Claims Delegations Oversight Specialist

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.

This is a remote position.