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Sr Manager, Operation and Business Configuration (Sr Manager I) CalOptima CalOptima Health is seeking a highly motivated Sr Manager, Operation and Business Configuration (Sr Manager I) to join our team. The Sr Manager I for Operation and Business Configuration will function as a primary point of contact for the claims analytical support unit which consists of data analytics, process improvement and claims clearinghouse vendor oversight. The incumbent will collaborate with leadership on the development and implementation of analytical tools to identify department trends and will manage dedicated resources for the day-to-day operations to carry out the strategic and tactical execution of CalOptima Health business operations, ensuring compliance with business rules and government regulations. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 316 - $120,881 - $193,410 ($58.12 - $92.9856) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>40% - Leadership Functions
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.</li>
<li>Hires, manages, trains, reviews and sets goals for the department and staff.</li>
<li>Provides an environment that engages staff to fully participate in the overall department functions and workload balancing strategies.</li>
<li>Develops and implements corrective action plans and trains staff as needed.</li>
<li>Establishes and manages teams to a set of standards and governance to improve performance and support effective development and outputs.</li>
<li>Provides management oversight and direction to Data Analysts Business team and serves as a liaison with internal and external entities such as Clearinghouse and health networks to ensure claims and authorization data load integrity.</li>
<li>Provides management oversight and direction to the Clearinghouse Data Analyst team for intake requirements, analysis, conducting clearinghouse user acceptance testing and identifies impacts to systems and processes.</li>
<li>Tracks and trends teams performances by way of dashboards, monitoring day-to-day activities of each claim operational areas, claims operational vendors and all clearinghouses.</li>
<li>Represents Claims department and participates in regulatory audit presentations and demonstrations and conducts follow up remediation action items from the audit as needed.</li>
<li>Works collaboratively with the Office of Compliance, Information Technology (IT), claims vendors and internal business teams on regulatory changes impacting claims adjudication and data integrity.</li>
<li>Manages all claims vendor contract or scope of work (SOW) renewals and takes the lead for any request for proposal projects.</li>
<li>Participates in CalOptima Health's enterprise projects impacting claims or operational payments and procedures/policies.</li>
<li>Conducts claims presentation to staff, senior level leadership and CalOptima Health network providers.</li>
<li>Maintains quality goals and production level within the department by collaborating with Claims department leadership teams and ensures that performance goals are consistently met and/or exceeded.</li>
<li>Anticipates future demands of initiatives, strategic plans and regulatory updates and design/implement solutions to meet these needs. </li>
</ul>
</li>
<li>35% - Program Oversight
<ul>
<li>Ensures compliance with applicable internal policies and procedures and external state and federal regulations for multiple product lines (Medi-Cal, Medicare, Commercial (Covered California) and Program of All-Inclusive Care for the Elderly (PACE). Ensures overall claims adjudication is in accordance with the California Department of Managed Health Care (DMHC), California Department of Health Care Services (DHCS) and Centers for Medicare &amp; Medicaid Services (CMS) health plan regulatory requirements and guidelines.</li>
<li>Intakes and reviews All Plan Letters (APL), CMS bulletins and regulatory guidance; oversees the development, timely and accurate implementation and publication/posting of claims-related regulatory requirements and reporting.</li>
<li>Serves as the primary point of contact to answer questions related to system configuration business rules, various claim adjudication issues and resolves complex claims or benefit adjudication issues for department staff as well as other internal customers; responsible for the identification and resolution of provider claim issues including support of provider education and customer service staff in communications back to providers.</li>
<li>Reviews and maintains department policies and procedures, recommends changes for more efficient operations, drafts new policies and procedures for director's review, communicates changes and updates to staff when appropriate.</li>
<li>Stays current with regulatory guidelines impacting essential functions and data requirements. </li>
</ul>
</li>
<li>20% - Technical Operations
<ul>
<li>Develops the claims data standards and deploys automation tools to obtain and process claims data from different sources. Constructs datasets to analyze, inform, identify trends and support stakeholder decision-making.</li>
<li>Identifies claims transaction inconsistencies, as well as implementation of controls and changes to systems and policies that support claims adjudication, thereby minimizing incorrect claims payment.</li>
<li>Manages activities/service requests with Facets configuration, IT and EDI teams to scope, prioritize, and implement requirement changes.</li>
<li>Manages and intakes all program implementation impacting Facets and systems supporting the Claims, Grievance and Appeals Resolution Services (GARS)/Provider Dispute Resolution (PDR) and Customer Service operations. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in health information management, business administration, health administration or related field PLUS 5 years of experience in information technology business experience implementing claims adjudication programs and projects in a health plan setting required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>5 years of management/leadership experience that manages claims operation from intake to output of the claims payment required. </li>
<li>5 years of experience utilizing Microsoft technologies required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>N/A</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6581261&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 22, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6581261" target="_blank">https://jobs.caloptima.org/jobs/sr-manager-operation-and-business-configuration-sr-manager-i-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-db1ce4f6b297cc42b37b4c6342de152b

