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Customer Service Representative (General) 505 City Parkway West
The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and provider with questions related to the Med-Cal programs.
Customer Service Representative, Sr. (OneCare) (Bilingual Required) 505 City Parkway West
The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and provider with questions related to the Med-Cal programs.
Data Analyst, Sr. (Finance - Encounter Data) 505 City Parkway West
The Finance department is responsible for procuring business insurance, reviewing the financial viability of the delegated entities, and processing delegated entities’ inbound encounter data to submit along with in-house claims data to CMS and DHCS as outbound encounter data for all lines of business.
Claims Examiner, Sr. 505 City Parkway West
The Claims Administration Department is responsible for managing and processing of all medical claims in accordance with industry standards and regulations, ensuring accuracy and timely reimbursement to healthcare providers.
Manager, Communications (Digital) 505 City Parkway West
The Manager, Communications (Digital) will lead the strategy, development and execution of content and messaging of CalOptima Health’s digital communications, including oversight of member-facing messaging across platforms such as texting, email, IVR and organization website.
Grievance & Appeals Nurse Specialist 505 City Parkway West
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.
Director, Pharmacy Management (Director IV) 505 City Parkway West
Pharmacy Management provides strategic leadership and operational oversight for all aspects of pharmacy services within a managed care organization.
Programmer Sr 505 City Parkway West
IT provides best-in-class technology solutions that enhance the health outcomes of our members and the community we serve.
Director, Information Technology (Clinical) (Director III) 505 City Parkway West
IT provides best-in-class technology solutions that enhance the health outcomes of our members and the community we serve.
Director, Information Technology (Encounters, EDI, HEDIS/Star) (Director IV) 505 City Parkway West
IT provides best-in-class technology solutions that enhance the health outcomes of our members and the community we serve.
Director, Information Technology (Data Analytics and Artificial Intelligence Technology) (Director IV) 505 City Parkway West
IT provides best-in-class technology solutions that enhance the health outcomes of our members and the community we serve.
Director, Information Technology (Claims, Membership, Benefits, Provider and Contact Center) (Director IV) 505 City Parkway West
IT provides best-in-class technology solutions that enhance the health outcomes of our members and the community we serve.
Claims Examiner Sr 505 City Parkway West
The Claims Examiner Sr. analyzes and processes claims. This position is responsible for following regulatory and internal guidance 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. 3-4 years of health claims processing background. Knowledge of Medicare and Medi-Cal processing preferred. Examiner is expected to adjudicate tier one claim type 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 investments is that the approval of this position will allow us to continue meeting regulatory compliance and timeliness requirements.
Claims Examiner Sr 505 City Parkway West
The Claims Administration Department is responsible for managing and processing of all medical claims in accordance with industry standards and regulations, ensuring accuracy and timely reimbursement to healthcare providers.
Program Assistant (Quality Initiatives) 505 City Parkway West
CalOptima Health is seeking a Program Assistant to provide administrative support projects and department leadership.
Customer Service Rep (CCSC) (Bilingual Required) County Community Service Center - Brea
The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and provider with questions related to the Med-Cal programs.
Intern (Training and Education) 505 City Parkway West
The Human Resources department fosters and engaged and inclusive workplace culture that helps supports and empowers our employees to serve our members and the community.
Activity Coordinator (PACE) PACE - Garden Grove
PACE is a health services plan designed for people of age 55 and older, who have ongoing health care needs. The services provided are all inclusive and authorized by the interdisciplinary team.
Program Specialist, Sr. (Community Relations) 505 City Parkway West
The Community Relations Department strives to strengthen partnerships by enhancing communications, understanding, and mutual support between CalOptima Health and community organizations.
Buyer 505 City Parkway West
Vendor Management is responsible for obtaining goods and services needed by CalOptima, ensuring compliance with all statutes and regulations regarding public procurement.

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