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Business Analyst (Claims) CalOptima CalOptima Health is seeking a highly motivated Business Analyst (Claims) to join our team. Under general supervision, the Business Analyst (Claims) will identify and design solutions within Claims Administration processes. The incumbent will interpret regulatory letters and memos to identify the impact on claims processes. The incumbent will be responsible for implementation of changes through project management, system configuration and User Acceptance Testing (UAT). The incumbent will work independently and perform more complex analytical and administrative responsibilities. The incumbent will exercise discretion and judgment and may coordinate a function and the work of others within the program or representing the program/project. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 310 - $72,096 - $115,353 ($34.66 - $55.4582) </li>
<li>Work Arrangement: Full Telework **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>Works in conjunction with the Claims Administration team, Contracting, Provider Relations, Coding Initiatives and/or Information Technology to implement benefit or process changes that impact system configuration due to federal and state notices.</li>
<li>Performs system research and testing to ensure regulatory, coding, contract updates and configuration changes produce expected results; ensures that all documentation accurately reflects the current status of changes and outstanding issues identified during testing.</li>
<li>Creates business user test scenarios and testing schedules, including time estimates and deadlines, monitors milestone completion, tracks all phases of testing and provides timely reporting of issues that impact the testing progress.</li>
<li>Communicates to the Claims Administration management team, training and staff regarding any system enhancements or changes, including any process deficiencies identified from claims look-back analysis and UAT.</li>
<li>Assists the Claims Administration management team in identifying training and development of desktop procedures and policies for the Medi-Cal and Medicare lines of business impacted by system and/or regulatory changes.</li>
<li>Provides analytical support and technical expertise on requests for information from executives, directors and other staff regarding claims.</li>
<li>Remains updated on state, federal and commercial health care environments, identifying impacts to CalOptima Health programs and claims processes utilizing MedLearn, Centers for Medicare &amp; Medicaid Services (CMS) Updates, Medi-Cal Provider Bulletins, Medi-Cal manuals and Industry Collaboration Effort (ICE).</li>
<li>Reviews ad-hoc analysis and generates reports as requested.</li>
<li>Collaborates with Claims Administration management process improvement, project management and Training Program Coordinator to identify process improvement opportunities.</li>
<li>Partners with trainer and Claims Administration management team to create or update document processes and procedures.</li>
<li>Serves as subject matter expert with end-to-end claims adjudication/processing.</li>
<li>Facilitates communication on claims related topics. </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, management or related field PLUS 2 years of both Medicare and Medi-Cal claims adjudication experience required, including experience with Current Procedural Terminology (CPT-4), Healthcare Common Procedure Coding System (HCPC) coding or International Classification of Diseases (ICD-10); 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>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=6372575&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/6372575" target="_blank">https://jobs.caloptima.org/jobs/business-analyst-claims-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-e67e1e573a7a6948a011a0304b064368

Business Analyst (Claims)

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

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=6372553&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/6372553" 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-f254b5d52e384f44aad2de542f28a181

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

Auditor Sr (Non-Clinical) CalOptima CalOptima Health is seeking a highly motivated Auditor Sr (Non-Clinical) to join our team. The Claims Administration Department is responsible for managing and processing all medical claims in accordance with industry standards and regulations, ensuring accuracy and timely reimbursement to health care providers. The Auditor Sr (Non-Clinical) will be responsible for conducting routine oversight monitoring and auditing of all business functions within CalOptima Health to ensure compliance with federal, state, regulatory and internal guidelines. The incumbent will ensure the Claims Administration department adheres to regulatory and internal guidelines in conjunction with CalOptima Health policies and procedures as they apply to claims processing. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 310 - $72,096 - $115,353 ($34.66 - $55.4582) </li>
<li>Work Arrangement: Full Telework **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>Conducts routine audits of claims processed to ensure continued adherence to CalOptima Health's policies and procedures and compliance with regulatory requirements.</li>
<li>Monitors and plans multiple concurrent audits and related projects, makes decisions around object, scope and ensures effective and efficient audit execution.</li>
<li>Serves as a knowledge expert for assigned functional areas.</li>
<li>Reports and tracks audit findings, identifies areas of concern and validates remediation efforts, including identifying potential solutions (immediate and long-term controls).</li>
<li>Provides written and oral summaries of audit analyses as needed.</li>
<li>Supports the facilitation of mock audits of departmental functions using designated audit tools and develops Corrective Action Plans (CAPs) to address deficiencies.</li>
<li>Conducts audits of department functions using designated audit tools and develops CAPs to address identified deficiencies.</li>
<li>Participates in workgroups that address non-clinical internal activities for which CalOptima Health must demonstrate improvement to meet its contractual requirements with the Centers for Medicare &amp; Medicaid Services (CMS), California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) and any other applicable entity.</li>
<li>Interprets and applies guidance from industry standards and audit protocols.</li>
<li>Collects and summarizes performance data, identifies improvement opportunities and presents findings to management.</li>
<li>Informs the department of any changes to regulatory requirements.</li>
<li>Performs audit validation of monthly claim submissions.</li>
<li>Serves as a liaison with other areas and business units. </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, health care administration or related field PLUS 4 years of medical health 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>
<li>3 years of experience in a managed care environment and interacting with governmental requirements and regulations (e.g., Medi-Cal/Medicaid, Medicare) required. </li>
<li>2 years of audit experience in audit and oversight, claims, customer service or related area required. </li>
<li>Experience with DHCS and CMS rules and regulations governing claims adjudication practices and procedures 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=6372586&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/6372586" target="_blank">https://jobs.caloptima.org/jobs/auditor-sr-non-clinical-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-06e544b287e00c4d9616015c6ae39f61

