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<p><b>Salary Range:&nbsp;</b>&nbsp;$135,136.00&nbsp;(Min.) -&nbsp;$175,676.00&nbsp;(Mid.) -&nbsp;$216,218.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Director, Center of Excellence &amp; Quality Assurance is responsible for leading the quality, compliance, training, and continuous improvement functions that ensure L.A. Care’s Core Administrative Operations ecosystem operates with accuracy, integrity, and regulatory readiness. This role builds a disciplined quality framework that strengthens upstream and downstream controls, enhances first-pass accuracy, reduces defects, and ensures consistent, predictable outcomes across Claims Administration, Configuration, Payment Integrity, and related operational areas.</p><p>The Director oversees enterprise claims quality auditing, claims compliance oversight, issue detection and validation, corrective action planning, root-cause analysis, and enterprise reporting on quality performance. This role oversees enterprise quality for both operational claims processing and system configuration, ensuring the accuracy of benefit builds, provider reimbursement logic, system edits, pricing methodologies, and operational rules prior to deployment and ensures the organization meets federal, state, and contractual requirements by maintaining effective monitoring, quality review programs, compliance validation, and documentation standards. The Director also leads training and policy interpretation for claims-related operations, ensuring teams have the knowledge, tools, and guidance needed to maintain accuracy and adhere to changing regulatory requirements.</p><p>The Director creates a disciplined quality framework that strengthens upstream and downstream controls, enhances first-pass accuracy, reduces defects introduced through system changes, and ensures consistent execution across Core Administrative Operations service lines. The Director serves as the primary partner to operational leaders on quality and compliance matters, providing subject matter expertise on regulatory interpretation, operational risk, quality trends, and systemic improvements. This position builds a high-performing team and fosters a culture of quality, operational rigor, accountability, and continuous improvement.</p><p>This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.&nbsp; Develops strategic plans, drives change and influences critical business outcomes.</p><h4>Duties</h4><p>Strengthens L.A. Care’s operational quality by creating a structured, disciplined approach to auditing, compliance, and process validation.&nbsp; Ensures quality is proactively managed, system and process changes are controlled, and risks are quickly identified and remediated. Through cross-functional collaboration, transparent reporting, and strong execution, that improves operational maturity, enhances accuracy, reduces rework, and supports sustainable performance across all core administrative operations.</p><p>Leads the continuous improvement and execution of the Core Administrative Operations quality audit program, including audit planning, sampling methodologies, examiner scorecards, and real-time quality monitoring, managing both examiner-level QA and configuration build validation.&nbsp; Ensures quality review processes measure end-to-end claims accuracy, including benefit interpretation, provider contract application, coding, pricing, and system logic.&nbsp; Oversees testing and validation of configuration changes, including benefit builds, reimbursement tables, pricing logic, clinical/non-clinical edits, and system enhancements.</p><p>Ensures robust pre-production testing (unit, peer, end-to-end, and regression testing) for all configuration changes.&nbsp; Implements quality gates and validation checkpoints to prevent configuration-related defects from reaching production.&nbsp; Builds and maintains quality dashboards and performance reports to provide transparency to leadership and operational teams.&nbsp; Oversees validation of operational improvements, new processes, and system changes to ensure sustained accuracy and alignment with expected outcomes.</p><p>Ensures compliance with all regulatory requirements, including the Department of Managed Health Care (DMHC), the California Department of Health Care Services (DHCS), the Centers for Medicare and Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA), and contractual obligations related to claims accuracy, turnaround times, interest payments, notices, and documentation.</p><p>Leads or supports internal and external audits, including preparation, documentation, sample reviews, responses, and corrective action plans.&nbsp; Monitors regulatory changes, interprets requirements, and ensures claims operations and related departments adopt compliant practices.&nbsp; Directs compliance monitoring of claims processing, Payment Integrity interventions, configuration changes, and related administrative controls.</p><p>Directs root-cause analysis of quality findings to identify systemic drivers of defects, inaccuracies, or compliance risks.&nbsp; Develops corrective action plans (CAPs) with clear ownership, timelines, and measurable outcomes; monitors implementation to ensure sustainable resolution.&nbsp; Provides findings to operational leaders and supports development of upstream fixes that reduce rework and strengthen control points.&nbsp; Tracks and trends error patterns to proactively identify emerging risks and improvement opportunities.</p><h4>Duties Continued</h4><p>Establishes and maintains standard operating procedures, quality checkpoints, and control frameworks across related functions, ensuring consistency of processes, documentation, and quality standards.&nbsp; Ensures all system/benefit changes have proper impact assessments, approval workflows, and documented validations prior to production deployment.&nbsp; Strengthens alignment and consistency across teams by deploying standardized guidelines, documentation practices, and cross-functional workflows.</p><p>Ensures operational readiness for regulatory updates, benefit changes, system enhancements, and organizational initiatives by validating impacts on quality.&nbsp; Partners with Configuration and Claims Administration to ensure system logic and operational workflows support accurate processing.</p><p>Oversees development and delivery of training programs related to claims accuracy, policy interpretation, regulatory requirements, documentation standards, and quality expectations.&nbsp; Ensures training programs are aligned with audit findings, regulatory changes, and systemic improvement needs.&nbsp; Maintains updated knowledge repositories, training materials, and reference documentation to support consistent operational execution.&nbsp; Provides coaching to leaders and teams on quality standards, audit results, and improvement expectations.</p><p>Serves as a strategic advisor to operational, technical, and management teams on quality, compliance, and process improvement initiatives.&nbsp; Collaborates with cross-functional teams to address quality issues and implement sustainable solutions.&nbsp; Provides input on operational readiness for system changes, regulatory updates, and enterprise improvement work.&nbsp; Represents the quality and compliance perspective in governance forums, operational reviews, and cross-functional committees.</p><p>Develops and maintains dashboards, KPIs, and scorecards to monitor quality performance, compliance adherence, and systemic risks.&nbsp; Ensures leadership receives clear, actionable insights on trends, risks, and opportunities for improvement.&nbsp; Monitors the effectiveness of quality interventions and updates strategies based on performance data.</p><p>Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees. Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Develops, and manages budgets, utilizing resources effectively.&nbsp;</p><p>Conducts strategic planning to utilize resources in order to meet current and future departmental and Enterprise-wide goals.&nbsp; Identifies and actualizes enhancements to support company vision.&nbsp;</p><p>Develops and maintains relationships with key stakeholders.&nbsp; Leads discussions on policy operationalization and oversees key policy perspective sharing.</p><p>Leads, trains, develops, and manages a team of quality auditors, compliance analysts, training specialists, and process improvement staff.&nbsp; Develops specialized configuration QA capabilities (e.g., test scripts, regression suites, system scenario modeling).&nbsp; Oversees hiring, training, performance evaluations, coaching, and succession planning.&nbsp; Fosters a culture of integrity, accountability, operational rigor, and continuous improvement.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 7 years of deep experience in claims quality, claims compliance, auditing, or related managed care administrative functions.</p><p>At least 5 years of experience leading, supervising and/or managing staff.</p><p>Experience in Medicaid, Medicare, and Commercial managed care lines of business.</p><p>Extensive understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing.</p><p>Demonstrated experience leading enterprise audit programs or quality assurance functions.</p><p>Experience interpreting regulatory requirements and applying them to operational workflows.</p><p>Experience overseeing corrective action implementation, issue remediation, or regulatory readiness activities.</p><p>Extensive experience supporting or preparing for regulatory audits ((Department of Managed Health Care (DMHC), California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS)), including corrective action planning.</p><p><strong>Preferred:</strong></p><p>Experience partnering with technical and configuration teams to validate system changes.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong interpersonal leadership skills and an ability to motivate and develop talent while driving accountability.</p><p>Extensive knowledge of claims adjudication, benefit structures, provider contracting, DoFR, pricing rules, and coding standards (Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS)/ International Classification of Diseases (ICD)/ Diagnosis Related Group (DRG)).</p><p>Strong understanding of regulatory requirements and compliance frameworks.</p><p>Advanced analytical, problem-solving, and root-cause analysis skills.</p><p>Strong project leadership and organizational skills; able to manage multiple priorities simultaneously.</p><p>Exceptional interpersonal, verbal, and written communication skills, including executive communication with ability to produce audit-ready documentation.</p><p>Ability to work collaboratively across diverse teams and influence without direct authority.</p><p>Proficiency with Microsoft Office and data reporting tools.</p><p>Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.</p><p>Demonstrated ability to make sound and timely decisions.</p><p>Demonstrated ability to adapt to changing situations and adjust strategies accordingly</p><p>Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.</p><p>Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment</p><p>Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicaid, Medicare, Insurance, Healthcare                                                    </p>

