LIBERTY Dental Plan jobs - 35 jobs

FLSA Status: Non-exempt Department: Community Based Programs Reports To: Manager, SDOH or Manager, Community Based Case Management Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521 GENERAL DESCRIPTION OF POSITION The Community Based Services Specialist serves as the lead, primary contact, and liaison for developing, supporting and monitoring the network of public and community based providers and vendors delivering Enhanced Care Management (ECM), Community Supports (CS), and/or other activities, programs or special projects addressing social determinants of health. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. * Develop and maintain updated knowledge of community based services, and capacity across Santa Clara County and support identification and assessment of ECM and/or CS provider network gaps. * Recommend for initial and ongoing needs to support ECM and/or CS delivery system and operational infrastructure including data exchange, workforce training and capacity building. * Support ECM and/or CS authorization and delivery process in accordance with DHCS-developed service definitions, eligibility criteria and reporting requirements. * Oversee the development and management of the ECM, SDOH and/or CS provider network including: * Serve as a knowledge and resource expert for ECM, CS and/or SDOH provider network operations. * Establish and manage positive and productive working relationships with all public and community-based providers and vendors delivering services to members under ECM, CS or SDOH projects. * Receive, research and respond to inquiries and issues that are raised by or impacting providers in a timely fashion and in collaboration with appropriate business units. * Proactively communicate and collaborate with providers to identify problem patterns, track and trend issues, prepare recommendations for potential service improvement opportunities and develop tools and processes to improve communication and other processes * Oversee collaboration with internal business units, particularly Provider Network Operations, Health Services Department, Finance and Claims, regarding provider communication, training and support and to ensure payments are made in accordance with vendor agreement terms. * Schedule, conduct and report on regular site visits with each provider as required and coordinate and host at least one annual meeting with providers. * Conduct orientation and ongoing training and education to community service providers and office staff including technical assistance, development of presentations and other written guidance or materials, in-person sessions, webinars and/or calls as needed. * Assist in the preparation of promotional materials for the public, website or newsletters. Oversee provider compliance with required ECM and/or CS trainings and technical assistance including in-person sessions, webinars, and/or calls as necessary. * Establish and oversee a program for communicating and tracking ECM and/or CS provider compliance with vendor agreement scope of work, key operational and financial objectives, and quality and performance metrics. * Maintain accurate and timely documentation of provider contacts in compliance with NCQA standards, DHCS, DMHC and CMS regulatory requirements. * Contribute to the development of ECM and/or CS pricing including recommending changes in pricing subsystems. * Support the Department Manager in generating reports and performing special projects. Troubleshoot with providers to address issues related to submission of claims and encounter data for ECM and/or CS services. * Understand and track applicable regulatory and reporting requirements. * Ensure accuracy and regulatory compliance for all materials or documents. * Attend off-site meeting or events as necessary. * Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Bachelor's Degree in public health, social welfare or related field; or equivalent experience, training, or coursework. (R) * Minimum two years of progressively responsible and direct work experience working with the essential duties and responsibilities described above. (R) * Demonstrated experience leading/managing projects, initiatives, and/or leading or directing the work of others. (R) * Knowledgeable in the field of home and community-based services and community resource networks and a particular interest in working to address health disparities and addressing the needs of low-income communities. * A deep understanding of SDOH that impact Santa Clara County and community members. (R) * Ability to think creatively and work strategically, to help develop and implement innovative solutions yielding measurable results to the organization. (R) * Ability to think creatively and strategically, gather and analyze data, organize and write reports, organize work efficiently. (R) * Ability to understand, interpret, and apply applicable rules and regulations, and establish and evaluate priorities. (R) * Advanced working knowledge and proficient with Microsoft Suite applications, and the ability to operate all applicable software. (R) * Excellent oral and written communication skills, including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments and outside entities over the telephone, in person or in writing.(R) * Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff (R). * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to take initiative and exercise good judgment when making decisions within the scope of the position. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely with respect to others, to property, and to individual safety. (R) * Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) * Knowledge of the community-based delivery system and managed care. (D) * Project Management Professional (PMP) certification (D) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to regular contact with co-workers, managers, external partners, and vendors, in person, by telephone, and via work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically, throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels.