Auditor Sr (Non-Clinical)

Manager Grievance &amp; Appeals (Provider Services) CalOptima CalOptima Health is seeking a highly motivated an experienced Manager, Grievance &amp; Appeals (Provider Services) to join our team. The Manager Grievance &amp; Appeals (Provider Services) will provide daily oversight and technical management for provider services, including provider disputes, provider grievances and provider appeal to ensure compliance with state, federal and accreditation standards applicable to CalOptima Health. The incumbent will work with CalOptima Health management staff and other affiliated health networks with a close interface to the program and process, including areas such as Utilization Management, Claims Administration, Delegation Oversight, Quality Improvement and health network relations. The incumbent will research complex claims problems, isolate root causes and partner with various entities for resolution. The incumbent will communicate with all levels of internal staff, regulatory agencies, health networks, providers, vendors, community-based organizations and medical groups. Position Information: 
<ul>
<li>Department: GA - Provider Disputes </li>
<li>Salary Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>50% - Program Oversight
<ul>
<li>Identifies and analyzes trends, collaborates with the Director to provide trends and makes recommendations for improvement.</li>
<li>Stays current on the local, state and federal health care environment, identifying issues that may impact CalOptima Health's programs as they relate to claims, provider disputes, grievances and provider appeals.</li>
<li>Develops, implements, maintains and reviews the adequacy of the CalOptima Health provider grievance systems, reporting, policies and functions to achieve stated goals, including, but not limited to, complaint resolution and timely responsiveness for all lines of business, to ensure compliance with all relevant regulatory requirements pertaining to provider disputes.</li>
<li>Works with the Audit and Oversight department and key departments to ensure internal departments and external partners (e.g., health networks and delegates) are up to date with regulatory, departmental and organizational changes impacting the grievance and appeals processes.</li>
<li>Ensures timely and effective data collection, summarization, integration and reporting, including, but not limited to, productivity, status and trend reports for specific committees such as the Quality Improvement Committee, Grievance and Appeals Committee, Quality Assurance Committee of the Board of Directors and other ad hoc reporting as required.</li>
<li>Serves as CalOptima Health's primary point of contact and subject matter expert related to provider services (disputes, grievances and appeals).</li>
<li>Participates in Department of Managed Healthcare (DMHC), Department of Health Care Services (DHCS) and Centers for Medicare and Medicaid (CMS) audits related to area of responsibility for all CalOptima Health programs. </li>
</ul>
</li>
<li>45% - Leadership
<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>Manages, hires, mentors and develops department staff.</li>
<li>Oversees the development and maintenance of internal policies and procedures and desktops to ensure compliance with all state and federal regulations for multiple lines of business.</li>
<li>Manages and makes recommendations on the development and maintenance of an effective dispute, appeals and grievance process and systems consistent with CalOptima Health policies and stated goals, including, but not limited to mechanisms to monitor provider disputes, grievances and appeals involving Legal, DMHC, DHCS, Independent Medical Review, Medi-Cal State Hearings, Office of Administrative Hearings and Appeals, CMS and external review agencies for CMS.</li>
<li>Partners with the management to ensure appropriate training and auditing tools are developed and maintained 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>Bachelor's degree in business administration, nursing, healthcare administration or related field PLUS 3 years of health care management experience in a related area of responsibility (provider disputes and appeals, claims administration, appeals and grievances) 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>3 years of leadership experience required. </li>
<li>Experience in health maintenance organization, Medi-Cal/Medicaid, Medicare Advantage, Medicare Part D, Special Needs Plans, Medicare-Medicaid Plans and/or the Program of All-Inclusive Care for the Elderly required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Experience with process improvement implementation.</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, work schedules that allow every other Monday or Friday off (9/80 schedule), 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=6357344&amp;targetURL=https://alliantbenefits.cld.bz/24caloptimacabenguide" target="_blank">2024 CalOptima Health Benefits Guide</a> and our <a href="https://apptrkr.com/get_redirect.php?id=6357344&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 16, 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/6357344" target="_blank">https://jobs.caloptima.org/jobs/manager-grievance-appeals-provider-services-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-cf7b2c04c4b10840a8654602344b5194

Manager Grievance & Appeals (Provider Services)