L.A. Care Health Plan

Director, Center of Excellence and Quality Assurance

<p><b>Salary Range:&nbsp;</b>&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Senior Manager, Clinical and Regulatory Operations, is responsible for leading clinical case operations, regulatory interpretation, and clinical decision stewardship across all grievance, appeal, and State Fair Hearing cases. This position ensures that clinical and non-clinical case handling meets medical necessity standards, regulatory requirements, internal policy expectations, and quality-of-care obligations across all product lines, including Medi-Cal, Medicare, Marketplace, and delegated entities.</p><p>The Senior Manager oversees clinical operations teams responsible for medical necessity reviews, clinical grievances and appeals, Quality of Care (QOC) referrals, clinician coordination, clinical documentation quality, and regulatory interpretation. The role ensures strong collaboration with Utilization Management, the UM Medical Director, physician reviewers, Compliance, Member Services, Provider Network Management, claims teams, and the Center of Quality &amp; Excellence to support compliant, timely, and high-quality case handling.</p><p>The Senior Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.&nbsp; Responsible for driving performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.&nbsp; Oversees the development, implementation, administration, and maintenance of the department's programs, policies, and procedures. Responsible for driving management and performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.</p><p>Collaborate closely with executive/ senior management to establish goals that align with the company’s mission and vision.</p><h4>Duties</h4><p>Oversees end-to-end clinical case handling, including clinical grievances, clinical appeals, medical necessity review coordination, and clinical case triage and ensures consistent application of evidence-based guidelines, clinical criteria, and regulatory standards in all clinical decisions. Partners with the clinical leadership to ensure clinical decision accuracy and appropriateness. Translates clinical guidelines, regulatory requirements, and service standards into operational workflows that ensure accurate, timely, and clinically sound case handling. Ensures clinical documentation is accurate, complete, defensible, and compliant with regulatory expectations.</p><p>Oversees Quality of Care (QOC) case identification, referral, coordination, and documentation ensuring timely escalation and coordination of complex or medically nuanced grievance and appeal cases.</p><p>Strengthens the clinical and regulatory integrity of Appeals &amp; Grievances (A&amp;G) operations by guiding staff in the application of medical necessity criteria, ensuring documentation quality, and providing expert regulatory interpretation. Interprets and applies Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), and internal policy requirements related to grievance and appeal processes, ensuring operations maintain regulatory alignment. Serves as a subject-matter expert for regulatory interpretation, providing guidance to operational staff and leadership. Reviews, interprets, and implements regulatory updates that impact clinical or operational grievance and appeal workflows. Partners with Compliance and Legal to resolve regulatory inquiries related to clinical and operational case-handling requirements. Supports creation and revision of clinical and operational policies, SOPs, templates, letters, and decision-support tools.</p><p>Partners with cross-functional stakeholders to ensure proper handling of clinical and non-clinical cases. Coordinates cross-functional involvement in complex cases, including providers, delegates, plan partners, and medical directors. Supports operational teams in resolving regulatory or clinical issues that arise during case handling.</p><p>Oversees training and competency development for clinical operations staff, ensuring consistent understanding of medical necessity criteria, regulatory requirements, and decision-making standards. Identifies opportunities to enhance staff capability, accuracy, and regulatory alignment across clinical case-handling processes.</p><p>Oversees clinical case reporting and trend analysis, identifying patterns in clinical appeals, grievances, and QOC findings. Provides insights to leadership related to clinical drivers of grievances and appeals, opportunities for operational improvements, and service or quality risks.</p><p>Manages staff and the day-to-day activities in the department. Participates in the department budgeting process.&nbsp; Responsible for scheduling, training, performance, corrective actions, mentoring, and developing of the team(s). Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Mentors and develops staff, building technical and critical thinking skills across the team.</p><p>Implements and provides guidance to the departmental and organizational processes and policies and works with senior and/ or executive management to define, prioritize, and develop projects and programs.</p><p>Responsible for Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.</p><p>Responsible for overseeing and managing the budgets of their respective departments.</p><h4>Duties Continued</h4><p>Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.</p><p>Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.&nbsp; Ensures strong clinical judgment, regulatory understanding, and documentation discipline across the team.</p><p>Builds a culture of rigor, transparency, analytical curiosity, proactive issue identification, cross-functional communication, accountability, transparency, and continuous operational improvement.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Nursing or Related Field<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 6 years of experience working in managed care operations, quality assurance, audit readiness, compliance, or related regulatory roles.</p><p>At least 5 years of experience in leading, supervising and/or managing staff.</p><p>Experience in Medicaid, Medicare, and Commercial managed care lines of business.</p><p>Demonstrated experience overseeing quality assurance programs, internal controls, or audit readiness functions within a health plan or similar setting.</p><p>Strong experience with DHCS, DMHC, CMS, and NCQA requirements related to grievances, appeals, quality-of-care processes, and audit expectations.</p><p>Experience developing and managing corrective action plans and driving sustainable remediation.</p><p>Experience collaborating with delegated entities, plan partners, or subcontracted networks.</p><p>Experience leading teams, projects, initiatives, or cross-functional groups.</p><p><strong>Preferred:</strong></p><p>Experience with analytic dashboards and visualization tools (Power BI, Tableau).</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Proven ability to lead universe submissions, mock audits, and regulatory audit responses.</p><p>Expert knowledge of regulatory requirements, audit processes, and quality assurance practices in managed care.</p><p>Strong analytical, problem-solving, and critical thinking skills, including ability to translate trends into corrective actions.</p><p>Ability to design, implement, and sustain standardized processes and internal control structures.</p><p>Exceptional written and verbal communication skills, including executive communication and the ability to translate trends and other findings into actionable recommendations.</p><p>Proficiency with Microsoft Office, case management systems, and reporting tools.</p><p>Strong people skills for building relationships, fostering teamwork, and creating a positive work environment. Ability to guide and support team members.</p><p>Strong attention to detail and ability to manage multiple priorities and tight deadlines.</p><p>Excellent ability to set clear goals, develop strategic plans to achieve those goals, and inspire others to work towards a shared vision.</p><p>Skilled in mediating disputes and resolving conflicts in a fair and constructive manner.</p><p>Must have a deep understanding of financial principles.</p><p>Ability and exceptional knowledge in developing and managing budgets, forecasting future financial outcomes, and making informed decisions about resource allocation.</p><p>Demonstrated ability to make informed decisions.</p><p>Deep understanding of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.</p><p>Strong ability and knowledge to analyze market trends, anticipate future changes, and develop long-term strategies that align with the company's goals.</p><h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.</p><p>This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Nursing, Registered Nurse, Medicare, Medicaid, Medical Research, Healthcare                                                    </p>

