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Claims Examiner CalOptima CalOptima Health is seeking a highly motivated Claims Examiner to join our team. The Claims Examiner will be responsible for analyzing and validating claim data elements and claims processing. The incumbent will be responsible for adhering to the regulatory and internal processing guidelines in conjunction with CalOptima Health policies and procedures related to claims adjudication. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) </li>
<li>Work Arrangement: Full Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>85% - Claims Support
<ul>
<li>Performs thorough review of pending claims for billing errors and/or questionable billing practices that might include duplicate billing and unbundling of services.</li>
<li>Processes non-institutional claim types.</li>
<li>Corrects system generated errors manually prior to final claims adjudication.</li>
<li>Processes claims based upon CalOptima Health contractual agreements or pricing agreements, applicable regulatory legislation, claims processing guidelines and CalOptima Health policies and procedures.</li>
<li>Analyzes and validates Medi-Cal pricing; researches, adjusts and adjudicates claims; reviews services for accurate charges and utilizes current billing code sets, including International Classification Diseases (ICD10) codes, Current Procedural Terminology (CPT) codes and/or authorization guidelines as reference.</li>
<li>Validates eligibility and other possible health insurance coverage on the claim.</li>
<li>Alerts manager or supervisor of more complex issues that arise.</li>
<li>Processes claim exception reports as assigned. </li>
</ul>
</li>
<li>10% - Administrative Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High school diploma or equivalent PLUS 1 year of related claims processing experience 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>
</ul>
 Preferred Qualifications: 
<ul>
<li>Experience processing online claims in a managed care environment. </li>
<li>Experience processing Medi-Cal claims.</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=6329575&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 11, 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/6329575" target="_blank">https://jobs.caloptima.org/jobs/claims-examiner-505-city-parkway-west-california-united-states-fd7ed77a-73a4-4bd2-9f12-47d82ac1ed30</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-a4cc42329aeb0d40b1127d796b9ce31e

Claims Examiner

Interdisciplinary Team Lead (Program Specialist) CalOptima CalOptima Health is seeking a highly motivated Program Specialist (Interdisciplinary Team Lead) to join our team. The Program Specialist (Interdisciplinary Team Lead) will be responsible for supporting the Manager PACE Center by holding primary responsibility for scheduling meetings and follow ups with the Interdisciplinary Teams (IDT), documenting attendance, recording decision-making, and managing authorizations for multiple IDT. The incumbent will interact with various clinical and non-clinical staff to coordinate participant care. Position Information: 
<ul>
<li>Department: PACE- Clinic </li>
<li>Salary Grade: 305 - $55,966 - $83,949 ($26.91 - $40.3601) </li>
<li>Work Arrangement: Full Office **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Coordinates calendars, meeting space, equipment and schedules to support IDT functions.</li>
<li>Serves as a scribe to all IDTs by tracking authorizations, service delivery requests and care coordination authorizations that are approved by the IDT.</li>
<li>Tracks and communicates to the Quality Improvement team the status of service delivery requests, including approved, denied or modified to ensure compliance with regulatory requirements.</li>
<li>Tracks and communicates the status of initial, semi-annual and annual assessments for all members of the IDT on behalf of the manager.</li>
<li>Assigns and tracks completion of PACE participant care plan approval.</li>
<li>Ensures completion of required documentation in electronic health records within 30-day requirement.</li>
<li>Serves as a liaison between manager and members of IDT and follows up on the progress of projects and activities assigned to other staff.</li>
<li>Determines the priority of matters of attention for the manager and redirects to supervisor, staff or handles matters directly as appropriate.</li>
<li>Provides back-up support to the Administrative Assistant by taking IDT minutes.</li>
<li>Maintains accurate and timely documentation in participant electronic health records.</li>
<li>Provides administrative support for specific and/or ongoing projects, such as regulatory audits by generating reports, logs, calendars and mailings as appropriate.</li>
<li>Attends and participates in in-services, staff meetings and case conferences as indicated. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, health care administration, public health, public policy or related field PLUS 2 years of administrative experience in a health care 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>1 year of experience working with the frail or elderly population required with relevant experience within the last 3 years required. </li>
<li>CPR and First-Aid Certification required or must be obtained within six (6) months of date of hire.</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=6322849&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 8, 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/6322849" target="_blank">https://jobs.caloptima.org/jobs/interdisciplinary-team-lead-program-specialist-pace-garden-grove-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-57516b5c0f361d49a2dff80b78f313ae