Customer Service Representative CalOptima CalOptima Health is seeking a highly motivated Customer Service Representative to join our team. The Customer Service Representative (CSR) will be the first line of contact for CalOptima Health's members and providers. The incumbent will assist members and providers with questions and/or complaints related to the Medi-Cal programs for Orange County. The incumbent will provide information regarding eligibility, enrollment, benefits and services to CalOptima Health's eligible members and providers. Position Information: 
<ul>
<li>Department: Customer Service </li>
<li>Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) </li>
<li>Work Arrangement: Full Office </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>80% - 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>Maintains departmental productivity and quality standards.</li>
<li>Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction.</li>
<li>Serves as a resource for other team members. </li>
</ul>
</li>
<li>15% - Administrative Support
<ul>
<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>Addresses member and provider inquiries, questions and concerns in all areas including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.</li>
<li>Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.</li>
<li>Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.</li>
<li>Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High School diploma or equivalent PLUS 6 months of experience in a call center capacity 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>Typing speed of 35 words per minute (WPM) required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>6 months of Medi-Cal/Medicaid or health services experience.</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=6337909&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 15, 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/6337909" target="_blank">https://jobs.caloptima.org/jobs/customer-service-representative-505-city-parkway-west-california-united-states-7d5bf04b-390c-46e1-91cb-12f6a1dd6e9a</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-fa21bddb4c4a0240925cf86da2f60f27

Customer Service Representative

TITLE: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;ChiefTalent Officer
LOCATION: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; &nbsp;New York, NY (Lower EastSide)
DEPARTMENT: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;Administration/Human Resources
REPORTS TO:&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; Chief Executive Officer (CEO)
SALARY RANGE: &nbsp; &nbsp; &nbsp;&nbsp;&nbsp;$175,000 to $200,000 annually depending onexperience, plus excellent benefits
DATE POSTED: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;July 2024

OUR CULTURE:&nbsp; At Grand St. we believeleaders are made, not born. &nbsp;We operate on auto trust,expecting staff will do their jobs well and continue to growprofessionally. &nbsp; We assume the best intentions and give gracewhenever needed. &nbsp; Diversity, equity, and inclusion areintegral parts of our culture and personified by our leadership.Grand St. is a community and we strive to make everyone –colleagues and constituents – feel supported and seen. &nbsp;
JOB SUMMARY:&nbsp; The Chief Talent Officer(CTO) provides executive-level leadership and guidance to theorganization’s HR strategies and operations for 600+ Union andManagement staff. The CTO is responsible not only for setting,enforcing, and evaluating legally compliant human resourcespolicies, procedures, and best practices, but also identifying andimplementing long-range strategic talent management goals. You willwork closely with the Executive Team performing all facets ofHR-related duties partnering with the Chief Financial Officer(CFO), Chief Program Officer of Youth &amp; Community Development,Chief Operating Officer (COO), Chief Development &amp;Communications Officer (CDCO), as well as senior management staff.&nbsp;This position carries out responsibilities in the followingfunctional and strategic areas: benefits administration, employeerelations, labor relations, training, performance management,onboarding, policy implementation, recruitment/employment,affirmative action and employment law compliance.&nbsp;
EDUCATION, EXPERIENCE AND SKILLREQUIREMENTS:
<ul>
<li>Masters preferred</li>
<li>Minimum of 10 years of Human Resource Management experiencerequired&nbsp;</li>
<li>HR Certification preferred</li>
<li>Strategic, Talent Management and/or Business Developmentexperience preferred</li>
<li>Knowledge of proven and emerging techniques in all aspects ofpersonnel management</li>