Senior Manager, Clinical and Regulatory Operations

<p><b>Salary Range:&nbsp;</b>&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Business Analyst III facilitates business process improvement via the methodical investigation, analysis, review and documentation of functional business specifications. This position manages the requirements development process through the elicitation, analysis, specification and verification of multiple levels of requirements from an end-to-end perspective and supports the ongoing management of the requirements. This position develops report and analysis for the department. It is responsible in communicating and coordinating with IT on a day-to-day department related efforts. The Business Analyst III manages and coordinates the implementation and/or integration of products or new features for clients including client training and provides subject matter expertise (SME) and support of the department's inbound and outbound functions. This position acts as mentor to Business Analysts I/ II.</p><h4>Duties</h4><p>Develop functional and user acceptance test plans and scenarios. Coordinate functional and user acceptance testing by executing the testing strategy, scheduling resources and tracking test performance. Perform data analysis to support evaluation of system defects or to develop requirements for new functionality; assist in various system trouble shooting and balancing and correction efforts including analysis, verification and validation of issues and fixes. Coordinate activities including on-time delivery, testing and production moves.</p><p>Collaborate with I.T. on all department &nbsp;related efforts, including submission of Service Requests and writing BRD's. Coordinate related data requests from internal departments, and/or assist I.T. with definition of criteria. Delegate data and reporting requests to business analysts. Facilitate collaborative system and data design sessions with the user community, technical architecture resources and development resources. Preparation of status updates to enterprise for distribution and communication.</p><p>Work as a technical support and liaison to designated I.T. personnel to provide testing, support and feedback on enhancement requests and regular updates/releases; adhere to release schedules. Provide analytical support for critical corporate initiatives including business function support for system migrations and consolidations, significant business area process improvement projects and complex product installations.</p><p>Demonstrate a high level of subject matter expertise in functional area to bridge business requirements and I.T. solutions; provide technical direction and ensure compliance with best practice solutions. Practice knowledge transfer and foster change management as the organization changes and new skills are required, focusing on team/individual development to be a valued contributor.</p><p>Participate and contribute on the development/ creation of data models and interface design specifications. Support internal/ external stakeholder's roadmap and audits as needed.</p><p><br>Oversee the business process support across multiple client engagements. Communication with internal/ external stakeholders for department's submission requirements. Review submission of data against established benchmarks and coordinate correction and improvement efforts. Monitor timely and accurate outbound data submission to state and federal recipients.</p><h4>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</h4><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><b>Required:</b></p><p>At least 5 years of successful experience in a quantitative role as a Business Analyst, Data Analyst, Programming Analyst, Claims processing, encounter processing.</p><h4>Skills</h4><p><strong>Required:</strong><br>Competent to work at the highest technical level of most phases of systems analysis.</p><p>Excellent verbal and written communication skills.</p><p>Coaching, Mentoring and Teaching skills.</p><p>Teamwork-focused/collaborative work style.</p><p>Demonstrated ability to work successfully on large projects.</p><p>Problem solving skills evidenced by demonstrated results in past positions.</p><p>Ability to work under tight deadlines and handle multiple/detail-oriented tasks.</p><p>Ability to influence at all levels of the organization.</p><p>Proficient in Microsoft Office and Vizio.</p><p><strong>Preferred:</strong><br>Ability to work on other programs such as SharePoint and/ or OneNote</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Department Specifics:</b></p><p><b>Customer Solution Center Appeals and Grievances:</b></p><p>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.</p><p>This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Business Analyst, Claims, Finance, Insurance                                                    </p>

