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<p><b>Salary Range:&nbsp;</b>&nbsp;$60,778.00&nbsp;(Min.) -&nbsp;$75,950.00&nbsp;(Mid.) -&nbsp;$91,166.00&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 Category Specialist II supports the execution of L.A. Care’s category management strategies by conducting spend analysis, preparing reports, and assisting in sourcing events across assigned categories. This position partners with stakeholders to track savings, review contracts and invoices for compliance, and maintain accurate vendor and spend data within procurement systems. The Specialist ensures policy compliance and provides the foundational insights needed for sourcing execution and category strategy.</p><h4>Duties</h4><p>Support category management activities by conducting spend analysis, supplier research, and market benchmarking to identify savings opportunities and rationalize vendors. (25%)</p><p>Develop and maintain detailed reports on spend and vendor performance, contract expirations, and cost savings by using source-to-pay systems and advanced Excel/Business Intelligence (BI) tools. (15%)</p><p>Assist in sourcing execution by preparing Request for x (RFx) documentation, consolidating supplier responses, conducting cost/price comparisons, and supporting contract negotiations. (20%)</p><p>Partner with internal stakeholders to collect requirements, track supplier performance, and ensure accurate application of purchase orders, invoices, and contracts. (10%)</p><p>Ensure compliance with procurement policies and procedures by supporting contract review, validation of supplier terms, and accurate application of Accounts Payable (A/P) documentation. (5%)</p><p>Contribute to strategic initiatives including vendor rationalization projects, supplier onboarding, and process automation within source-to-pay platforms. (10%)</p><p>Provide project and administrative support for sourcing events, supplier scorecards, and quarterly business reviews. (5%)</p><p>Perform other duties as assigned, including supporting special projects and process improvement initiatives. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Business or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><strong>Required:</strong></p><p>At least 2 years of experience in procurement, strategic sourcing, purchasing or contract management, analyzing data in a financial and legal context.</p><p>Ariba or similar experience with strong understanding of master data management.</p><p>Experience utilizing leading-edge analytics and research tools and technologies.</p><p><strong>Preferred:</strong></p><p>Experience in managing initial and ongoing Vendor Risk elements, including cyber.</p><p>Experience negotiating and managing supplier agreements for a wide variety of goods and services.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Familiar with procurement and sourcing concepts, practices, systems and procedures.</p><p>Quick and reliable learner with extreme attention to detail.</p><p>Highly organized multi-tasker with ability to independently spot issues and work through problems with minimal to no assistance.</p><p>Excellent verbal, written communication, analytical, organizational and presentation skills.&nbsp;</p><p>&nbsp;Familiarity with healthcare and legal terminology and methodology.</p><p>Ability to prepare amendments, contracts and basic legal documents from templates.</p><p>Proficient in Microsoft PowerPoint, Excel and Office.</p><p>Strong procurement skills to support vendor relationship management.</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>                    Accounts Payable, Administrative Assistant, Relationship Manager, Finance, Administrative, Customer Service                                                    </p>

L.A. Care Health Plan

Category Specialist II

<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, Configuration develops and leads the strategy, execution, and continuous enhancement of authorization, benefit, pricing, provider, and&nbsp; configuration governance framework across L.A. Care’s core administrative platforms (QNXT) and associated tools. This position ensures that configuration is accurate, efficient, and designed to function as a preventative control mechanism mitigating downstream defects by strengthening upstream processes, validating requirements, and building predictable, repeatable system behaviors.</p><p>The Director oversees the full configuration life cycle – from impact assessment and requirements analysis through design, build, testing, and post-implementation validation, ensuring that changes are implemented with discipline and high reliability. The Director partners closely with cross-functional teams and other operational departments to ensure configuration supports a high-performing claims environment with strong control points, reduced rework, and timely, accurate adjudication.</p><p>The Director 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><p>The Director drives skill development, accountability, and operational consistency within the team. This position also serves a key role in supporting enterprise initiatives that require coordinated, scalable, and well-governed configuration changes. </p><h4>Duties</h4><h4>Develops, and implements standards, quality gates and governance frameworks.&nbsp; Ensures that the core system configuration is executed with rigor, transparency, and precision. Strengthens upstream quality and operational readiness by leading disciplined change processes, anticipating downstream impacts, and establishing a consistent framework that reduces defects, improves accuracy, and enhances the reliability of the claims environment. Through active planning, structured governance, and strong cross-functional partnerships, ensures configuration supports a more standardized, predictable, and efficient operational ecosystem.</h4><h4>Oversees the end-to-end configuration life cycle including analysis, requirements validation, design, build, testing, migration, and post-deployment monitoring. &nbsp;&nbsp;Establishes standardized processes, documentation requirements, and quality gates to ensure accuracy, traceability, and reliable execution of configuration changes. &nbsp;&nbsp;Ensures configuration solutions support accurate adjudication and align with operational needs, regulatory requirements, and enterprise readiness.&nbsp; Leads development and maintenance of configuration standards, controls, and governance frameworks that promote consistency and reduce manual rework.</h4><h4>Collaborates with cross functional teams on configuration priorities, impacts, and implementation timelines.&nbsp; Partners in configuration quality assurance (QA) activities to validate accuracy, completeness, and compliance with internal standards and regulatory expectations and to ensure clarity of requirements, appropriate test scenarios, and full understanding of configuration logic.&nbsp; Supports operational readiness by coordinating clarification, defect research, requirement updates, and post-deployment validation support.<br><br></h4><h4>Ensures configuration work meets established quality gates.&nbsp; Leads issue identification and root-cause analysis for configuration-related errors, ensuring sustainable upstream fixes.&nbsp; Establishes and monitors process-level controls that prevent recurring defects and improve configuration accuracy over time.&nbsp; Tracks and trends configuration errors, collaborating on remediation planning, systemic improvements, and prevention strategies.</h4><h4>Duties Continued</h4><h4>Oversees benefit configuration, pricing methodologies, provider reimbursement logic, and other adjudication rules requiring technical precision.&nbsp; Ensures configuration environments support stable performance, controlled releases, and effective integration with system enhancements and updates.&nbsp; Partners with key stakeholders to support migrations, module updates, automation opportunities, and system changes that strengthen functional performance.</h4><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><h4>Leads, trains, and develops staff, ensuring technical competence, consistency, and high-quality execution.&nbsp;&nbsp;&nbsp; Fosters a culture of proactive issue identification, cross-functional communication, accountability, transparency, and continuous operational improvement.</h4><h4>Performs other duties as assigned.</h4><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 experience in a system configuration or managed care operations involving core administrative platforms (e.g. Cognizant QNXT).</p><p>At least 5 years of experience leading, supervising and/or managing staff in technical or operational environments.</p><p>Significant experience configuring benefits, pricing methodologies, provider payment logic, and related adjudication rules.</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>Advanced knowledge of and experience with American Health Information Management Association (AHIMA) coding standards.</p><p>Knowledge of and experience with utilizing Systems Development Life Cycle (SDLC), configuration change management methodologies, testing protocols, document standards, and best practices.</p><p>Experience supporting audits, corrective actions, and regulatory reviews.</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 understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing.</p><p>Knowledge of SDLC procedures in planning system configuration changes (i.e., use of rigorous documentation, testing and quality assurance protocols prior to deployment of changes into production).</p><p>Advanced knowledge of standard programming and logic to facilitate the maintenance of system configuration files and tables, along with supporting documentation.</p><p>Strong ability to translate regulatory requirements and operational needs into clear, accurate system configuration.</p><p>Exceptional analytical, planning, organization, and communication skills.</p><p>Exceptional presentation skills, written and verbal communication skills, including executive communication skills with the ability to produce audit-ready documentation.</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, Medical Coding, Insurance, Healthcare                                                    </p>