FLSA Status: Exempt Department: Marketing, Outreach and Enrollment Reports To: Manager, Medicare Outreach The Medicare Outreach Agent executes SCFHP's Medicare outreach and enrollment operations to grow SCFHP Medicare enrollment in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements, and in support of organizational objectives. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. * Execute sales and outreach strategy to maximize membership growth, including meeting Medicare enrollment goals as well as individual sales and performance goals. * Ensure timely follow-up on questions, issues and concerns from beneficiaries, members, providers, community partners. * Organize and conduct sales presentations in the community and assist eligible beneficiaries to enroll, including conducting a needs assessment to best explain product offerings. * Make outbound calls to follow up and close business; receive and manage inbound enrollment calls. * Manage and execute outreach plan to providers and community based organizations to support achievement of Medicare enrollment objectives. * Seek opportunities to improve SCFHP image/visibility in the community. Contribute ideas to increase retention and enrollment. * Develop, maintain and use competitive analysis to inform outreach and retention efforts, including identifying and studying key competitors and their products, as well as related industry issues to maintain a personal awareness of competitive advantages and disadvantages; share the competitive analysis with the Marketing and Outreach teams. * Stay current on SCFHP product and competing products; stay current on CMS Medicare Marketing Guidelines and with California specific Medicare-Medicaid Plans Medicare Marketing Guidelines. * Successfully complete SCFHP required product and certification training; maintain California Life, Accident and Health Insurance License. * Identify issues and trends (data, systems, beneficiary, member, provider, other) as well as general departmental questions/concerns and report relevant information to management; make recommendations. * Address member questions, concerns, grievances, appeals or requests for services in accordance with policies and procedures, including appropriate documentation and communication with other departments. * Assist with new hire training by having new hires shadow, observe in the community, and listen to calls, in accordance with training guidelines and protocols. Observe new hires and provide feedback to the Department Manager. * Attend and actively participate in daily, weekly, and monthly departmental meetings, training and coaching sessions. * Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Associate's Degree in a related field of study, or equivalent training/experience. (R) * Minimum two years of Medicare sales, Medicare benefits advisory work, or Medi-Cal eligibility advisory work experience. (R) * Strong presentation skills with intent to sell. (R) * California Life, Accident and Health Insurance License, or the ability to obtain within 60 days of employment. (R) * Self-directed with proven ability to assume responsibility, work independently, meet deadlines and prioritize with minimum supervision. (R) * Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) * Experience with, and understanding of, Medicare outreach and/or sales. (R) * Experience with managed care and Medi-Cal. (D) * Knowledge of current trends, practices, strategies, tools for outreach and sales, including customer relation management applications. (D) * Ability to establish and maintain effective working relationships with providers, community based organizations and program participants. (R) * Bilingual in Spanish, Vietnamese, Mandarin or Cantonese. (R) * Ability to work nights and/or weekends as needed. (R) * Working knowledge of and the ability to efficiently operate all applicable computer software including a working knowledge of computer applications such as Outlook, Word and Excel. (R) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to beneficiaries, SCFHP members, providers and outside entities in person, over the telephone, or in writing. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to take initiative and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely with respect to others, to property, and to individual safety. (R) WORKING CONDITIONS Duties are performed away from the office in varied community settings, and also in an office environment while sitting or standing at a desk. Incumbent's responsibilities require frequent contact with beneficiaries, members and providers, as well as interaction with co-workers and managers, in person, by telephone, and via electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 20 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS Outside of the office - community settings, meeting rooms. In the office - general office conditions. May be exposed to moderate noise levels.