Business Analyst III

<p><b>Salary Range:&nbsp;</b>&nbsp;$55,245.00&nbsp;(Min.) -&nbsp;$69,045.00&nbsp;(Mid.) -&nbsp;$82,867.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Lead Service Liaison position is responsible for supporting daily management functions of the outreach team, helping ensure productivity, quality, and performance targets are met.</p><p>This position serves as the subject matter expert for the execution of member and provider outreach efforts for all lines of business. This position leads and works closely with assigned team daily. This position will mentor, coach, and may provide feedback to management on performance of staff. Ensure team effectiveness and project completion.</p><h4>Duties</h4><p>Monitors and facilitates timely contact of members regarding all outreach and retention programs for all lines of business. Provides recommendations for process improvements. Monitors real-time activity and campaign management, as needed. Ensures system of record is functional to provide complete, accurate information. (50%)</p><p>Assists management in ensuring staff provides accurate, timely and quality service to our members and providers, ensuring adherence to all departmental policies, procedures, and standards. Assists with special projects and campaigns that can provide feedback for membership satisfaction. Assists with campaign management functions for outreach efforts across all lines of business. (20%)</p><p>Assists management in providing accurate and timely reports to senior leadership. Performs Quality Assurance functions for vendor outbound campaigns. Interfaces and collaborates with management and stakeholders within and outside of the organization to address and resolve questions, elevate areas of member dissatisfaction, and barriers to care. Assists with identifying and implementing related process and system improvements. (20%)</p><h4>Leads the work of assigned staff; regularly assigns and checks the work of others, providing guidance, training, and feedback on performance to department management. Assist management in the oversight of the daily office workflow, recommends enhancements to process and procedures.</h4><h4>Guide the assigned staff in ensuring that the team's work is completed effectively. May assist in the assigning tasks and communicating project goals. Participates in team problem-solving, decision-making, and conflict resolution.</h4><h4>Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.</h4><h4>Performs other duties as assigned. (10%)</h4><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4>Associate's Degree<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 2 years of customer service experience in a contact center environment, preferably in a managed care plan setting.</p><p>At least 3 months of experience leading a process, program, and/or staff.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong coaching and motivational skills.</p><p>Proficiency with Customer Relationship Management (CRM) systems and dialing platforms.</p><p>Ability to analyze data and make performance-driven recommendations.</p><p>Proficiency in Microsoft Office suite.</p><p>Ability to communication, conflict resolution, and motivational skills.</p><p>Ability to collaborate closely with a team in a collaborative and interactive environment.</p><p>Skilled in fostering teamwork and collaboration.</p><p>Ability to adjust to changing circumstances within the team.</p><p>Good verbal and written communication skills.</p><p><strong>Preferred:</strong></p><p>Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese&nbsp;&nbsp;</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Relationship Manager, Customer Service                                                    </p>

Lead Service Liaison

<p><b>Salary Range:&nbsp;</b>&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Senior Manager, Electronic Data Interchange (EDI) &amp; Data Operations is responsible for leading and optimizing the day-to-day operational, analytical, and technical functions that support electronic data exchange, authorization data ingestion, accumulator management, and Explanation of Benefits (EOB) processing for L.A. Care. This includes operational oversight of all Health Insurance Portability and Accountability Act (HIPAA) standard and proprietary EDI transactions, delegated and internal authorization data loads, accumulator workflows, and the operational components of EOB generation and remediation.</p><p>The Senior Manager oversees a team who manage file intake, data validation, routing, reconciliation, testing, and issue resolution across the enterprise. This position ensures that all electronic and paper-to-electronic data supporting claims and administrative operations is accurate, timely, and compliant with regulatory, contractual, and quality expectations.</p><p>This position plays a critical leadership role in enhancing upstream controls, reducing rework, improving automation, supporting system changes, and driving continuous improvement in data operations.</p><p>Manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.&nbsp; Responsible for driving performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.&nbsp; Oversees the development, implementation, administration, and maintenance of the department's programs, policies, and procedures. Responsible for driving management and performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.</p><p>Collaborate closely with executive/ senior management to establish goals that align with the company’s mission and vision.</p><h4>Duties</h4><p>Strengthens the reliability, accuracy, and efficiency of all electronic data processes that support claims operations, ensuring data flows through systems as intended, issues are rapidly identified and remediated, and upstream controls are continuously enhanced. Helps drive predictable outcomes, improve payment accuracy, and maintain regulatory readiness across the data ecosystem.</p><p>Manages end-to-end operational oversight of all inbound and outbound HIPAA-standard and proprietary EDI transactions (837, 835, 270/271, 276/277, 834, 278). Ensures timely, accurate, and compliant processing of electronic claims, encounters, eligibility updates, and related administrative data.</p><p>Oversees transaction monitoring, exceptions, error queues, and data rejects; ensures prompt triage and resolution. Provides oversight of requirements documentation, including business and functional requirements (BRDs/FRDs), workflow mapping, and data specifications that support operational effectiveness.</p><p>Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.&nbsp;</p><p>Leads oversight of delegated Electronic Load of Delegated Authorizations (ELDA) and internal clinical authorization data loads into QNXT. Ensures authorization data is timely, complete, reconciled, and supportive of accurate claims adjudication.</p><p>Monitors authorization load success rates and partners with upstream teams to resolve recurring issues. Guides enhancements that reduce manual lookup burden for claims and increase automation.</p><p>Manages operational components of the Member Out-of-Pocket (MOOP) accumulator workflow, including reconciliation, error correction, escalation management, and member remediation.</p><p>Ensures accumulator data is accurate across intake systems, accumulator databases, QNXT, and output files.</p><p>Provides reporting and trending on accumulator performance, error patterns, and upstream causes.</p><p>Shares responsibility with the Director, EDI for operational oversight of EOB generation, validation, and data flow.</p><p>Ensures EOB output files reflect accurate benefit application, share of cost, accumulation, claim decisions, and meets regulatory requirements. Troubleshoots and resolves EOB-related issues, including cost-share miscalculations, missing data, formatting discrepancies, and system defects. Supports testing of EOB templates, logic updates, and system enhancements that impact EOB accuracy and delivery.</p><p>Leads complex root cause analyses for issues impacting claims data, authorizations, accumulators, or EOBs.</p><h4>Duties Continued</h4><p>Coordinates remediation efforts with cross-functional departments. Implements and provides guidance to the departmental and organizational processes and policies and works with senior and/ or executive management to define, prioritize, and develop projects and programs.</p><p>Ensures corrective actions are documented, validated, and monitored to prevent recurrence. Identifies systemic issues and recommends upstream solutions to strengthen operational controls and improve accuracy.</p><p>Responsible for Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval. Leads process and workflow redesign efforts to increase automation, reduce manual work, and improve overall data quality.</p><p>Oversees User Acceptance Testing (UAT) planning, test case creation, execution, and validation for system changes affecting EDI, authorization data, accumulators, and EOBs.</p><p>Ensures strong quality gates are consistently applied before production releases.</p><p>Works closely with the Director, EDI to prioritize enhancements and support operational readiness for system changes.</p><p>Serves as an operational liaison to cross-functional departments and delegated entities.</p><p>Communicates system availability, planned changes, incident statuses, and file processing updates clearly and consistently.</p><p>Supports internal and external partners with non-standard data requests, testing analysis, and troubleshooting.</p><p>Manages staff and the day-to-day activities in the department. Participates in the department budgeting process. Responsible for scheduling, training, performance, corrective actions, mentoring, and developing of the team(s). Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Mentors and develops staff, building technical and critical thinking skills across the team. Responsible for overseeing and managing the budgets of their respective departments.</p><p>Maintains a culture of rigor, transparency, analytical curiosity, proactive issue identification, cross-functional communication, accountability, and continuous operational improvement.</p><p>Perform other duties as assigned.&nbsp;</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 6 years of experience working with healthcare data, EDI transactions, claims data operations, or managed-care administrative systems.</p><p>At least 5years of experience in leading, supervising and/or managing staff.</p><p>Experience with system integrations, data migrations, or large-scale technical implementations.</p><p>Demonstrated experience leading complex issue resolution and root cause analysis efforts.</p><p>Experience leading teams, projects, initiatives, or cross-functional groups</p><p><strong>Preferred:</strong></p><p>Experience developing test cases, leading UAT, or supporting system configuration changes.</p><p>Experience with commercial health plan operations or delegated partner management.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong knowledge of HIPAA-standard EDI transactions and healthcare data structures.</p><p>Knowledge of MOOP accumulators, authorization workflows, and EOB data flows.</p><p>Familiarity with claims adjudication rules, cost-share logic, and benefit application.</p><p>Proficiency in SQL, Access, Excel, and related reporting or analysis tools.</p><p>Ability to interpret and produce BRDs, FRDs, process flows, and technical documentation.</p><p>Strong analytical, problem-solving, and system-thinking skills.</p><p>Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment. Ability to guide and support team members.</p><p>Excellent attention to detail and ability to manage multiple priorities and tight deadlines.</p><p>Excellent ability to set clear goals, develop strategic plans to achieve those goals, and inspire others to work towards a shared vision.</p><p>Skilled in mediating disputes and resolving conflicts in a fair and constructive manner.</p><p>Ability to develop and manage budgets, forecast future financial outcomes, and make informed decisions about resource allocation.</p><p>Demonstrated ability to make informed decisions.</p><p>Excellent verbal, written communication, and presentation skills.</p><p>Deep understanding of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.</p><p>Strong ability to analyze market trends, anticipate future changes, and develop long-term strategies that align with the company's goals.</p><p><strong>Preferred:</strong></p><p>Working knowledge of relational databases, system interfaces, or data transformation logic.</p><p>Experience with delegated entity data submissions or clearinghouse integrations.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Insurance                                                    </p>

