NewAI Automation Engineer Alignment Healthcare USA, LLCAI Automation EngineerOrange, CAFull timeThe Artificial Intelligence & Automation Engineer is a hands-on technical contributor on the Data & Technology Solutions team, responsible for designing, building, and deploying intelligent AI systems and automated workflows that drive operational efficiency and elevate the quality of care for our Medicare Advantage members. You will partner closely with AI Scientists, Data Engineers, Product Managers, Clinical Operations, and Application Engineering teams to translate complex business problems - from claims processing and prior authorization to member communication and revenue integrity - into scalable, production-grade solutions.
Centralized Processing Specialist East West BankCentralized Processing SpecialistEl Monte, California$20–$26 / hourFull timeOur teams of experienced, multi-cultural professionals help guide businesses and community members on both sides of the Pacific looking to explore new markets and create new opportunities, and our sustained growth and expertise in industries like real estate, entertainment and media, private equity and venture capital, and high-tech help build sustainable businesses and expand our associates’ potential for career advancement. As a Payment Specialist, you will work in a fast-paced environment and be responsible for managing tasks related to ACH processing, which includes reviewing, processing and reconciling ACH prefunding files, ACH exceptions (reversals, stop payment requests, failed batches, etc.) ensuring the usage of correct ACH codes, and assisting with EFT claim processing (disputes/chargebacks) within the established SLAs.
System Configuration Analyst LIBERTY Dental PlanSystem Configuration AnalystTustin, CA$65,000–$75,000 / yearIn this highly collaborative role, you'll partner with Claims, UM, Account Management, Quality Management, Compliance, and IT teams to configure, test, and maintain system logic that directly supports high‑quality service delivery and sound operational outcomes. Our first-class benefits package supports employees and their dependents with: Competitive pay structure and savings options to help you reach your financial goals.
Auto Collision Estimator Auto Collision Group, Inc.Auto Collision EstimatorGardena, CAFull timeA Collision Estimator is responsible for accurately and efficiently appraising vehicle damages to determine the cost of repairs for the customer or insurance companies: · Writes complete estimates/supplements in accordance with company and insurance guidelines with an emphasis on repairing versus replacing parts. A typical work day for an estimate writer includes inspecting damaged vehicles, consulting guide books for repair costs and creating estimation documents.
NewData Governance Analyst Alignment Healthcare USA, LLCData Governance AnalystOrange, CAFull timeWorking alongside governance operations leaders, business data stewards, and technology teams, this role provides the analytical depth and hands-on execution that keeps governance processes running reliably and data assets well-documented. Analytical Reporting & Communication: Ability to synthesize data findings into clear governance status reports, quality dashboards, and issue summaries for both technical and business audiences; proficiency with Excel or BI tools (Power BI, Tableau).
Audit Manager - Insurance and Banking Weaver And Tidwell LLPAudit Manager - Insurance and BankingManhattan Beach, CA$120,000–$160,000 / yearYou will be responsible for managing the day-to-day execution of complex financial services audits, mentoring and developing Associates, Senior Associates, and Supervisors, and collaborating closely with Partners on client service, project management, and business development. Working knowledge of U.S. GAAP and Statutory Accounting Principles (SAP) as they apply to property & casualty and/or life insurance companies, including familiarity with statutory financial reporting, the Model Audit Rule, and state insurance department regulatory requirements.
Senior Investigator Pharmacy - Los Angeles County, CA UnitedHealth Group Inc.Senior Investigator Pharmacy - Los Angeles County, CALos Angeles, CA$60,200–$107,400 / yearWe are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes.
Network Compliance Auditor, FSR SCAN Health PlanNetwork Compliance Auditor, FSRLong Beach, CaliforniaRemoteConducts closing meetings with audited providers to give them a preliminary overview of completed compliance audits Assists providers in achieving and maintaining compliance with SCAN, Federal, State and NCQA requirements and guidelines including the development and implementation of corrective action plans (CAP), monitoring CAP activities and providing education and tools Responds to audited providers as disagreements with audit findings arise Analyzes submitted reports from providers, including the request for corrections from providers as needed Communicates regulation interpretations and explains their application, provides supplemental information if needed Conducts detailed review, analysis, and interpretation of legislative, statutory, regulatory, and contract language. Conducts all aspects of annual oversight projects, individual correspondence; coordination of projects with internal SCAN staff and departments; monitoring and reporting delegated compliance; tracking, trending and reporting upon project status; coordinating with Compliance regarding report submissions and regulatory updates Uses critical thinking skills and identifies impactful areas for provider data requirements to develop an effective implementation and communication plans.
Director, Medical Economics - REMOTE Molina Healthcare IncDirector, Medical Economics - REMOTELong Beach, CARemoteAdvanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.).
NewProgram Support Representative I Cencora IncProgram Support Representative IOrange, CA$21–$25 / hourSummary of Role: Under general supervision of the Elevate Provider Network Management Team, this associate will perform duties and tasks related to the daily operations of the Network and provide support to the managed care/pharmacy services department including primary telephone coverage, management of network database, and creation and distribution of network materials and communications. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions: Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling, repetitive motions, talking and hearing.