Interdisciplinary Team Lead (Program Specialist)

Sr Manager, Fraud, Waste and Abuse (Investigations) (Sr Manager I) CalOptima CalOptima Health is seeking a highly motivated Sr Manager, Fraud, Waste and Abuse (Investigations) (Sr Manager I) to join our team. The Sr Manager I for Fraud, Waste and Abuse (FWA) will be responsible for leading the team of CalOptima Health investigators to detect, investigate and mitigate FWA issues. The incumbent will ensure investigations are handled effectively and in a timely manner and will engage with regulatory agencies. The incumbent will partner with the director in long-term strategy planning to accomplish the department's goals and mission to enhance the program and payment integrity of the organization. Position Information: 
<ul>
<li>Department: Office of Compliance </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>45% - 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, supports, develops and evaluates direct reports.</li>
<li>Directs work assignments, measures results and initiates personnel actions.</li>
<li>Ensures that team members are trained and equipped with the necessary skills and resources.</li>
<li>Collaborates with the director in departmental budgeting activities.</li>
<li>Oversees the planning, scoping and execution of audits and the development of audit tools; ensures alignment with organizational goals and regulatory requirements.</li>
<li>Oversees the planning, scoping and execution of investigations and the development of investigative tools; ensures alignment with organizational goals and regulatory requirements.</li>
<li>Assists the director on development of the annual FWA risk assessment and Anti-Fraud, Waste and Abuse Plan.</li>
<li>Assists department leadership in the management of critical business risks by communicating best practices, promoting process improvement, and monitoring remediation activities. </li>
</ul>
</li>
<li>35% - Program Oversight
<ul>
<li>Provides expertise and guidance to staff, management and other department areas on sensitive and complicated program integrity concerns, oversight and referrals.</li>
<li>Creates and manages effective monitoring of ongoing investigations, including quality control, timeliness and business relations to continually evaluate FWA related activities.</li>
<li>Performs reviews of investigations for sufficiency of content and documentation and escalates where appropriate.</li>
<li>Prepares timely and accurate reporting on investigations, including scope, activities, methodologies, observations, deficiencies, recommendations and remediation activities.</li>
<li>Presents investigative reports including findings, risks and recommendations to senior management.</li>
<li>Collaborates with business areas to enhance systems, workflows and internal controls.</li>
<li>Identifies benchmarking standards (leading practices) for identifying potential control gaps and/or opportunities for improving efficiency and compliance.</li>
<li>Proposes recommendations for enhancing operational efficiency and identifying other areas of improvement.</li>
<li>Provides excellent customer service by addressing concerns promptly and delivering actionable, professional insights. </li>
</ul>
</li>
<li>15% - Investigative Activities
<ul>
<li>Performs investigation activities for complex cases.</li>
<li>Partners with staff in performing investigations of difficult cases. </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 business administration, accounting, health information management, or another related field PLUS 5 years of relevant work experience in health care investigations 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 managerial experience within a managed care health plan in audits or investigations, or as an outside consultant engaged to perform audit work for a managed care health plan required. </li>
<li>Have access to means of transportation for work away from the primary office approximately 15% of the time.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Master's degree.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI) or similar certification completion, currently pursuing a related certification or has completed more than half of the requirements towards a certification.</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=6305723&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 June 30, 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/6305723" target="_blank">https://jobs.caloptima.org/jobs/sr-manager-fraud-waste-and-abuse-investigations-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-7b45ba9efc4d8747a6f8e14e16e01d8e