Senior Manager, Electronic Data Interchange and Claims Data Operations

<p><b>Salary Range:&nbsp;</b>&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Senior Manager, Payment Integrity (PI) Operations, manages and leads critical components of L.A. Care’s enterprise Payment Integrity program, overseeing the design, execution, and continuous refinement of pre-payment and post-payment accuracy activities. This position integrates operational management with analytic, regulatory, and contract-driven development to prevent inappropriate payments, strengthen upstream controls, and ensure accurate financial outcomes across all lines of business.</p><p>The Senior Manager manages multi-functional teams responsible for prospective edit development, clinical and non-clinical pre-payment reviews, retrospective audits, overpayment/underpayment identification, recovery operations, and pipeline management. This position ensures PI programs are executed consistently, documented clearly, and aligned with regulatory, contractual, and financial expectations.</p><p>The Senior Manager works closely with cross-functional stakeholders to translate insights into actionable system changes and preventive modifications. The Senior Manager serves as the operational driver for Payment Integrity interventions, ensuring programs scale effectively, are audit-ready, and deliver measurable reductions in inaccurate or wasteful spend.</p><p>Manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.&nbsp; Responsible for driving performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.&nbsp; Oversees the development, implementation, administration, and maintenance of the department's programs, policies, and procedures. Responsible for driving management and performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.</p><p>Collaborate closely with executive/ senior management to establish goals that align with the company’s mission and vision.</p><h4>Duties</h4><p>Leads daily operations of pre-pay and post-pay PI activities, ensuring accuracy, timeliness, and effective case management. Oversees prospective review programs including clinical editing, code auditing, algorithm-driven controls, and provider contract/benefit interpretation. Ensures post-pay functions, including data mining, recovery validation, provider outreach, and reconciliation, are accurate, transparent, and compliant. Establishes standardized workflows, documentation, and quality review expectations across all PI teams. Ensures Payment Integrity operates as a disciplined, analytically driven, and preventive control function.</p><p>Strengthens the reliability of claims processing, increases automation and cost avoidance, manages complex PI workflows, and translates regulatory and contract-driven requirements into systematic, sustainable accuracy improvements.</p><p>Oversees development, refinement, and implementation of new edits, rules, and clinical/non-clinical logic that reduce future payment errors. Translates regulatory updates, provider contract terms, benefit changes, and emerging industry standards into edit or algorithm recommendations. Manages the PI pipeline of prospective initiatives, ensuring strong prioritization, impact modeling, and timely deployment. Partners with key stakeholders to implement upstream corrections and reduce recurring defects. Ensures prospective controls improve auto-adjudication, accuracy, and reduction of rework.</p><p>Oversees identification and validation of overpayments and underpayments from solicited/unsolicited sources, analytics, and vendor partners. Ensures recoveries follow compliant workflows, including provider notification, appeal support, repayment management, and financial reconciliation. Ensures post-pay insights translate into upstream corrective actions, edit changes, or preventive improvements. Oversees development of operational processes that strengthen coordination between internal recovery teams and external vendors.</p><p>Directs analytic and data mining efforts to detect billing anomalies, emerging risk patterns, and high-impact cost avoidance opportunities. Partners with enterprise analytics to refine predictive modeling, trending dashboards, and reporting frameworks. Ensures analytical findings convert into operational interventions, policy updates, or system changes. Identifies high-risk providers, services, or claims behaviors requiring new controls or deeper review.</p><h4>Duties Continued</h4><p>Ensures PI programs align with federal, state, and contractual requirements for all lines of business. Interprets regulatory updates and directs teams to integrate changes into rules, workflows, and edit development. Ensures that benefit structures, contract terms, and pricing methodologies are correctly reflected in both pre- and post-pay activities. Partners with Compliance and SIU on cases requiring heightened review or escalated investigation.</p><p>Oversees operational execution of vendor-driven PI programs, ensuring strong Service level agreement (SLA) performance, validated results, and accurate financial reporting. Supports vendor onboarding, implementation, testing, and algorithm or rule customizations. Ensures internal teams coordinate effectively with external partners across pre-pay and post-pay programs.</p><p>Partners with cross-functional key stakeholders to resolve system issues and strengthen upstream accuracy. Serves as an advisor to internal partners on PI trends, risk areas, provider behavior insights, and recommended control changes. Ensures PI findings are shared proactively and used to influence broader operational and configuration improvements.</p><p>Manages staff and the day-to-day activities in the department. Participates in the department budgeting process.&nbsp; Responsible for scheduling, training, performance, corrective actions, mentoring, developing of the team(s). Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Mentors and develops staff, building technical and problem-solving skills across the team.</p><p>Implements and provides guidance to the departmental and organizational processes and policies and works with senior and/ or executive management to define, prioritize, and develop projects and programs.</p><p>Responsible for Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.</p><p>Responsible for overseeing and managing the budgets of their respective departments.</p><p>Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.</p><p>Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:&nbsp; </strong></p><p>At least 6 years of Payment Integrity, Program Integrity, medical cost containment, Fraud Waste and Abuse (FWA), data mining, claim accuracy, or related experience.</p><p>At least 5 years of experience in leading staff, Supervising and/or managing staff.</p><p>Experience leading teams, projects, initiatives, and cross-functional groups.</p><p>Experience in Medicaid, Medicare, and Commercial managed care lines of business.</p><p>Experience in pre-pay and/or post-pay review, edit development, recovery operations, or claim logic development.</p><p>Experience interpreting provider contracts, payment methodologies, and managed care benefit structures.</p><p>Experience handling complex claim review, root-cause evaluation, and adhering to regulatory TAT requirements</p><p>Experience working with COB and Third-Party Liability (TPL) claims in a managed care setting.</p><p>Experience with vendor-managed PI programs.</p><p><strong>Preferred:</strong></p><p>Experience applying predictive analytics or algorithm-based PI solutions.</p><p>Experience with SQL, BI tools, or data mining platforms.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong understanding of adjudication, coding, and the application of Division of Financial Responsibility (DOFR) to claims processing.</p><p>Extensive knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD)-10, DRG/ Ambulatory Payment Classification (APC), and pricing methodologies.</p><p>Understanding of benefit interpretation, contract terms, and payment rules.</p><p>Strong analytical, investigative, financial, and operational skills.</p><p>Exceptional written and verbal communication skills, including executive communication and the ability to translate technical findings into actionable recommendations.</p><p>Advanced project leadership, workflow management, and prioritization skills.</p><p>Ability to collaborate with internal and external stakeholders at all levels.</p><p>Proven problem-solving skills and ability to translate knowledge to the department.</p><p>Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment. Ability to guide and support team members.</p><p>Excellent ability to set clear goals, develop strategic plans to achieve those goals, and inspire others to work towards a shared vision.</p><p>Skilled in mediating disputes and resolving conflicts in a fair and constructive manner.</p><p>Must have a deep understanding of financial principles.</p><p>Ability and excellent knowledge in developing and managing budgets, forecasting future financial outcomes, and making informed decisions about resource allocation.</p><p>Demonstrated ability to make informed decisions.</p><p>Strong verbal, written communication and presentation skills.</p><p>Deep understanding of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.</p><p>Strong ability and knowledge to analyze market trends, anticipate future changes, and develop long-term strategies that align with the company's goals.</p><p><strong>Preferred:</strong></p><p>Knowledge of SIU/FWA methodologies and risk indicators.</p><p>Experience with SQL, BI tools, or data mining platforms.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Professional Coder (CPC) designation by the American Academy of Professional Coders<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medical Coding, Claims, Medicare, Medicaid, Healthcare, Insurance                                                    </p>