<li>Strong communication skills (both verbal and written)</li>
</ul>
<ul>
<li>Excellent supervisory, leadership, interpersonal and conflictresolution skills</li>
<li>Excellent organizational skills</li>
<li>Strong analytical and problem-solving skills</li>
<li>Thorough knowledge of employment-related laws andregulations</li>
<li>Experience with development and implementation of humanresource information and payroll systems</li>
<li>&nbsp;Experience with labor relations in a unionizedenvironment</li>
</ul>
Supervisory Responsibilities:
<ul>
<li>Supervises Management-level HR and Payroll staff</li>
<li>Oversees the daily workflow of the HR department and theadministration of human resource programs including, but notlimited to, compensation, benefits and leaves, disciplinarymatters, disputes and investigations, performance &amp; talentmanagement, evaluations, recognition, morale, occupational healthand safety, and training and development</li>
</ul>
ESSENTIAL DUTIES AND RESPONSIBILITIES:
<ul>
<li>Partners with the Executive Team to develop, implement andcommunicate human resource policies, procedures, laws, standardsand government regulations</li>
<li>Maintains the Employee Handbook</li>
</ul>
<ul>
<li>Collaborates with executive leadership to definethe&nbsp;organization's&nbsp;long-term mission and goals;identifies ways to support this mission through talentmanagement</li>
<li>Identifies key performance indicators (KPI’s) forthe&nbsp;organization's&nbsp;human resource and talent managementfunctions and assesses the&nbsp;organization's&nbsp;success andmarket competitiveness based on those metrics</li>
<li>Researches, develops, and implements competitive compensation,benefits, performance appraisal, and employee incentiveprograms</li>
<li>Oversees benefits administration including claims resolution,change reporting, approval of invoice payment, and communicatingbenefit&nbsp;information to employees</li>
<li>Ensures compliance with employment benefits, insurance, safety,401K, EEOC and other labor laws, regulations, and requirements</li>
</ul>
<ul>
<li>Administers and manages the 401K Plan</li>
</ul>
<ul>
<li>Maintains knowledge of laws, regulations, and best practices inemployment law, human resources, compensation and talentmanagement</li>
<li>Drafts and implements the&nbsp;organization's&nbsp;staffingbudget for the department.</li>
<li>Participates in professional development and networkingconferences and events.</li>
</ul>
<ul>
<li>Oversees department’s recruitment efforts including the postingof positions, recruitment advertising and other outreachpartnerships</li>
</ul>
<ul>
<li>Handles labor relations matters and coordination of thegrievance process</li>
</ul>
<ul>
<li>Monitors unemployment claims and assists with appeals onworkers’ compensation claims and coordinates between the employeeand insurance carrier</li>
<li>Responsible for Workers Compensation and 401k Audits</li>
<li>Performs other duties as required and assigned.</li>
</ul>
&nbsp;Your Skills &amp;Knowledge&nbsp;
<ul>
<li>Build a strong organizational culture that aligns with GrandStreet Settlement mission and implements all of those values onevery level of the organization</li>
<li>You take ownership of your work, think strategically, and takethoughtful action with very little direction</li>
<li>Excellent verbal and written communication skills</li>
<li>Excellent analytical and organizational skills</li>
<li>Extremely proficient with Microsoft Office Suite, Google Suiteor related software</li>
<li>People-centric and contributes to Grand St. Settlement’slegacy</li>
</ul>
BENEFITS:
<ul>
<li>Full medical insurance coverage</li>
<li>9% employer contribution to our 401k plan after 1 year</li>
<li>24 vacation days annually, 4 discretionary days, 12 sick daysannually</li>
<li>Guaranteed life Insurance and long-term disabilityinsurance</li>
<li>Flexible spending accounts</li>
<li>Travel/ commute reimbursement</li>
</ul>
HOW TO APPLY:
Please submit a resume and thoughtful cover letter outlining howyour skills &amp; experience meet the job descriptionto&nbsp;<a href="mailto:ctosearch@grandsettlement.org" target="_blank">ctosearch@grandsettlement.org</a>.Please include three professional references that we can contact;at least one should be a former supervisor.&nbsp;
If selected for this position, must obtain NYC Dept.of Health fingerprint clearance and State Central Registry (SCR)clearance (fees may apply); ability to maintain State CentralRegistry (SCR) clearance and fingerprint clearance throughout theduration of employment.
Employment Opportunity Employer (EOE)&nbsp;