Remote Psychiatric Mental Health Nurse Practitioner (Pmhnp) Seasoned RecruitmentRemote Psychiatric Mental Health Nurse Practitioner (Pmhnp)Baldwin Hills, CARemoteBenefit from total schedule control, guaranteed patient volume, and dedicated back-office support so you can focus on quality patient outcomes. Role Overview Seeking Board-Certified PMHNPs to deliver virtual psychiatric evaluations and medication management.
Pharmacy Audit Analyst - Frequent Travel Required UnitedHealth Group Inc.Pharmacy Audit Analyst - Frequent Travel RequiredIrvine, CA$49,700–$88,800 / yearIntermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy and/or commercial health insurance). 2+ years of experience working independently and researching/conducting investigations; must be analytical, self-motivated, goal oriented, and could successfully investigate complex issues.
NewProgram Support Representative I Cencora, Inc.Program Support Representative IOrange, CA$21–$25 / hourSummary of Role: Under general supervision of the Elevate Provider Network Management Team, this associate will perform duties and tasks related to the daily operations of the Network and provide support to the managed care/pharmacy services department including primary telephone coverage, management of network database, and creation and distribution of network materials and communications. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions: Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling, repetitive motions, talking and hearing.
Manager, Vehicle Accounting Hyundai Motor AmericaManager, Vehicle AccountingFountain Valley, CA$91,000–$130,000 / yearApply technical accounting expertise, employee relations judgment, and management skills to lead the department and interact effectively with employees, auditors, dealers, vendors, affiliates, and related financial institutions. Excellent verbal and written communication skills, including the ability to formally present financial information related to accounts receivable, vehicle inventory, and cost of sales.
Bilingual Pharmacy Support Specialist Loblaw Companies LtdBilingual Pharmacy Support SpecialistCA$60,000–$82,500 / yearTwo to three years of advanced experience/knowledge of current pharmacy business practices, prescription claims processes, workflows and pharmacy legislation, which includes in depth knowledge of provincial and third party drug plan rules and adjudication processes in Quebec (national knowledge an asset). Demonstrated understanding of the pharmacy landscape in Quebec including regulations impacting pharmacy practice in Quebec, prescription reimbursement plans and prescriptions claims processing (public and private), clinical programs, pharmacy workflow, and health technology would be an asset.
NewCLIN APPL TRAINER 3 HX - PB Financial Services - FT Days University of California, IrvineCLIN APPL TRAINER 3 HX - PB Financial Services - FT DaysAnaheim, CaliforniaFull timeAs Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center , American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. *Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.
Healthcare Process Risk Senior Associate Grant Thornton International LtdHealthcare Process Risk Senior AssociateNewport Beach, CA$101,200–$140,760 / yearIn the U.S., Grant Thornton delivers professional services through two specialized entities: Grant Thornton LLP, a licensed, certified public accounting (CPA) firm that provides audit and assurance services ― and Grant Thornton Advisors LLC (not a licensed CPA firm), which exclusively provides non-attest offerings, including tax and advisory services. Common engagements include but are not limited to co-sourced and outsourced internal audit, internal control assessments, enterprise risk management program assessments, tests of control design and operating effectiveness for Sarbanes-Oxley (SOX) and other compliance requirements, and helping clients design and implement internal controls.
Regulatory Complaint Coordinator, Intermediate Blue Cross and Blue Shield AssociationRegulatory Complaint Coordinator, IntermediateLong Beach, CABe involved in evaluating and researching end-to-end timelines of member health provider services, claim processing, and other data to determine decision and/or alternative ways to resolve grievance/appeal. Requires at least 2 years in health insurance operations such as I&M, Claims, Customer Services, Regulatory Affairs and/or Appeals/Grievances, at least 1 year of which is Appeals/grievance direct experience, or similar combination.
Pharmacy Contact Center Manager (Hybrid) Alignment Healthcare USA, LLCPharmacy Contact Center Manager (Hybrid)Orange, CAFull timeAlignment Health is seeking an experienced and people-focused Pharmacy Operations Manager to lead a team of Pharmacy Technician Leads and Pharmacy Technicians supporting pharmacy operations in a fast-paced call center environment. You'll partner closely with pharmacy leadership and cross-functional teams to ensure operational excellence, regulatory compliance, and strong service delivery.
NewManager, Incentives Operations Hyundai Motor AmericaManager, Incentives OperationsFountain Valley, CA$91,000–$130,000 / yearDemonstrated ability to lead employees and cross-functional teams, communicate with dealers and senior stakeholders, manage competing priorities, make sound decisions under pressure, and document complex processes clearly. This role protects dealer confidence and business continuity by translating approved incentive strategies into clear program rules, reliable systems, accurate communications, controlled payment processes, meaningful business insights, and timely issue resolution.