Senior Manager, Payment Integrity Operations

The e-Commerce Sales Manager has the opportunity to lead a sales team to create an exceptional experience for customers.&nbsp; This role is responsible for selecting, training, coaching, developing and retaining the very best e-Commerce Sales Associates for the store and driving a high-level of performance among the sales team to increase market share, achieve targeted unit sales and profit margins while delighting every Customer along the way. &nbsp;<p></p><p></p><h1><b>Lead the Future of Automotive Retail.</b></h1><p>At AutoNation, innovation drives everything we do—from automotive retail to vehicle service to automotive finance. As a Fortune 200 company, we’re looking for leaders who are ready to shape the future of automotive retail.</p><h1><b>Why You’ll Love Working Here:</b></h1><ul><li><p>National scale with entrepreneurial spirit</p></li><li><p>Inclusive culture and diverse leadership</p></li><li><p>Competitive compensation and benefits</p></li><li><p>Opportunities to make a real impact</p></li><li><p>Our values and culture</p></li></ul><h1><b>What We’re Looking For:</b></h1><ul><li><p>Proven leadership experience</p></li><li><p>Strategic thinking and execution skills</p></li><li><p>Passion for innovation and people development</p></li></ul><p>Explore leadership opportunities at AutoNation today.</p><h1>What are the day-to-day responsibilities?</h1><ul><li><p>Leading yourself and the team in a way that supports AutoNation’s Vision and Mission</p></li><li><p>Setting a clear vision and goals for the sales team to achieve targeted performance in new and used vehicle sales and profit</p></li><li><p>Engaging and motivating the team to achieve key goals, performance expectations and AutoNation best practice processes</p></li><li><p>Driving the business through a high-level of involvement in the day-to-day operations</p></li><li><p>Ensuring that e-leads are handled timely, answering questions, providing information and ideally setting an appointment for a visit to the store</p></li><li><p>Manage the follow-up with e-leads to assist them as needed through their research phase until ready for a vehicle purchase</p></li><li><p>&nbsp;Ensure Customers are transitioned effectively from phone and internet contact to their in-store experience</p></li><li><p>Managing the negotiation process with Sales Associates ensuring that customers understand their vehicle purchase options and pricing</p></li><li><p>Appraising vehicles for trade</p></li><li><p>Managing all three areas of customer traffic: &nbsp;Showroom, E-Commerce, and Phones</p></li><li><p>Partnering with General Manager and/or General Sales Manager to plan and manage new and used vehicle inventory</p></li><li><p>Assisting in managing controllable expense elements for the New and Used Vehicle Departments</p></li><li><p>Analyzing the business to determine shortfalls and developing action plans to improve performance</p></li></ul><h1>How will I know if I am successful?</h1><ul><li><h1>The performance of a Sales Manager is measured by achieving:</h1></li><li><p>Targeted e-lead conversions to appointments</p></li><li><p>Targeted unit sales and gross profit</p></li><li><p>Targeted Associate retention</p></li><li><p>Targeted Customer Satisfaction Index</p></li></ul><h1>What are the requirements for this job?</h1><ul><li><p>High School diploma or equivalent</p></li><li><p>Proven success in eCommerce automotive sales</p></li><li><p>Proven leadership ability to mentor and train others</p></li><li><p>Ability to set and achieve targeted goals</p></li><li><p>Ability to drive an exceptional Customer experience</p></li><li><p>Demonstrated communication and interpersonal skills</p></li><li><p>Organization and follow-up skills</p></li><li><p>Experience and desire to work with technology</p></li><li><p>Valid in-state driver’s license and have and maintain an acceptable, safe driving record</p></li></ul><h1>What are the opportunities for career growth?</h1><ul><li><p>Our Sales Managers have a few options for career growth and development after success in this role. &nbsp;Opportunities may include:</p></li><li><p>Used Vehicle Manager</p></li><li><p>Financial Services Director</p></li></ul><p></p><p></p><p>Compensation: $4,800 - $17,941 Monthly</p><p></p><h2>Exciting Benefits and Perks Await You:</h2><ul><li><p>Competitive compensation and 401k matching</p></li><li><p>Enjoy a healthy work-life balance with insurance plans (health, dental, vision) and maternity benefits.</p></li><li><p>Associate purchase and discount programs for new and pre-owned vehicles, services, parts, collision, accessories, and AutoGear</p></li><li><p>Access amazing deals and discounts through YouDecide, a website with offers from top providers and retailers</p></li><li><p>Join our DRVPNK mission to raise and donate millions of dollars to cancer research and treatment, partnering with cancer charities nationwide</p></li></ul><p></p><p></p><p>AutoNation is one of the largest automotive retailers in the United States, offering innovative products, exceptional services, and comprehensive solutions, empowering our customers to make the best decisions for their needs. With a network of dealerships nationwide strengthened by a recognized brand, we offer a wide variety of new and used vehicles, customer financing, parts, and provide expert maintenance and repair services. Through DRV PNK, we have raised over $40 million for cancer-related causes, demonstrating our commitment to making a positive difference in the lives of our Associates, Customers, and the communities we serve.<br>&nbsp;</p><p>AutoNation is committed to creating a diverse, equitable, and inclusive environment in our workplace and the services we provide. We welcome candidates from all backgrounds who are passionate about making a positive impact. Even if you do not meet every requirement, we encourage you to apply. Join our team and help us foster a culture of belonging while contributing to our revolutionary work in the automotive industry. We value innovation, teamwork, and a commitment to making a positive impact in the world.</p>

