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Grievance & Appeals Nurse Specialist
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505 City Parkway West
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| The Grievance and Appeals Resolution Services (GARS) Department is responsible for coordinating thorough reviews to provide appropriate resolutions to verbal and written complaints, appeals and disputes for both members and providers. |
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Claims Examiner
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505 City Parkway West
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| The Claims Examiner analyzes, and processes claims. This position is responsible for following regulatory and internal guidelines in conjunction with CalOptima policies and procedures as they apply to claims adjudication. The Claims Examiner is responsible to adjudicate claims that require minimal research and problem solving. 1 - 2 years of health claims processing background. Knowledge of Medicare or Medi-Cal processing line of business preferred. Examiner is expected to adjudicate tier one claim types with attention to detail in order that high quality standards are met. The challenge of consistently and accurately processing an increased volume of claims in a production environment is attainable with appropriate staffing levels. The return on the investment is that approval of this position will allow us to continue meeting regulatory compliance and timeliness requirements. |
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Program Specialist Int
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505 City Parkway West
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| The Provider Data Operations department is responsible for managing operations of the provider network to ensure timely access to care for our members. |
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Intern (Communications)
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505 City Parkway West
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| The Communications department is here to create, support, implement and direct CalOptima’s internal and external communications in a manner that promotes and preserves CalOptima, its mission, and strategic goals and objectives. |
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Sr. Program Manager, Strategic Initiatives
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505 City Parkway West
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| The Program Manager Sr for Strategic Initiatives plays a vital role in the program design, development, implementation and overall support of strategic initiatives, pilots and programs related to the department’s priorities. |