Sr Manager, Fraud, Waste and Abuse (Investigations) (Sr Manager I)

About the Role:
CrowdStrike is seeking a Corporate Account Manager - SMB to ensure that our customers are successful and thriving with our next generation endpoint technology. This is a great opportunity for those who want to cultivate and sharpen their sales skills. CrowdStrike offers a robust sales training and development program where you will learn about our industry leading product and services.
This is a full sales cycle role in which you will proactively advocate for the customers in the small to mid-size business segment, while focusing on high levels of adoption to ensure customer satisfaction. You will balance discovering upsell and cross-sell opportunities while partnering with our renewals team to ensure timely renewals.
This is a hybrid-remote role and will require you to go into the office just 1x a week at our Austin, TX for team building, unity, and collaboration.
 What You’ll Do:
<ul>
<li>
Serve as the primary point of contact for clients while collaborating with various internal stakeholders (Customer Success, Managed Services, etc.) to ensure the existing customer base is receiving the value they expect from their previous purchase
</li>
<li>
Manage the contract renewal cycle from scheduling initial meetings through negotiation, contract changes, and signature while ensuring customers renew at an escalated ARR rate.
</li>
<li>
Achieve a quota of new sales growth within customer base.
</li>
<li>
Be a customer advocate, driving relationships with key customers and creating new champions.
</li>
<li>
Identify whitespace in accounts and create value-based presentations to promote upgrades and cross-sells.
</li>
<li>
Consult with our existing customers to recommend additional solutions from the CrowdStrike portfolio to increase ingestion.
</li>
<li>
Devise and execute account strategies and plans to maximize account growth.
</li>
<li>
Provide high touch customer service, including escalation and coordination of support issues as needed.
</li>
<li>
Deliver feedback to the Product Management team on new feature requests and product enhancements from your customer base.
</li>
</ul>
 What You’ll Need:
<ul>
<li>
1+ years in sales development and/or 1+ years of full sales cycle experience in an account management or net new logo capacity, selling to a technical audience such as engineers, IT, security, and other related fields.
</li>
<li>
Bachelor's degree is preferred
</li>
<li>
Light experience and/or understanding of sales qualification frameworks such as Medic, Medpicc, and/or Sandlar
</li>
<li>
Track record of meeting or exceeding expectations in an individually focused, quota and/or metric carrying role.
</li>
<li>
Ability to successfully balance a wide variety of daily tasks and adjust priorities on the fly in a fast-paced environment over multiple engagements.
</li>
<li>
Strong technical aptitude and ability to learn new concepts quickly.
</li>
<li>
Exceptional written and verbal communication skills demonstrated through email, conference calls, client visits and presentations, and internal meetings
</li>
<li>
High level of comfort handling client objections and negotiations.
</li>
<li>
Security or SaaS experience is a plus.
</li>
</ul>
#LI-JN1
#LI-HK1

SMB Account Manager (Hybrid, Austin)

