Your Role The Special Investigations Unit team is responsible for preventing, detecting, investigating, and resolving health care fraud, waste, and abuse . The Special Investigations Investigator, Consultant will report to the SIU Manager. In this role you will represent a high level of professionalism both internally and externally. Conduct investigations in accordance w

Workers' Compensation Matter Coordinator Job Locations US CA Woodland Hills Requisition ID 2024 16706 Category Legal Position Type Regular Full Time Overview If you have a deep understanding of California Workers ' Compensation law and are looking to join a dynamic team of professionals, we encourage you to apply for this position. As a Workers Compensation Matter Coordin

Your Work In this role, you will Be responsible for analytic work required to convert pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute Build and update models that allow the actuarial team to quantify financial gaps and opportunities at a provider level Conduct and devel

Conduct on site inspections and assessments of property damages for both residential and commercial claims Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions

Duties WHAT IS THE INFORMATION TECHNOLOGY (IT) DIVISION? A description of the business units can be found at Vacancies will be filled in the following specialty areas Information Technology Applications Development The following are the duties of this position at the full working level. Performs extensive operational reviews, prepares comprehensive program analyses/evalua

Your Role The Federal Employee Program team is responsible for Federal Employee Health Benefits and serves all federal employee is the state of California. The Account Manager Federal Employee Program, Senior Central Valley will report to the Senior Manager, Account Management, FEP. In this role you will be primarily responsible for the sales, retention, and support of go

Your Work In this role, you will Be responsible for converting pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute Create value for the Growth team General Managers by ensuring they have a voice when it comes to key network decisions and network strategy Create value for th

Your Role The Population Health Management (PHM) Governance team, under the state mandate of the California Advancing and Innovating Medi Cal (CalAIM) program, is designed to proactively assess and address the care needs of beneficiaries with tailored interventions. The Business Analyst, Consultant will report to the Sr. Manager, Governance, Population Health Management.

Your Role The Network Management and Provider Partnerships team is responsible for supporting Enterprise led mandates and managing all Business led mandates. The Program Manager, Principal will oversee the intake, review, and impact assessment for all mandates to determine what Network Management teams may be impacted. This role will ensure appropriate representation from

As a Contract Management Specialist, you will join a team responsible for overseeing the day to day management of our proposal and contract management process. You will be responsible for quality assurance reviews of customer proposals and/or Statements of Work. Ensuring accuracy, completeness and compliance with our internal control policies and quality standards (legal,

Duties WHAT IS THE INFORMATION TECHNOLOGY (IT) DIVISION? A description of the business units can be found at Vacancies will be filled in the following specialty areas Information Technology The following are the duties of this position at the full working level. If this vacancy includes more than one grade and you are selected at a lower grade level, you will have the opp

Your Role The Medi Cal Program Support (MPS) team ensures sufficient and complete Medi Cal operational documentation by reviewing and supporting development of business process documentation; development of regulatory data and files process documentation; and development of employee trainings. The Business Analyst will report to the Senior Manager of the Business Process

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Your Role The Network Performance Analysis and Contracts is part of the Provider Partnerships & Network Management Division and focuses on provider network performance analysis, reporting, and consulting. The Data Analyst Health, Experienced will report to the Manager, Data Analysis. In this role you will provide analytical support through the analysis and interpretation

& Responsibilities Design, develop and continuously improve our solutions to provide value to design engineers to validate their design. In particular, the mission is to deliver simulation solutions addressing key mainstream workflows with a focus on filling functional gaps, democratizing the user experience, and striving for best in class performance and robustness. With