops training curricula for benefit/authorization interpretation, regulatory updates, pricing/reimbursement requirements, provider contract terms, system logic impacts, and other operational topics. Ensures training incorporates regulatory expectations, audit findings, corrective action themes, and emerging rules. Maintains an enterprise training repository (SOPs, desk procedures, job aids, reference guides) to ensure consistent understanding and execution. Provides onboarding training, cross-training programs, and targeted training for new systems, regulatory changes, and operational enhancements. Partners with key stakeholders to ensure staff have the knowledge required to maintain accuracy in a highly regulated environment. Duties Continued Oversees creation, maintenance, and governance of policies, procedures, desk-level workflows, and job aids across Core Admin Ops. Ensures documentation is aligned with current regulatory requirements, contractual obligations, and operational processes. Maintains structured documentation approval processes and version control to support audit readiness and com