About the Role:
CrowdStrike is seeking a Regional Sales Manager (individual contributor) to manage our largest accounts known as Majors. You will take CrowdStrike’s product capabilities and value to potential and existing clients to help defeat adversary.
The successful candidate has executive level contacts; is flexible and adaptable to rapidly changing situations. You must be extremely results driven, customer focused, technologically savvy, and innovative at building internal relationships/external partnerships to attack the market with.
What You'll Do:
<ul>
<li>
Identify, develop and execute account strategy to close new business opportunities and expanding revenue with customers across the assigned region; independently and cooperatively.
</li>
<li>
Scope, negotiate and bring to closure agreements to exceed booking and revenue quota targets.
</li>
<li>
Target and gain access to decision makers in key prospect accounts in the assigned territory.
</li>
<li>
Establish access and maintain existing relationships with key decision makers (typically at the CIO and CISO level) in industry, partners, and enterprise customers to drive all pertinent issues related to sales strategy and goal attainment.
</li>
<li>
Collaborate with operative peers across functions (including the Field Sales, Channel, Marketing, Sales Operations, System Engineering, Services, Customer Support, and Product Development) to create visibility with target accounts and drive engagement of target prospects at both the individual contributor and executive level.
</li>
<li>
Work cooperatively with partners to leverage their established account presence and relationships.
</li>
<li>
Capture, maintain, and disseminate accurate and relevant prospect information using Salesforce.com
</li>
<li>
Be familiar and comfortable with the MEDDPICC sales methodology framework.
</li>
<li>
Identify, develop and execute account strategy to close new business opportunities and expanding revenue with customers across the assigned accounts; independently and cooperatively.
</li>
<li>
Scope, negotiate and bring to closure agreements to exceed booking and revenue quota targets.
</li>
<li>
Target and gain access to decision makers in key prospect accounts
</li>
<li>
Establish access and maintain existing relationships with key decision makers (typically at the CIO and CISO level) in industry, partners, and enterprise customers to drive all pertinent issues related to sales strategy and goal attainment.
</li>
<li>
Collaborate with operative peers across functions (including the Field Sales, Channel, Marketing, Sales Operations, System Engineering, Services, Customer Support, and Product Development) to create visibility with target accounts and drive engagement of target prospects at both the individual contributor and executive level.
</li>
<li>
Work cooperatively with partners to leverage their established account presence and relationships.
</li>
<li>
Forecast, capture, maintain, and disseminate accurate and relevant prospect information using Salesforce.com
</li>
</ul>
What You’ll Need:
<ul>
<li>
8+ years of sales experience in a field sales capacity at an enterprise level in cybersecurity for SaaS, Technology, and/or Security (cybersecurity preferred)
</li>
<li>
Demonstrated experience in the Global Automotive market with target account selling, solution selling, and/or consultative sales is desired.
</li>
<li>
Capable of closing 7 figure global deals in solutions and services opportunities
</li>
<li>
Proven successful track record meeting and/or exceeding individually owned quota and performance metrics
</li>
<li>
Strong problem-solving skills, ability to analyze complex multivariate problems and use a systematic approach to gain swift resolution.
</li>
<li>
Strong understanding of Cybersecurity, Cloud and/or SaaS technologies and competitive offerings in the marketplace.
</li>
<li>
Significant and proven experience developing relationships with senior executives and alliance partners.
</li>
<li>
An aptitude in the cybersecurity market, &nbsp;understanding how technology products and solutions solve business problems with ability to explain complicated concepts to a variety of audiences and skill levels.
</li>
<li>
Outstanding presentation, written, verbal and closing skills.
</li>
<li>
Strong time management, organizational and decision-making skills.
</li>
<li>
Self-motivated ability to work independently and as part of a team.
</li>
<li>
Strong communication (written and verbal) and presentation skills, both internally and externally.
</li>
<li>
Ability to work remotely and travel up to 50%
</li>
</ul>
#LI-Remote
#LI-JJ1
#LI-AB3

Regional Sales Manager - Majors (Remote)