AutoNation

Sales Manager - AN Land Rover South Bay

<p><strong>Join the Clean Energy Revolution</strong></p><p>Become a <strong>Accounts Payable Specialist</strong>at Southern California Edison (SCE) and build a better tomorrow. In this job, you’ll facilitate payment-related activities, ensuring compliance with company financial policies for the Claims Department. As a&nbsp;<strong>Accounts Payable Specialist</strong>, your work will help power our planet, reduce carbon emissions and create cleaner air for everyone. Are you ready to take on the challenge to help us build the future?</p><h4><b>Responsibilities</b></h4><ul><li>Reconciles accounts payable total and general ledger with other applicable records (e.g., subsidiary vendors' ledger).</li><li>Assists reconciling monthly statements and transactions for accounting records and ledgers.</li><li>Analyzes invoices such as non-PO transactions expense reports for payment eligibility and accuracy.</li><li>Collects invoices to ensure proper authorization, adherence to SCE policies, and accuracy.</li><li>Maintains proper documentation of purchases for use in periodic audits and tax preparation.</li><li>Ensures payment terms and vendor agreement compliance by processing payments accurately and timely.</li><li>Supports the growth of SCE by implementing new controls and procedures and following existing procedures.</li><li>Ensures timely and accurate payments; oversees cash ﬂow reporting.</li><li>Analyzes ﬁnancial data/KPIs to identify trends and provides recommendations aimed at identifying potential improvement opportunities.</li><li>Properly handles and codes invoices to maintain inventory records and general ledger expense accounts by preparing guidelines.</li><li>A material job duty of all positions within the Company is ensuring the protection of all its physical, ﬁnancial and cybersecurity assets, and properly accessing and managing private customer data, proprietary information, conﬁdential medical records, and other types of highly sensitive information and data with the highest standards of conduct and integrity.</li></ul><h4><b>Minimum Qualifications</b></h4><ul><li>Three or more years of experience with reconciliation of accounts payable and general ledger with other applicable records.</li></ul><p><strong>Preferred Qualifications</strong></p><ul><li>Experience with SAP and/or SCE Systems</li><li>Experience processing claims and workers’ compensation payments</li><li>At least two year of data analytics experience</li><li>Ability to show strong attention to detail and accuracy</li><li>Demonstrated ability to adapt to changing priorities and take initiative when faced with new challenges.</li></ul><p><strong>Additional Information</strong></p><ul><li>This position’s work mode is&nbsp;<strong>hybrid.&nbsp;</strong>The employee will report to an SCE facility for a set number of days with the option to work remotely on the remaining days.  Unless otherwise noted, employees are required to work and&nbsp;reside in the state of California.  Further details of this work mode will be discussed at the interview stage.&nbsp;The work mode can be changed based on business needs.</li><li>Visit our&nbsp;Candidate Resource&nbsp;page to get meaningful information related to benefits, perks, resources, testing information, hiring process, and more!</li><li>Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.&nbsp;</li><li>Relocation does not apply to this position.</li></ul><p><strong>About Southern California Edison</strong></p><p>The people at SCE don't just keep the lights on. Our mission is so much bigger. We’re fueling the kind of innovation that’s changing an entire industry, and quite possibly the planet. Join us and create a future with cleaner energy, while providing our customers with the safety and reliability they demand. At SCE, you’ll have a chance to grow personally and professionally, making a real impact in Southern California and around the world.</p><p>Southern California Edison is a proud Equal Opportunity Employer, including disability and protected veteran status.</p><p>We are committed to ensuring that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodations at (833) 343-0727.</p>