Director, Configuration

<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 Customer Engagement and Experience Compliance and Quality Auditor II is responsible for evaluating the accuracy, compliance, and quality of customer interactions within L.A. Care’s Customer Engagement and Experience operations. This position conducts targeted audits of member interactions, documentation, and service workflows to ensure adherence to federal/state regulations, Centers for Medicare and Medicaid Services (CMS) and Medicaid requirements, National Committee for Quality Assurance (NCQA) standards, internal policies, and customer service best practices. The Auditor identifies risks, trends, training needs, and opportunities for improvement while supporting regulatory readiness and service excellence initiatives.</p><h4>Duties</h4><p>Evaluates customer interactions across all channels (calls, chat, email, and correspondence) for accuracy, professionalism, empathy, and service quality. Verifies representatives provide correct benefit information, follow call scripts, and use approved language. Reviews documentation to ensure complete, timely, and accurate recording of member interactions. Audits customer interaction records to ensure adherence to CMS guidelines, state Medicaid rules, NCQA standards, Health Insurance Portability and Accountability Act (HIPAA), privacy regulations, and internal compliance policies. Identifies potential compliance risks such as benefit misinterpretations, incomplete disclosures, or policy deviations. Flags issues for corrective action and escalates high-risk findings per protocol. (50%)</p><p>Prepares detailed audit reports summarizing findings, trends, error types, and opportunities for improvement. Tracks performance results at the individual, team, and process level. Presents audit insights to leadership. (10%)</p><p>Participates in Root Cause Analysis (RCA) for recurring quality issues, compliance gaps, or service failures. Collaborates with internal teams to develop and implement corrective actions. Validates the effectiveness of remediation efforts through follow-up audits. (5%)</p><p>Provides feedback to key stakeholders regarding knowledge gaps, script deviations, or policy misunderstandings. Assists in creating or updating Quality Assurance (QA) scorecards, training materials, workflows, and Standard Operating Procedures (SOPs). Participates in calibration sessions to maintain scoring accuracy and consistency. (10%)</p><p>Assists with audit readiness for CMS, California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), NCQA, internal audits, and other external oversight bodies. Maintains documentation and evidence supporting compliance with regulatory audit requirements. Supports quality improvement initiatives tied to Consumer Assessment of Healthcare Providers and Systems (CAHPS), Medicare Stars, grievance reduction, call accuracy, and member experience targets. (10%)</p><p>Works closely with internal teams to support operational excellence. Serves as a key resource on contact center quality and compliance expectations. (5%)</p><p>Performs other duties as assigned. (10%)</p><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 experience in health plan operations, contact center quality assurance, compliance auditing, or member services.</p><p>Experience in managed care customer service or contact center environments.</p><p><strong>Preferred:</strong></p><p>Experience with Medicaid/Medicare/Commercial requirements, CMS contact center standards, and NCQA regulations.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong knowledge of health plan benefits, customer service workflows, and contact center operations.</p><p>Familiarity with CMS call monitoring guidelines and regulatory requirements.</p><p>Excellent attention to detail and ability to identify compliance and quality issues.</p><p>Strong critical thinking, analytical, and documentation skills.</p><p>Excellent communication skills, with ability to deliver constructive feedback.</p><p>Proficient in QA platforms, CRM systems, and call monitoring tools.</p><p>Ability to maintain confidentiality and adhere to HIPAA/privacy standards.</p><p>Proficient in MS Office.</p><p>Ability to coach and train employees.</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.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>American Society for Quality - Certified Quality Auditor (ASQ - CQA) Certification<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>                    Medicaid, Medicare, Audit, Healthcare, Finance                                                    </p>

Customer Engagement and Experience Compliance and Quality Auditor II

<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>

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