About the Role:
CrowdStrike is seeking a Regional Sales Manager, in Southeast Michigan (individual contributor) to manage our largest accounts known as Majors. You will take CrowdStrike’s product capabilities and value to potential and existing clients to help defeat adversary.
The successful candidate has CISO executive level relationships; is flexible and adaptable to rapidly changing situations. The candidate must be comfortable in selling a large portfolio and have the ability to have a CISO dialog and translate the clients challenges into opportunities.&nbsp; You must be extremely results driven, customer focused, technologically savvy, and innovative at building internal relationships/external partnerships to attack the market with.
What You'll Do:
<ul>
<li>
Identify, develop and execute Major Account strategy to close new business opportunities and expanding revenue with customers across the assigned accounts; independently and cooperatively.
</li>
<li>
Scope, negotiate and bring to closure agreements to exceed booking and revenue quota targets.
</li>
<li>
Target and gain trust to decision makers in key prospect accounts.
</li>
<li>
Establish access and maintain existing relationships with key decision makers (typically at the CIO and CISO level) in industry, partners, and enterprise customers to drive all pertinent issues related to sales strategy and goal attainment.
</li>
<li>
Collaborate with operative peers across functions (including the Field Sales, Channel, Marketing, Sales Operations, System Engineering, Services, Customer Support, and Product Development) to create visibility with target accounts and drive engagement of target prospects at both the individual contributor and executive level.
</li>
<li>
Work cooperatively with partners to leverage their established account presence and relationships.
</li>
<li>
Capture, maintain, and disseminate accurate and relevant prospect information using Salesforce.com
</li>
<li>
Be familiar and comfortable with the MEDDPICC sales methodology framework.
</li>
<li>
Operations hygiene, forecast, capture, maintain, and disseminate accurate and relevant prospect information using Salesforce.com
</li>
</ul>
What You’ll Need:
<ul>
<li>
8+ years of sales experience in a field sales capacity at an Large enterprise level in cybersecurity for SaaS, Technology, and/or Security (cybersecurity preferred)
</li>
<li>
Demonstrated experience in the Global Automotive market with target account selling, product based solution selling model
</li>
<li>
Capable of closing 7 figure global deals in solutions and services opportunities
</li>
<li>
Proven successful track record meeting and/or exceeding individually owned quota and performance metrics
</li>
<li>
Strong problem-solving skills, ability to analyze complex multivariate problems and use a systematic approach to gain swift resolution.
</li>
<li>
Strong understanding of Cybersecurity, Cloud and/or SaaS technologies and competitive offerings in the marketplace.
</li>
<li>
Significant and proven experience developing relationships with senior executives and alliance partners.
</li>
<li>
An aptitude in the cybersecurity market, &nbsp;understanding how technology products and solutions solve business problems with ability to explain complicated concepts to a variety of audiences and skill levels.
</li>
<li>
Outstanding presentation, written, verbal and closing skills.
</li>
<li>
Strong time management, organizational and decision-making skills.
</li>
<li>
Self-motivated ability to work independently and as part of a team.
</li>
<li>
Ability to work remotely and travel up to 50%
</li>
</ul>
#LI-Remote
#LI-SL1
#LI-AB3

Regional Sales Manager – Majors (Remote)

About the Role: 
CrowdStrike is seeking a Corporate Account Manager, Medlar to ensure that our customers are successful and thriving with our next generation endpoint technology. This is a full sales cycle role in which you will proactively advocate for the customers in the medium to large segment, while focusing on high levels of adoption to ensure customer satisfaction. You will balance discovering upsell and cross-sell opportunities while partnering with our renewals team to ensure timely renewals.
This is a hybrid-remote role and will require you to go into the Austin, TX office just 1x a week for team building, unity, and collaboration.
 What You’ll Do:
<ul>
<li>
Serve as the primary point of contact for clients while collaborating with various internal stakeholders (Customer Success, Managed Services, etc.) to ensure the existing customer base is receiving the value they expect from their previous purchase
</li>
<li>
Manage the contract renewal cycle from scheduling initial meetings through negotiation, contract changes, and signature while ensuring customers renew at an escalated ARR rate
</li>
<li>
Achieve a quota of new sales growth within customer base.
</li>
<li>
Be a customer advocate, driving relationships with key customers and creating new champions
</li>
<li>
Identify whitespace in accounts and create value-based presentations to promote upgrades and cross-sells
</li>
<li>
Consult with our existing customers to recommend additional solutions from the CrowdStrike portfolio to increase ingestion
</li>
<li>
Devise and execute account strategies and plans to maximize account growth
</li>
<li>
Provide high touch customer service, including escalation and coordination of support issues as needed
</li>
<li>
Deliver feedback to the Product Management team on new feature requests and product enhancements from your customer base
</li>
</ul>
 What You’ll Need:
<ul>
<li>
2+ years of full sales cycle experience in an account management or net new logo capacity, selling to a technical audience such as engineers, IT, security, and other related fields
</li>
<li>
Bachelor's degree is preferred
</li>
<li>
Strong ability to run a discovery, manage full sales cycle, handle objections, implement a multi-faceted sales strategy such as working with partners, and close deals
</li>
<li>
Proficient and/or good understanding of sales qualification frameworks such as Medic, Medpicc, and Sandlar
</li>
<li>
Track record of meeting or exceeding expectations in an individually focused, quota and/or metric carrying role
</li>
<li>
Ability to successfully balance a wide variety of daily tasks and adjust priorities on the fly in a fast-paced environment over multiple engagements
</li>
<li>
Strong technical aptitude and ability to learn new concepts quickly
</li>
<li>
Exceptional written and verbal communication skills demonstrated through email, conference calls, client visits and presentations, and internal meetings
</li>
<li>
High level of comfort handling client objections and negotiations.
</li>
<li>
Security or Saas experience is a plus
</li>
</ul>
#LI-HK1
#LI-JN1