Southern California Edison

Accounts Payable Specialist

<h4><b>Summary of Position</b></h4><p>Lionsgate has an immediate opening for a Director, Finance – SAP ERP &amp; Process Improvement &amp; Governance. This person will lead finance process design and governance in SAP S/4HANA, including Procure-to-Pay (P2P), Master Data Governance (MDG), and Intercompany Matching &amp; Reconciliation (ICMR). The role ensures timely quarter closes, accurate SEC reporting, robust SOX controls, and successful external audits.</p><p>This person will also be a key leader on finance and accounting projects for senior management, including M&amp;A activities, due diligence and integration, capital and debt offerings, process improvement, and system implementations. The role will act as business owner for SAP finance capabilities and drive continuous improvement.</p><h4><b>Responsibilities</b></h4><ul><li>Key GL owner for SAP S/4HANA finance landscape (FI/CO) and integration with P2P/MM and AP processes.</li><li>Lead Procure-to-Pay process improvements and automation utilizing best in class tools and practices.</li><li>Establish SAP Master Data Governance (MDG) for Business Partners, GL accounts, cost/profit centers; internal orders, project systems, title master and enforce data standards and workflows.</li><li>Manage intercompany processes using SAP ICMR: configure matching rules, variance workflows, and auto postings to accelerate close.</li><li>Enable Group Reporting integration for consolidations and intercompany eliminations.</li><li>Implement SOX and internal controls in SAP: user access, segregation of duties, and audit dashboards using SAP GRC.</li><li>Serve as product owner for SAP finance enhancements: requirements, testing, cutover, training, and hypercare.</li><li>Drive continuous improvement using SAP Signavio for process mining and KPI tracking.</li><li>Oversee accounting for joint ventures and subsidiaries with unique reporting requirements.</li><li>Coordinate quarterly close readiness and ensure timely SEC filings and successful audits.</li><li>Partner with FP&amp;A and Tax for accurate intercompany and royalty accounting.</li><li>Act as signatory on designated bank accounts and align bank integrations with SAP payment processes.</li></ul><h4><b>Qualifications and Skills</b></h4><ul><li>Bachelor’s degree in Accounting, Finance, or Information Systems; CPA preferred.</li><li>5+ years of relevant experience.</li><li>Expertise in SAP ECC, SAP S/4HANA Finance (FI/CO) and integration with P2P/MM and AP.</li><li>Experience implementing SAP MDG and Business Partner governance.</li><li>Knowledge of SAP ICMR and Group Reporting for intercompany and consolidation.</li><li>Strong understanding of SOX controls and SAP GRC Access Control.</li><li>Systems design and implementation experience, including testing, conversions and change management.</li><li>Strong US GAAP knowledge and advanced Excel skills.</li><li>Excellent communication and collaboration skills; ability to work under tight deadlines.</li><li>Advanced SAP reporting skills across ECC and BW and Report Painter.</li><li>Ability to navigate and work in a fast pace environment, multitasking on many initiatives across global locations.&nbsp;</li><li>Proven track record for implementing process improvements and technology across global organizations.</li><li>International accounting and Media and Entertainment experience preferred.</li></ul><h4><b>Nice to Haves</b></h4><ul><li>Experience with Central Finance and multi-ERP integration.</li><li>Public accounting experience.</li></ul><h4><b>About Lionsgate</b></h4><p>Lionsgate (NYSE: LION) is one of the world’s leading standalone, pure play, publicly traded content companies. It brings together diversified motion picture and television production and distribution businesses, a world-class portfolio of valuable brands and franchises, a talent management and production powerhouse and a more than 20,000-title film and television library, all driven by the studio’s bold and entrepreneurial culture.</p><h4><b>Our Benefits</b></h4><ul><li>Full Coverage – Medical, Vision, and Dental</li><li>Work/Life Balance – generous sick days, vacation days, holidays, and Impact Day</li><li>401(k) company matching</li></ul><h4><b>Compensation</b></h4><p>$140,000 – $150,000</p><h4>EEO Statement</h4><p><em>Lionsgate is an equal employment opportunity employer. All employees and applicants are evaluated on the basis of their qualifications, consistent with applicable state and federal laws. In addition, Lionsgate will provide reasonable accommodations for qualified individuals with disabilities. Lionsgate will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable state and federal law. &nbsp;</em></p>

Lionsgate

Director, Finance - SAP ERP & Process Governance

<h3>Job Description:</h3><h3>Relationship Manager</h3><p>As a Relationship Manager, you will be facilitating relationships with Fidelity’s most valuable clients. Through your honesty and integrity, we know you will inspire client dedication and engagement in order to develop long-lasting, positive relationships with Fidelity. You will learn how to nurture a book of business and successfully find opportunities to add value to the relationship. You will see your impact on the business and have rewarding interactions with clients every single day. </p><h3>The Expertise We’re Looking For</h3><ul><li>FINRA Series 7 &amp; 63 licensed; Series 65 or 66 licensed and appropriate state registrations OR ability to acquire series 65/66 upon hire</li><li>1-3 years in financial services with an emphasis in providing an excellent customer experience</li><li>Planning experience and knowledge of financial markets and products</li><li>Strong social skills and the ability to deliver highly personalized service to each client</li><li>Ability to find success in a dynamic, deadline driven, and detailed compliance environment</li><li>Ability to think creatively and be comfortable making decisions with the support of your team</li><li>Degree and/or other professional certifications are helpful; if you don’t already have a CFP or degree, our Tuition Reimbursement program can help you obtain one</li></ul><h3>The Purpose of Your Role</h3><p>The Relationship Manager is a pivotal role within the branch team responsible for fostering client relationships and finding opportunities to deepen the relationship in meaningful ways. You will keep the Financial Consultants organized and ensure the daily work is carried with the client’s needs top of mind.</p><h3>The Skills You Bring</h3><ul><li>You are able to facilitate setting targeted appointments that improve engagement with clients</li><li>You are client oriented and bring great perspective on financial planning</li><li>You have a vested interest in being an advocate for your clients</li><li>You are professional with a polished communication style compatible with high net worth clientele</li><li>Being coachable, collaborative, and curious are your "go to" attributes</li></ul><h3>Our Investments in You</h3><h3>Fidelity’s greatest advantage is our people, and we believe it is important to approach life holistically. We offer a competitive total rewards package, including a stable base salary, to recognize associate achievements. And our benefit programs are designed to help you and your family strike the right balance. We offer training in-branch, regionally, nationally, and virtually to help you with all aspects of your business. You will not fail due to a lack of training or onboarding!</h3><h3>The Value You Deliver</h3><ul><li>You are key to the Fidelity relationship strategy</li><li>Deepening client relationships through long term mentorship</li><li>Collaborating with the Relationship Manager team company wide</li><li>Being responsible for the client contact strategy</li><li>Building long-lasting meaningful relationships with clients</li></ul>The base salary range for this position is $61,000 - $80,000 per year. <p>Placement in the range will vary based on job responsibilities and scope, geographic location, candidate’s relevant experience, and other factors.</p><p>Base salary is only part of the total compensation package. Depending on the position and eligibility requirements, the offer package may also include bonus or other variable compensation. </p><p><br>We offer a wide range of <a href="https://jobs.fidelity.com/benefits/" target="_blank">benefits</a> to meet your evolving needs and help you live your best life at work and at home. These benefits include comprehensive health care coverage and emotional well-being support, market-leading retirement, generous paid time off and parental leave, charitable giving employee match program, and educational assistance including student loan repayment, tuition reimbursement, and learning resources to develop your career. Note, the application window closes when the position is filled or unposted.</p><p>Most roles at Fidelity are Hybrid, requiring associates to work onsite every other week (all business days, M-F) in a Fidelity office. This does not apply to Remote or fully Onsite roles.</p><p>Please be advised that Fidelity’s business is governed by the provisions of the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, ERISA, numerous state laws governing securities, investment and retirement-related financial activities and the rules and regulations of numerous self-regulatory organizations, including FINRA, among others. Those laws and regulations may restrict Fidelity from hiring and/or associating with individuals with certain Criminal Histories.</p><h3>Certifications:</h3>Series 07 - FINRA, Series 63 - FINRA<h3>Category:</h3>Relationship Management

390 Full Time Jobs in Beverly Hills, CA, USA