Sr Manager, Operation and Business Configuration (Sr Manager I)

Sales/Trader (Prime Services) (SG Americas Securities, LLC, New York, NY)
Multiple positions available. Analyze market conditions, regulations, and financial data to identify investment opportunities. Ensure full compliance with investment policies, including CFTC rule 1.25 and SEC Rule 15c3-3, for all customer assets deposited under the bank’s FCM and Securities Prime Brokerage activities. Adhere to and ensure compliance with IIROC regulations in relation to SGCC FCM operations. Oversee the protection, investment, and placement of customer cash and non-cash collateral, working closely with Treasury, Operations, and Finance teams. Escalate any regulatory, operational, or trading issues as needed. Optimize customer cash and non-cash collateral across external and internal counterparties, fixed income reverse repo trading, CCPs, banks, and carrying brokers while meeting performance targets. Manage borrowings from Treasury, ensuring optimal placements, investments, and returns. Execute foreign exchange (forex) hedging to support single currency margining product. Collaborate with the Risk Management team to ensure adherence to trading risk metrics such as DV10, VaR, and stress testing. Participate in CCP and exchange collateral meetings. Support IT development efforts by enhancing trading tools and systems, including automation, pricing engines, analytical tools, and new hedging strategies. Provide short coverage and long financing on securities to external clients through internal desks. Offer financing solutions to Prime clients (Hedge Funds, PTGs, Asset Managers). Collaborate with internal teams to drive synergies in secured financing. Develop and execute strategies to grow the business sustainably, ensuring a diversified and recurring revenue stream. Optimize global book positions and scarce resources, including cash consumption, liquidity ratios, and balance sheet management. Manage daily risk exposure, position tracking, risk follow-ups, and Profit &amp; Loss (P&amp;L) analysis. Provide market insights and money market updates to client as part of their Prime Services experience. Salary: $ 152,339 -$275,000 per year.
 MINIMUM REQUIREMENTS: Master's degree or U.S. equivalent in Financial Engineering, Mechanical Engineering, Finance, Economics, Statistics, or related field, plus 3 years of professional experience as a Trader, Financial Quantitative Analyst or any occupation/position/job title optimizing Client Collateral at a global financial institution.
Must also have the following: 3 years of professional experience working in a global bank with Future Commission Merchants (FCMs) or Broker Dealers (BDs); 3 years of professional experience utilizing risk knowledge to combine proprietary and CCP models for exchange traded derivatives (including VaR, cVaR, ES, SIMM, IMM, Exchange IM (including SPAN and Prisma), 3F, and Cross Margin); 3 years of professional experience analyzing balance sheets (in US GAAP and IFRS norms) and scarce resources including RWAs, Leverage, LCR and NSFR; 3 years of professional experience performing collateral management and book optimization of scarce resources (including axis, balance sheet optimization for both long and short, and pricing); 3 years of professional experience pricing Options and Futures Clearing, Financing (Loan and Synthetic) and OTC and FX Clearing portfolios; 3 years of professional experience adhering to regulatory rules governing client asset including the protection of customer assets; and 3 years of professional experience performing agency execution and optimization trades and investments (including reverse repo and FX swaps).
CONTACT: Please email resume to: <a href="mailto:us-humn-recruitment@sgcib.com" target="_blank">us-humn-recruitment@sgcib.com</a>. Must specify Ad Code KLGKCK in the subject line. &nbsp;

