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Supervisor, Claims Optimization

San Francisco Health Plan

San Francisco Health Plan

People & HR, Operations
San Francisco, CA, USA
Posted on Saturday, September 2, 2023

We have an excellent new opportunity within our Claims Operations Team at San Francisco Health Plan (SFHP)

The Supervisor, Claims Optimization, oversees the daily activities of Claims Analysts. You are responsible for optimizing Claims operations, driving automation initiatives, development of reports, and data analysis. In addition- you will conduct team training, develop user acceptance testing (UAT), and develop policies and procedures updates. This position aims to optimize the claims processing, ensure compliance with healthcare regulations, and drive continuous improvement within the department.


  • Supervise a team of Claims Analysts in data analysis, operations enhancements, process automation, training, P&Ps and desktop procedures updates, and UAT to optimize Claims operations.
  • Conduct in-depth analysis of claims data to identify trends, anomalies, and opportunities for improvement.
  • Identify and implement automation strategies to streamline claims processing and works with other departments to reduce Claims manual intervention.
  • Analyze ROI on claims backlog and uses this information to drive prioritization of ongoing work in consultation with the Claims Leadership.
  • Represent Claims in projects and other stakeholder forums. Work with the Claims Manager to lead the development of business requirements and test scenarios for organizational projects.
  • Proactively identify issues and provide recommendations for improvement and resolution.
  • Collaborate with the Claims Manager to identify staff training needs and conducts training programs to enhance the skills and knowledge of the Claims team.
  • Collaborate with IT, Business Solutions, and other departments to improve system capabilities, drive automation, and implement new enhancements.


  • Five years of experience in managed health care, Medi-Cal, and Medicare programs
  • One to three years of leadership experience
  • Solid understanding of standard claims processing and claims data analysis
  • Solid working knowledge of claims coding, regulation requirements, and medical terminology
  • Superb skills in collecting and analyzing data
  • Proficiency in QNXT, especially claims-related functions desired
  • Knowledge of SQL and complex data analysis is preferred
  • Expertise in conducting all necessary research to identify complex claims issues accurately. Strong knowledge of claims processing in managed care plans, Medi-Cal, and Medicare programs
  • A bachelor’s degree in business, health care administration, or a related field or equivalent experience


  • Medical Plans: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the HMO plans are currently available at no cost and dependent coverage is heavily subsidized by SFHP.
  • Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available at no cost.
  • Time Off: 23 days of Paid Time Off and 12 observed company holidays.
  • Professional development: Opportunities for tuition reimbursement, professional license/membership.

Established in 1997, San Francisco Health Plan (SFHP) is an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 170,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports and respects all individuals and in which our processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.