Chief Talent Officer

I. I. General Summary Responsible for overall control of safety and health for all plant aspects including, but not limited to, OSHA and state related safety compliance, team member health and wellness, and workers' compensation. Coordinates the planning, organizing, scheduling and implementation of safety policies, programs, and procedures within plant including a safety audit/inspection system. Monitors site condition, practices, and procedures for compliance with health and safety requirements. Selects and implements corrective action and follow-up to ensure proper action has been taken. II. Essential Job Functions: A. Assist management in appropriate loss control and accident prevention measures to comply with TBA and plant mission and objectives. B. Ensure plant compliance with current OSHA and other federal, state, and local agency laws and regulations as they pertain to safety and environmental issues. 1. Act as plant liaison with governmental agencies and serves as the plant representative in case of injuries, inspections, etc. to correct deficiencies and minimize impact on the plant. 2. Act as plant liaison with insurance carriers, third party administrators, parent companies, and professional safety and health providers for audits, training, hygiene sampling, etc. 3. Attend necessary seminars and training to maintain and update skills in industrial safety and federal and state occupational safety and health laws and regulations. C. Develop, implement, and manage safety policies, programs, and procedures that will reduce frequency and severity of personal injuries and illnesses. 1. Develop and implement safety policies and procedures based on program needs, laws and regulations, and TBA/TBJ standards. 2. Assist Group Leaders with the evaluation of safety problems and team members' safety recommendations and complaints. Recommend corrective measures accordingly. 3. Perform periodic safety and compliance audits including identifying and promptly informing management of compliance issues, safety risks, and improvement opportunities. 4. Perform accident investigations and implements countermeasures to prevent reoccurrence. Investigate incidents and unsafe working conditions, compiling statistical data and providing remedial actions to achieve effective accident and loss prevention. 5. Conduct risk assessments related to new equipment introductions and jobs performed (Job Hazard Analysis) including ergonomic evaluations and essential job function investigations to identify and recommend appropriate risk mitigation measures and standards for injury/illness prevention. 6. Coordinate all aspects of industrial hygiene programs by establishing baselines and developing systems that reduce workplace exposures. 7. Administer lockout/tagout, electrical safety, overhead crane safety, hearing protection, respiratory protection, hazard communication, hazardous waste operations (HAZWOPER), blood borne pathogens, emergency response, etc. programs. 8. Influence behavior and inspire commitment on the part of all team members in complying with safety standards and maintaining a safe work environment. D. Serve as plant safety and health coordinator. 1. Serve as principle source of information on safety and health of team members. 2. Coordinate Safety Committee and risk assessment activities. 3. Serve as Workers' Compensation administrator, process claims, and conduct related activities. 4. Maintain protocols with workers' compensation carrier regarding team member appointments, diagnosis, litigation, and injury investigation. 5. Correspond with workers' compensation attorney regarding litigations. 6. Coordinate post accident / injury care of team members. 7. Maintain required paperwork, records, and documentation related to accidents, injuries, and illnesses to comply with OSHA, state, and TBA standards. 8. Maintain safety and first aid supplies. 9. Develop and implement behavior based safety programs and recognition and incentives. 10. Maintains up-to-date information and regulatory postings on bulletin boards throughout the plant. E. Develop and deliver training and coaching for team members, contractors, and others on safety, security, and environmental issues to ensure skills competence, understanding of policies and procedures, and to maintain compliance with corporate, federal, state, and local regulations, directives, standards, policies, and procedures. 1. Develop and deliver safety, health, and environmental orientation to new hires, contractors, and others as required. 2. Conduct annual compliance training. 3. Conduct CPR/AED, first aid, and blood borne pathogen training as required. 4. Create and maintain the Safety Dojo. F. Lead and perform security and disaster protection activities. 1. Create appropriate safety standards, conduct tests/audits of system, coordinate fire/tornado drills, communicate risks/problem areas to management, and implement countermeasures. 2. Administer the fire protection program and system engineering to ensure compliance with fire safety and life safety regulations of local, state and federal jurisdictions. 3. Act as primary technical liaison with companies installing, testing, maintaining, and servicing fire alarm, fire extinguishing, and firefighting systems and equipment. 