Claims Supervisor - Hybrid

Payroll Title:
MGD CARE SPEC 3 Department:
PHSO - MSO Hiring Pay Scale
$98,000 - $140,000 / Year Worksite:
Greenwich Drive Appointment Type:
Career Appointment Percent:
100% Union:
Uncovered Total Openings:
1 Work Schedule:
Days, 8-Hour Shifts, Monday-Friday


#139765 Claims Supervisor - Hybrid

Extended Deadline: Wed 6/24/2026
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UC San Diego values and welcomes people from all backgrounds. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.


UCSD Layoff from Career Appointment : Apply by 06/03/26 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.


Reassignment Applicants : Eligible Reassignment clients should contact their Disability Counselor for assistance.

This position will work a hybrid schedule which includes a combination of working both onsite at Greenwich Drive (San Diego, CA) and remote.

DESCRIPTION

The Claims Supervisor is responsible for direct, day to day oversight of the claim examiners who report directly to this position. The Claims Supervisor serves as the primary point of contact and subject matter expert for the claims team and functions as the go to operational resource for daily claim processing activities. The Claims Supervisor's focus is on execution and consistency within established workflows. Specifically:

• Provides hands on guidance, clarification, and training to frontline claim examiners
• Supports real time problem solving related to individual claims and processing workflows
• Closely monitors claim turnaround times, quality metrics, and productivity
• Distributes and prioritizes work to ensure departmental performance standards are met
• Ensures claims are processed accurately and timely according to defined procedures

Participates in short and long-range planning for the department. Encourages growth and development among staff and serves as role model in areas of appropriate work ethics and professionalism. Establishes and maintains positive relationships with internal departments and internal/external customers. Assists Claims Manager with development, maintenance, monitoring and review of reporting metrics and tools to meet payor delegation and regulatory requirements. Serves as one of the primary points of contact for IT regarding system and software upgrades, testing and implementation. Performs other related duties and projects as assigned. Job standards are to be performed at the EXPERT level.

MINIMUM QUALIFICATIONS

• Seven (7) years of related experience, education/training, OR a Bachelor's degree in related area plus three (3) years of related experience/training.
• Strong interpersonal and customer service skills, with the ability to cultivate and maintain constructive working relationships with both internal and external constituencies
• Proven analytical, critical-thinking, and problem-solving skills, with the ability to assess complex problems, respond effectively to questions and concerns, and identify and present potential solutions.
• Strong detail orientation, organizational and project management skills to negotiate, manage, and track complex managed care contracts
• Highly proficient with MS Office (Word, Excel, PowerPoint, Outlook),specialized contract databases and managed care systems.

PREFERRED QUALIFICATIONS

• Minimum of 2 years' experience processing claims within Epic Tapestry.
• Ability to provide effective direction to Claims Examiners on claim adjudication protocols.
• Lead and/or Supervisory experience.
• Expert knowledge of and experience with HMO claims processing for Commercial and Senior lines of business.
• Strong knowledge of managed care claim regulatory and delegation requirements.

SPECIAL CONDITIONS

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.

Pay Transparency Act


Annual Full Pay Range: $97,200 - $182,000 (will be prorated if the appointment percentage is less than 100%)


Hourly Equivalent: $46.55 - $87.16


Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).

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If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements. If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.


UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and dozens of outpatient clinics. We invite you to join our team!


Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community .

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.

For the University of California's Anti-Discrimination Policy, please visit:


UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.


UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.


Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.


a. "Misconduct" means any violation of the policies governing employee conduct at the applicant's previous place of employment, including, but not limited to, violations of policies prohibiting sexual harassment, sexual assault, or other forms of harassment, or discrimination, as defined by the employer. For reference, below are UC's policies addressing some forms of misconduct:

• UC Sexual Violence and Sexual Harassment Policy
• UC Anti-Discrimination Policy
• Abusive Conduct in the Workplace