Corporate Account Manager (Hybrid)

Job Position: Part Time School Food Service Aides.
Location: Reading School District.
Pay Rate: $15.00/ Hour.
Shift: Work: 4 hour morning shifts, could work up to 6 hours a day.
Job Title: School Cafeteria Food Service Aide
Job Summary: We are seeking dedicated individuals to join SOS Group as School Cafeteria Food Service Aides. As a vital part of our school community, you will play a crucial role in ensuring the smooth and efficient operation of the cafeteria. Your primary responsibilities will include assisting in food preparation, serving meals, maintaining a clean and organized dining area, and providing excellent customer service to students and staff.
Responsibilities:
<ol>
<li>
Food Preparation:
</li>
</ol>
<ul>
<li>
Assist in the preparation of meals according to established recipes and portion sizes.
</li>
<li>
Follow food safety and sanitation guidelines to ensure the quality and safety of meals.
</li>
</ul>
<ol>
<li>
Meal Service:
</li>
</ol>
<ul>
<li>
Serve meals to students and staff in a courteous and efficient manner.
</li>
<li>
Monitor portion control to minimize waste and ensure all individuals receive appropriate servings.
</li>
</ul>
<ol>
<li>
Cleanliness and Organization:
</li>
</ol>
<ul>
<li>
Maintain a clean and sanitized work environment, including kitchen and dining areas.
</li>
<li>
Clean and sanitize utensils, dishes, and equipment regularly.
</li>
<li>
Dispose of waste and ensure proper recycling procedures are followed.
</li>
</ul>
<ol>
<li>
Team Collaboration:
</li>
</ol>
<ul>
<li>
Work collaboratively with other cafeteria staff to ensure a cohesive and efficient operation.
</li>
<li>
Communicate effectively with kitchen and cafeteria personnel.
</li>
</ul>
Qualifications:
<ul>
<li>
Minimum of a high school diploma or equivalent.
</li>
<li>
State and federal Background checks required.
</li>
<li>
Excellent communication and interpersonal skills.
</li>
<li>
Ability to lift up to 50 pounds.
</li>
<li>
Physically capable of standing for extended periods and moving quickly if necessary.
</li>
</ul>
<ol>
<li></li>
</ol>