4. Perform in various roles on emergency response teams including first responder, technician, safety officer, and incident commander. G. Administer the construction safety and security programs for modifications and expansion projects and processes through coordination with TBA Production Engineering and their suppliers and contractors. Includes conducting equipment safety reviews in buy-off procedure. H. Conduct periodic inspections of plant machinery, equipment, and working conditions to ensure conformance to appropriate safety and health standards and regulations. I. Maintain accurate daily, weekly and monthly safety and health metrics reporting to onsite management teams and corporate based reporting systems. J. Lead and manage all ISO14001 and related environmental activities. III. Minimum Qualifications/Requirements: Education: • Bachelor's Degree in Safety, Environmental Science, Industrial Hygiene, Engineering or related field required, or an equivalent combination of education and experience. • Certification as Occupational Safety and Health Technician (OSHTEC), Associate Safety Professional (ASP), Certified Safety Professional (CSP), or Certified Industrial Hygienist (CIH). Experience: • Minimum of 4 years diversified experience in safety, loss prevention, emergency response management, consulting, supervision, and administration in a manufacturing environment required (preferably automotive). • Experienced in emergency response and be able to maintain current First Aid and CPR certificates. • Previous exposure to a multicultural office environment preferred. • Toyota Tier 1 or other OEM Tier 1 automotive parts production experience is a plus. Personal/Technical Skills: • Must have a basic knowledge of regulatory requirements including federal and state safety and health laws (e.g., OSHA, EPA, DOT, EPA Risk Management Plans, and Industrial Hygiene). • Must have an understanding of ergonomic principles and company safety procedures, regulations and requirements. • Basic math skills. • Strong leadership qualities. • Excellent problem solving skills. • Effective time management skills. • Strong customer service orientation. • Strong organization and planning skills. • Ability to adopt a self-directed work style. • Hands-on, self-starter with a strong work ethic. • Ability to compile effective and concise visual reports. • Ability to train and transfer knowledge to plant personnel. • Must have demonstrated ability to prioritize and multi-task. • Good collaboration, interpersonal, and communication skills. • Ability to work in a fast-paced, multicultural team environment. • Develop team member relations centered on trust and teamwork. • Ability to work with multiple departments and prioritize activities. • Ability to maintain on call flexibility to control abnormal conditions. • Excellent project skills and ability to coordinate multiple projects and programs. • Ability to maintain confidentiality in matters involving security and/or personnel issues. • Must be able to work a fixed or rotating shift schedule, including daily or weekend overtime. • Ability to clearly communicate and work well with TBA corporate and plant team members at all levels. • Demonstrate a personality that works in cooperation with other departments towards building a sense of company teamwork. • Thorough understanding and working knowledge of TBA's organization, automotive plants and processes/principles, company products, trade terminology, and manufacturing processes, tooling and equipment, and machine operation is a plus. Language Skills: • Strong verbal and written communication skills in English. • Japanese, Spanish, and/or Portuguese would be helpful. Computer/Software: • Solid working knowledge and experience with Microsoft Office and other computer-based applications (e.g., MS Word, MS Excel, MS PowerPoint, Outlook, Internet, etc.). IV. Work Environment/Conditions: Office: Open Office Environment, moderate noise level. Plant: Standard automotive plant environment with moderate noise level. PPE (Personal Protective Equipment) such as safety glasses, steel toe shoes, hearing protection, etc. may be required in engineering, manufacturing, or industrial areas. Personal attire standards may apply. Travel: Must be able to travel 0-40% of the time. V. Physical Demands: Ability to sit and work on a computer for extensive periods of time is required. While performing the duties of this job, the team member is required to talk, see, and hear. The team member must be capable of walking, sitting, and standing for extended periods of time (e.g., during safety audits) and may be occasionally required to lift up to 30 pounds. The ability to travel by automobile and airplane are both required. Disclaimer: This job description is intended to identify the general nature and level of work performed by team members within this classification, as well as certain essential job functions. It is not intended, and should not be interpreted, as a comprehensive inventory of all duties, responsibilities, and qualifications required of team members assigned to this job. To qualify for this job, however, a team member must be able to perform its essential functions with or without reasonable accommodation. Under no circumstances may this job description be construed as altering the at-will nature of the employment relationship between TBA and any team member. EOE Toyota Boshoku America is an equal opportunity employer and considers applications for all positions without regard to race, sex, religion, color, national origin, pregnancy, genetic information or any other characteristic protected by applicable law. If you require a reasonable accommodation to apply for a posted position, please email us at .