Sales/Trader (Prime Services)

IT: Saks.com LLC seeks Application Analyst-- Service Cloud in NY, NY to support new &amp; existing Salesforce user base w/questions &amp; issues across Service Cloud. Req'mts: Bachelor's or foreign equiv in CS, Info. Systs, Softw Eng'g or rel. field &amp; 2 yrs of exp in job offered or rel. occupation: utilizing technologies such as Lightning, Apex, SOQL, REST Web services to build features in Service Cloud; exercising knowledge of Salesforce Objects, Data Model, &amp; Salesforce Standard Objects &amp; bus. processes to understand bus. req'mts, review peer changes, write unit tests &amp; fix defects in Contact Center app; utilizing exp w/Salesforce governor limits, licensing, &amp; best practices to support Customer Service operations; &amp; identifying &amp; applying best practices, standards &amp; SDLC concepts to all functional areas. Telecommuting &amp;/or work from home may be permissible pursuant to company policies. Offered salary is btwn $115,763.00 to $142,800.00/yr. Pls email resume to <a href="mailto:jobs@saks.com" target="_blank">jobs@saks.com</a>. Ref: SY06112025NYT.

Application Analyst-- Service Cloud

Application Developer, IBM Corporation, Armonk, NY and various unanticipated client sites through the US (Up to 40% telecommuting permitted): Participate in end to end interaction with the client and end user to understand the business requirements. Understand client pain areas and provide user friendly solutions. Work as technical expert for Enterprise Asset Management (EAM) processes by reviewing the processes and mitigate any required audit exposure in the various functional modules like asset management, work management, and service request management which is implemented in Maximo. Create new attributes, roles, actions as per business requirement. Design UI by using application designer application in Maximo. Ensure on time delivery of the solutions for the tickets that are received on Maximo. Lead application maintenance and support. Deploy the final solution to production and keep track of every change throughout the development cycle. Monitor all environment health and make sure all environments are up and running it in its full capacity. Monitor the interfaces and cronjobs to ensure transactions are successful at Maximo end. Perform planned system outages and unplanned system outages for the system maintenance. Perform all deployment activity single handedly and ensure system are back online on time. Ensure timely documentation of functional and technical changes to Maximo 7.6/Maximo Anywhere 7.6.2. Provide fixes to already existing solutions that are not user friendly or throwing error and can be avoided by customizing Maximo 7.6. Utilize: Maximo, WebSphere/WebLogic, Oracle, Linux/Windows Servers, SQL, Java, Jython, Python, Putty and Agile Methodology. Required: Bachelor's degree or equivalent Engineering, Science, Information Systems or related and two (2) years of experience as an IT Consultant, Software Analyst or related. Two (2) years of experience must include utilizing Maximo, WebSphere/WebLogic, Oracle, Linux/Windows Servers, SQL, Java, Jython, Python, Putty and Agile Methodology. $103210 to $122300 per year. Please send resumes to <a href="mailto:recruitad@us.ibm.com" target="_blank">recruitad@us.ibm.com</a>. Applicants must reference V90a in the subject line.

Application Developer

<h3>Job Description</h3>
Job Description
Title: Customer Service Analyst Location: Somerville NJ Duration: 2 years Description:
<ul>
<li>The analyst is the subject matter expert for REMS Evaluation products.</li>
<li>The analyst provides superior key analytics and accelerates growth by building strong and collaborative relationships.</li>
<li>The analyst seeks out new Business Development opportunities to streamline and enhance the Customer Service function.</li>
<li>This position will require in-depth knowledge of each operating company's policies and procedure.</li>
<li>This position will require in-depth knowledge of FDA/DEA requirements and the varying elements to assure safe use per REMS Evaluation product.</li>
<li>Must possess high-level multi-tasking and organizational skills.</li>
</ul>
 Top Three Skills: SAP knowledge (Atlas or ROTC), Communication, Independent