Food Service Aide

Job Position: Part Time Food Service Aide
Location: Hempfield School District.
Pay Rate: $14.25/ Hour.
Shift: M-Fr, 8:00am-2:00pm
Job Title: School Cafeteria Food Service Aide
Job Summary: We are seeking dedicated individuals to join SOS Group as School Cafeteria Food Service Aides. As a vital part of our school community, you will play a crucial role in ensuring the smooth and efficient operation of the cafeteria. Your primary responsibilities will include assisting in food preparation, serving meals, maintaining a clean and organized dining area, and providing excellent customer service to students and staff.
Responsibilities:
<ol>
<li>
Food Preparation:
</li>
</ol>
<ul>
<li>
Assist in the preparation of meals according to established recipes and portion sizes.
</li>
<li>
Follow food safety and sanitation guidelines to ensure the quality and safety of meals.
</li>
</ul>
<ol>
<li>
Meal Service:
</li>
</ol>
<ul>
<li>
Serve meals to students and staff in a courteous and efficient manner.
</li>
<li>
Monitor portion control to minimize waste and ensure all individuals receive appropriate servings.
</li>
</ul>
<ol>
<li>
Cleanliness and Organization:
</li>
</ol>
<ul>
<li>
Maintain a clean and sanitized work environment, including kitchen and dining areas.
</li>
<li>
Clean and sanitize utensils, dishes, and equipment regularly.
</li>
<li>
Dispose of waste and ensure proper recycling procedures are followed.
</li>
</ul>
<ol>
<li>
Team Collaboration:
</li>
</ol>
<ul>
<li>
Work collaboratively with other cafeteria staff to ensure a cohesive and efficient operation.
</li>
<li>
Communicate effectively with kitchen and cafeteria personnel.
</li>
</ul>
Qualifications:
<ul>
<li>
Minimum of a high school diploma or equivalent.
</li>
<li>
State and Federal Background checks required.
</li>
<li>
Excellent communication and interpersonal skills.
</li>
<li>
Ability to lift up to 50 pounds.
</li>
<li>
Physically capable of standing for extended periods and moving quickly if necessary.
</li>
</ul>

Job Position: Substitute School Food Service Aides.
Location: Radnor School District.
Pay Rate: $16.32/ Hour.
Shift: Flexible Various shifts Monday - Friday, 8:00am-11:00am/10:00am-1:00pm.
Job Title: School Cafeteria Food Service Aide
Job Summary: We are seeking dedicated individuals to join SOS Group as School Cafeteria Food Service Aides. As a vital part of our school community, you will play a crucial role in ensuring the smooth and efficient operation of the cafeteria. Your primary responsibilities will include assisting in food preparation, serving meals, maintaining a clean and organized dining area, and providing excellent customer service to students and staff.
Responsibilities:
<ol>
<li>
Food Preparation:
</li>
</ol>
<ul>
<li>
Assist in the preparation of meals according to established recipes and portion sizes.
</li>
<li>
Follow food safety and sanitation guidelines to ensure the quality and safety of meals.
</li>
</ul>
<ol>
<li>
Meal Service:
</li>
</ol>
<ul>
<li>
Serve meals to students and staff in a courteous and efficient manner.
</li>
<li>
Monitor portion control to minimize waste and ensure all individuals receive appropriate servings.
</li>
</ul>
<ol>
<li>
Cleanliness and Organization:
</li>
</ol>
<ul>
<li>
Maintain a clean and sanitized work environment, including kitchen and dining areas.
</li>
<li>
Clean and sanitize utensils, dishes, and equipment regularly.
</li>
<li>
Dispose of waste and ensure proper recycling procedures are followed.
</li>
</ul>
<ol>
<li>
Team Collaboration:
</li>
</ol>
<ul>
<li>
Work collaboratively with other cafeteria staff to ensure a cohesive and efficient operation.
</li>
<li>
Communicate effectively with kitchen and cafeteria personnel.
</li>
</ul>
Qualifications:
<ul>
<li>
Minimum of a high school diploma or equivalent.
</li>
<li>
State and Federal Background checks required.
</li>
<li>
Excellent communication and interpersonal skills.
</li>
<li>
Ability to lift up to 50 pounds.
</li>
<li>
Physically capable of standing for extended periods and moving quickly if necessary.
</li>
</ul>

654,622 Customer-Service Jobs