EHS Specialist

The initial cutoff date for referral is 8/3/2023. Applicants applying by the initial cutoff date will be given first consideration. Additional referral lists will be created monthly or as vacancies become available. Serves as a Chinese Mandarin language teacher at the Defense Language Institute Foreign Language Center (DLIFLC) located on the Presidio of Monterey in Monterey, CA. DLIFLC offers intensive foreign language instruction in fourteen languages and dialects languages on a schedule that extends throughout the year. Courses are taught six hours per day, five days a week with the exception of federal holidays. Learn more about&nbsp;<a href="https://www.youtube.com/watch?v=z_5e3--107U" target="_blank">student life</a>&nbsp;and our&nbsp;<a href="https://vimeo.com/261328850" target="_blank">Institute</a>&nbsp;in these videos.
DLIFLC provides high quality culturally based foreign language training to enhance the national security of the United States. As an accredited institution, it awards Associates of Arts and Bachelor degrees to qualified graduates. U.S. Citizenship is not required, although candidates must have work authorization for the U.S. Candidates wishing to use Optional Practical Training (OPT) work authorization may be considered. DLIFLC may be able to support candidates with an H1-B visa under certain circumstances. Application information Starting salary for Assistant Professor is $83,309-$88,103 per year. All applications must be made via&nbsp;<a href="https://www.usajobs.gov/job/722168700" target="_blank">USAJobs</a>, the federal government's official hiring website. Applicants who do not qualify for initial appointment at the&nbsp;<a href="https://www.usajobs.gov/job/735129200" target="_blank">Assistant Professor</a>&nbsp;level may be eligible for appointment at the&nbsp;<a href="https://www.usajobs.gov/job/735130800" target="_blank">Instructor</a>&nbsp;or&nbsp;<a href="https://www.usajobs.gov/job/735130200" target="_blank">Senior Instructor</a>&nbsp;level. Why work for DLIFLC?In addition to competitive salaries with locality pay, as a Department of Defense organization, employees receive a government pension in addition to Social Security; employees are also eligible for the Thrift Savings Plan with government contributions of up to 5% of salary. Health insurance can be carried over into retirement, with the federal government paying up to 75% of the premiums.A government sponsored wellness program allows for three hours per week of exercise on government time. Free access is offered to a state-of-the art gym located on the Presidio. After one year of service, employees receive up to 12-weeks of paid parental leave upon the birth of a child. Access to government childcare facilities may be available, and fee assistance for private childcare may be available subject to eligibility guidelines. DLIFLC offers generous paid time off benefits, with 13 days of sick leave each year plus 13-26 days of annual leave (vacation time) depending on length of service. Additionally, DLIFLC offers an Educational Assistance Program that may pay tuition for courses related to the employee's work assignment. To learn more about DLIFLC, visit our&nbsp;<a href="https://www.dliflc.edu/administration/employment" target="_blank">website</a>&nbsp;or find us on&nbsp;<a href="https://www.facebook.com/DLIFLC" target="_blank">Facebook.</a> Additional information
<ul>
<li>Please be sure to note all requirements and application procedures as contained on the official USAJobs vacancy announcement. If there are any discrepancies between this posting and that on the official USAJobs site, the USAJobs terms will prevail.</li>
<li>Relocation expenses may be authorized subject to approval, funding, and federal regulations.</li>
<li>Recruitment and Relocation incentives may be authorized subject to approval, funding, and federal regulations.</li>
<li>NOTICE OF VETERANS PREFERENCE: Department of Defense considers veterans' preference eligibility a positive factor for hiring. Applicants eligible for veterans' preference must include that information in their cover letter or resume and attached supporting documentation (e.g., DD Form 214, "Certificate of Release or Discharge from Active Duty") to their submissions. Although the point-preference system is not used, applicants eligible to claim 10-Point preference must submit a Standard Form (SF) 15, "Application for 10-Point Veteran Preference," and supporting documents required for specific type of preference claimed. (SF 15, which lists the types of 10-Point Preference and the required supporting documents, is available from the Office of Personnel Management Website at&nbsp;<a href="http://www.opm.gov/" target="_blank">www.opm.gov</a>.).</li>
</ul>
DEPARTMENT OF THE ARMY EQUAL EMPLOYMENT OPPORTUNITY POLICY STATEMENT March 21, 2023 As Secretary of the Army, I am committed to developing and fostering an environment that promotes and reflects diversity, equity, inclusion, and accessibility. Individually, these concepts enhance the Army's ability to create cohesive teams, which is integral to building trust at all levels; collectively, they leverage the strength of our people, advance opportunity, and optimize talent. These concepts enable the Army to fight and win our Nation's wars. As an integral part of that mission, the Army must protect our own employees from unlawful discrimination, harassment, and retaliation to ensure continued success. This equal employment opportunity (EEO) policy statement is a reminder that all Army employees are protected from unlawful discrimination. Army employees and applicants for employment are covered by Federal laws and Presidential Executive Orders designed to safeguard them from discrimination based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (family medical history), political affiliation, military service, or other non-merit-based factors. These protections extend to all management practices and employment decisions, including recruitment and hiring, performance appraisals, promotions, training, and career development programs. Consistent with these obligations, the Army provides reasonable accommodations to employees and applicants for functional limitations caused by disabilities, and for sincerely held religious beliefs, observances, and practices. Army employees and applicants are also protected against retaliation. Consistent with Federal laws, acts of retaliation against an employee or applicant who engages in protected activity, such as reporting discrimination or harassment or participating in the EEO process, will not be tolerated. The Army will take prompt action if an employee or applicant is subjected to workplace discrimination, retaliation, or harassment (including sexual harassment). We must be diligent in maintaining a workplace free from discrimination. This includes working to ensure that harassment, on any protected basis, does not occur within our Army. Army managers and supervisors play a critical role and have a responsibility to help prevent and eliminate harassment in the workplace, and all employees have a duty not to engage in harassing conduct and to report any such conduct if it occurs. Army employees or applicants who believe that they have been subjected to discrimination, harassment, or retaliation should contact their local EEO office. It is incumbent upon all of us to ensure that the Army is a model employer and serves as an example of equity and inclusiveness for all workplaces, within and outside the Federal government. Likewise, each of us must take responsibility for implementing the Army's EEO policy and cooperating fully in its enforcement. In so doing, we reaffirm our collective commitment to a work environment free from unlawful discrimination, harassment, and retaliation. Christine E. Wormuth Secretary of the Army