Customer Service Analyst

<h3>Job Description</h3>
Job Description
Akido is rebuilding the healthcare experience from the ground up. Through early interventions designed around social determinants of health (SDoH), world-class care focused on chronic disease, and human-centered technology, we believe we can build a healthcare model that allows for all patients to live their fullest lives. We are a fast-growing, impact-focused, Y Combinator company created out of the University of Southern California's D-Health Lab with the idea that empowering government, healthcare, and nonprofit services with population-based data could help usher in a new era of preventive public health. Today we are building a full stack medical network that leverages our predictive capabilities to provide a frictionless experience for both our patients and care providers. 
The Opportunity We are seeking an Operations Analyst to join our team. This role is crucial for enhancing our communication systems and streamlining business operations. You will work hands-on at the intersection of technology and business, ensuring our telephony infrastructure and internal business processes are efficient and effective.
What you'll do
<ul>
<li>Design, configure, and maintain our interactive voice response (IVR), phone, and call center systems to ensure a seamless customer experience.</li>
<li>Develop and generate comprehensive reports from telephony platforms to provide actionable insights into call volumes, agent performance, and customer interactions.</li>
<li>Generate dashboards and reports to help clinic teams manage their clinics to key performance indicators (KPIs).</li>
<li>Collaborate with stakeholders across departments to understand business processes, identify pain points, and propose solutions for improvement.</li>
<li>Reengineer and optimize business workflows, leveraging telephony capabilities and other tools to enhance efficiency.</li>
<li>Coordinate digitization efforts, working with clinics, scanning vendors, and the indexing team to ensure smooth document management.</li>
<li>Test and troubleshoot telephony configurations and process changes to ensure accuracy and functionality.</li>
<li>Provide training and support to end-users on new telephony features and process updates.</li>
<li>Research complaints and coordinate with Clinic and Call Center Teams.</li>
<li>Stay current with industry best practices and emerging technologies in telephony and business process management.</li>
</ul>
Who you are
<ul>
<li>Proven experience in configuring and managing telephony systems, including IVRs, call routing, and reporting functionalities.</li>
<li>Strong understanding of business process analysis and reengineering methodologies.</li>
<li>Ability to translate business requirements into technical specifications for telephony solutions.</li>
<li>Proficiency in data analysis and reporting, with the ability to extract meaningful insights from large datasets.</li>
<li>Excellent problem-solving skills and a keen eye for detail.</li>
<li>Strong communication and interpersonal skills, with the ability to collaborate effectively with technical and non-technical teams.</li>
<li>Ability to manage multiple projects simultaneously and prioritize tasks in a fast-paced environment.</li>
</ul>
Benefits
<ul>
<li>Stock-options package</li>
<li>Health benefits include medical, dental and vision</li>
<li>401K</li>
<li>Long-term disability</li>
<li>Unlimited PTO</li>
<li>Life insurance</li>
<li>Paid Leave Program</li>
</ul>
Salary range$85,000—$115,000 USD
Akido Labs, Inc. is an equal opportunity employer, and we encourage qualified applicants of every background, ability, and life experience to contact us about appropriate employment opportunities.

Operations Analyst | Customer Service

<h3>Job Description</h3>
Job Description
We are hiring a Data Analyst &amp; Customer Service Specialist to join our growing remote team. This hybrid role blends sharp analytical skills with a passion for helping people. You’ll dive into customer and performance data to generate insights, while also being the frontline hero assisting customers via email and chat.
This is not a typical call center or entry-level job—we're looking for someone who’s thoughtful, self-driven, and eager to build solutions that improve both the customer journey and internal processes.

Data Analyst & Customer Service Specialist

<h3>Job Description</h3>
Job Description
Industrial Data Analyst/Customer Service position at local laboratory. We provide customers with insight into their equipment and oil through different types of laboratory analysis. The data analyst position takes all the data and compiles a report for the customer and contacts customer on results. Maintenance, Data Mining, Plant, Engineering or Mechanical background helpful. Customer base is very broad and ranges from mining to aviation. Must be good with people, computers, statistics and have basic understanding of mechanics and equipment.
Company Description<a href="https://www.oillab.com/" target="_blank">https://www.oillab.com/</a> 
<h3>Company Description</h3>
<a href="https://www.oillab.com/" target="_blank">https://www.oillab.com/</a>

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