Claims Manager

South San Francisco, CA 94080 | Direct Hire

Post Date: 02/28/2018 Job ID: 12632 Industry: Clinical & Scientific

Bayside  Solutions is seeking a Claims Manager  to be a part of our partner’ s team in the South San Francisco. This is an opportunity to provide access to a stable and comprehensive network of providers, and a benefits program that promotes preventive care with staff devoted to ensuring Medi-Cal patients receive high quality, coordinated health care.

Our Company Bio:  Bayside Solutions was founded in 2001, Bayside was recognized as one of the fastest growing professional staffing companies in Northern California. The numbers tell the story: We have close to a 100% client retention rate, 700% growth in four plus years and over 95% repeat business. Our dedication to building partnership relationships with both our clients and our recruits is the key to our phenomenal success.

You can find additional information on our company website at

Claims Manager

Job Benefits:
  • An opportunity to join a local non-profit health care plan that offers health coverage and a provider network to San Mateo County' s under-insured population.
  • Company that currently serve more than 145, 000 County Residents
  • Competitive compensation commensurate with experience
  • Excellent benefits package offered, including HPSM paid premiums for employee’ s coverage in the medical HMO plan and majority of PPO medical cost.

Summary of Responsibilities:


This role will manage the functional operation of assigned claims activities.  This may include claims processing, claims adjudication, or/and quality assurance. 

The essential duties and responsibilities will include the following:    
  • Accomplish staff results by communicating  job expectations; planning, monitoring, and appraising  job results; coaching, counseling, and implementing  corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.  Complete performance evaluations in a timely manner.
  • Develop strategies and schedules for meeting stated goals.  
  • Continuously monitor and evaluate unit performance and take steps to improve the efficiency and quality of unit operations. 
  • Create and update unit procedures, workflows, and resource material.
  • Effectively implement and maintain processes and workflows to meet the needs of internal and external customers. 
  • Implement necessary policy and regulatory changes. 
  • As required, develop and manage auditing and quality control processes.
  • Be available as a resource and functional area expert to other HPSM employees. 
  • Analyze new or updated regulations, laws and contract language and implement appropriate changes to internal policies, procedures and workflows
  • Maintain knowledge of industry trends, best practices, and regulatory requirements.
  • Facilitate and document meetings.
  • Perform other duties as assigned.



Required Qualifications:
  • Education and Experience: Bachelor’ s degree in business, finance or related field. Five (5) years of claims management experience with at least two (2) years in a supervisory role. 

  • Knowledge of: Medi-Cal and Medicare programs. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint. Supervisory principles and practices as well as techniques and methods to organize and manage direct reports.

  • Ability to: Manage multiple priorities of a complex nature and meet deadlines. Motivate, guide and lead staff to excellence. Communicate effectively, verbally and in writing. Analyze and problem solve, making good decisions. Provide excellent customer service.



Submissions without a Cover Letter and salary expectations may not be considered.




Felicia Id-Deen

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