Assistant Professor of Chinese: Chinese Mandarin Language and Culture Instructor

The initial cutoff date for referral is 8/3/2023. Applicants applying by the initial cutoff date will be given first consideration. Additional referral lists will be created monthly or as vacancies become available. Serves as a Russian language teacher at the Defense Language Institute Foreign Language Center (DLIFLC) located on the Presidio of Monterey in Monterey, CA. DLIFLC offers intensive foreign language instruction in fourteen languages and dialects languages on a schedule that extends throughout the year. Courses are taught six hours per day, five days a week with the exception of federal holidays. Learn more about&nbsp;<a href="https://www.youtube.com/watch?v=z_5e3--107U" target="_blank">student life</a>&nbsp;and our&nbsp;<a href="https://vimeo.com/261328850" target="_blank">Institute</a>&nbsp;in these videos.
DLIFLC provides high quality culturally based foreign language training to enhance the national security of the United States. As an accredited institution, it awards Associates of Arts and Bachelor degrees to qualified graduates. U.S. Citizenship is not required, although candidates must have work authorization for the U.S. Candidates wishing to use Optional Practical Training (OPT) work authorization may be considered. DLIFLC may be able to support candidates with an H1-B visa under certain circumstances.
Application information Starting salary for Assistant Professor is $83,309-$88,103 per year. All applications must be made via&nbsp;<a href="https://www.usajobs.gov/job/722169100" target="_blank">USAJobs</a>, the federal government's official hiring website. Applicants who do not qualify for initial appointment at the&nbsp;<a href="https://www.usajobs.gov/job/733986800" target="_blank">Assistant Professor</a>&nbsp;level may be eligible for appointment at the&nbsp;<a href="https://www.usajobs.gov/job/733988500" target="_blank">Instructor</a>&nbsp;or&nbsp;<a href="https://www.usajobs.gov/job/733987800" target="_blank">Senior Instructor</a>&nbsp;level. Why work for DLIFLC? In addition to competitive salaries with locality pay, as a Department of Defense organization, employees receive a government pension in addition to Social Security; employees are also eligible for the Thrift Savings Plan with government contributions of up to 5% of salary. Health insurance can be carried over into retirement, with the federal government paying up to 75% of the premiums.A government sponsored wellness program allows for three hours per week of exercise on government time. Free access is offered to a state-of-the art gym located on the Presidio. After one year of service, employees receive up to 12-weeks of paid parental leave upon the birth of a child. Access to government childcare facilities may be available, and fee assistance for private childcare may be available subject to eligibility guidelines. DLIFLC offers generous paid time off benefits, with 13 days of sick leave each year plus 13-26 days of annual leave (vacation time) depending on length of service. Additionally, DLIFLC offers an Educational Assistance Program that may pay tuition for courses related to the employee's work assignment. To learn more about DLIFLC, visit our&nbsp;<a href="https://www.dliflc.edu/administration/employment" target="_blank">website</a>&nbsp;or find us on&nbsp;<a href="https://www.facebook.com/DLIFLC" target="_blank">Facebook.</a> Additional information
<ul>
<li>Please be sure to note all requirements and application procedures as contained on the official USAJobs vacancy announcement. If there are any discrepancies between this posting and that on the official USAJobs site, the USAJobs terms will prevail.</li>
<li>Relocation expenses may be authorized subject to approval, funding, and federal regulations.</li>
<li>Recruitment and Relocation incentives may be authorized subject to approval, funding, and federal regulations.</li>
<li>NOTICE OF VETERANS PREFERENCE: Department of Defense considers veterans' preference eligibility a positive factor for hiring. Applicants eligible for veterans' preference must include that information in their cover letter or resume and attached supporting documentation (e.g., DD Form 214, "Certificate of Release or Discharge from Active Duty") to their submissions. Although the point-preference system is not used, applicants eligible to claim 10-Point preference must submit a Standard Form (SF) 15, "Application for 10-Point Veteran Preference," and supporting documents required for specific type of preference claimed. (SF 15, which lists the types of 10-Point Preference and the required supporting documents, is available from the Office of Personnel Management Website at&nbsp;<a href="http://www.opm.gov/" target="_blank">www.opm.gov</a>.).</li>
</ul>
DEPARTMENT OF THE ARMY EQUAL EMPLOYMENT OPPORTUNITY POLICY STATEMENT March 21, 2023 As Secretary of the Army, I am committed to developing and fostering an environment that promotes and reflects diversity, equity, inclusion, and accessibility. Individually, these concepts enhance the Army's ability to create cohesive teams, which is integral to building trust at all levels; collectively, they leverage the strength of our people, advance opportunity, and optimize talent. These concepts enable the Army to fight and win our Nation's wars. As an integral part of that mission, the Army must protect our own employees from unlawful discrimination, harassment, and retaliation to ensure continued success. This equal employment opportunity (EEO) policy statement is a reminder that all Army employees are protected from unlawful discrimination. Army employees and applicants for employment are covered by Federal laws and Presidential Executive Orders designed to safeguard them from discrimination based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (family medical history), political affiliation, military service, or other non-merit-based factors. These protections extend to all management practices and employment decisions, including recruitment and hiring, performance appraisals, promotions, training, and career development programs. Consistent with these obligations, the Army provides reasonable accommodations to employees and applicants for functional limitations caused by disabilities, and for sincerely held religious beliefs, observances, and practices. Army employees and applicants are also protected against retaliation. Consistent with Federal laws, acts of retaliation against an employee or applicant who engages in protected activity, such as reporting discrimination or harassment or participating in the EEO process, will not be tolerated. The Army will take prompt action if an employee or applicant is subjected to workplace discrimination, retaliation, or harassment (including sexual harassment). We must be diligent in maintaining a workplace free from discrimination. This includes working to ensure that harassment, on any protected basis, does not occur within our Army. Army managers and supervisors play a critical role and have a responsibility to help prevent and eliminate harassment in the workplace, and all employees have a duty not to engage in harassing conduct and to report any such conduct if it occurs. Army employees or applicants who believe that they have been subjected to discrimination, harassment, or retaliation should contact their local EEO office. It is incumbent upon all of us to ensure that the Army is a model employer and serves as an example of equity and inclusiveness for all workplaces, within and outside the Federal government. Likewise, each of us must take responsibility for implementing the Army's EEO policy and cooperating fully in its enforcement. In so doing, we reaffirm our collective commitment to a work environment free from unlawful discrimination, harassment, and retaliation. Christine E. Wormuth Secretary of the Army

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