FLSA Status: Exempt Department: Case Management Reports To: Health Services Management Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521 The Social Work Case Manager is responsible for providing on-going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate, the Social Work Case Manager II facilitates communication and coordination among all participants of the care team, to ensure member identified goals and needed services are provided to promote quality cost-effective outcomes. Through the development and implementation of member individualized care plans, the Social Work Case Manager II provides psychosocial and behavioral case management support to help coordinate resources and services for individuals across the healthcare and social services continuum, and facilitates the use of available healthcare benefits in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. * Conduct, review and document comprehensive psychosocial assessments for assets and deficits and on-going follow-up interventions to measure progress towards meeting goals as they relate to a member's physical, psychosocial, environmental, safety, developmental, cultural and linguistic needs. * Maintain case files by ensuring that they are documented timely in accordance with SCFHP policies and procedures, state and federal requirements and organized in a manner that adheres to standards for audit requirements. * Facilitate involvement of the member and/or family/responsible party for development and implementation of a member specific care plan which includes individualized prioritized goals. Provide appropriate social work interventions to members and/or family/responsible party with related psychosocial process teaching and information. * Coordinate member's care with primary care providers, specialists, behavioral health providers, Long Term Services and Supports providers, public services, community providers, and vendors as necessary and appropriate to assist member to achieve and maintain optimal level of functional independence to reside in the most appropriate level of care. * Communicate and coordinate member's psychosocial and behavioral health needs with member's interdisciplinary care team including SCFHP internal staff, as well as the member's providers, specialists, public services, community agencies and vendors to ensure appropriate care plan development and successful coordination of benefits and services aligned with the member's preferences. * Assist member's interdisciplinary care team in understanding social and emotional factors related to health condition and potential barriers and coping mechanism to accessing care. * Provides guidance, education and referrals to help members seek solutions to specific social, cultural, or financial problems that impact their ability to manage their health care needs. * Conduct telephonic and in-person interview, baseline assessments, survey, assess self-care ability, assess knowledge and adherence, comprehensive clinical assessments as indicated, and developing member centric plan in the office, home, facilities, clinics, or community settings. * Collaborate with team members on cross-departmental improvement efforts, organizational and departmental objectives, quality improvement projects, optimization of utilization management, and improvement of member satisfaction. * Attend and actively participate in Health Services meetings, operational meetings, training and coaching sessions, including off-site meetings as needed. * Perform other duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Master's Degree in Social Work, or related field. (R) * Certified Case Manager (CCM). (D) * Active California registered Licensed Clinical Social Worker (LCSW) without restriction. (R) * Minimum three years of experience in social work, behavioral health, or case management, or education or certifications, or equivalent experience. (R) * Knowledge of social case management and conflict resolution. (R) * Knowledge of long-term services and supports, behavioral health and/or relevant public services and community resources. (R) * Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) * Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D) * Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children). (D) * Ability to work within an interdisciplinary team structure. (R) * Travel to off-site locations for work such as in office, home, facility, clinic, and other community settings. (R) * Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) * Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R) * Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing as mandated by social work scope of practice. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely and with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels.

Objective World Investment Advisors is currently seeking a Director of Finance to provide strategic financial leadership and oversight to drive the financial health and performance of the organization. The Director of Finance will be responsible for developing and implementing financial strategies, managing budgeting and forecasting processes, ensuring compliance with regulatory standards, and delivering data-driven insights to support executive decision-making. This role will play a key part in optimizing capital structure, enhancing profitability, and supporting sustainable growth within the dynamic landscape of the financial services industry. Typical Duties and Responsibilities Creating forecasts that get updated on a regular basis (e.g., each month or maybe 1x/quarter). Running point on creating the budget each year Building the templates and/or implementing the tools to obtain input from unit leaders, department heads, etc. Loading the data into NetSuite once the budget is complete Meeting with unit leaders and/or department heads to review their budgets Provide detailed analysis/write-up on budget vs. actual each month Review reported results vs. budget to identify variances Meet with unit leaders and/or department heads to review variances (both positive and negative) Identify opportunities to either grow revenue or improve margins Prepare board materials to support Renae/Troy when they meet with the board Work with accounting to identify ways to improve analytical reporting capabilities E.g., review results with Controller to identify any data anomalies Work with colleagues to transition new acquisitions into “standard FPA process” for forecasting and reviewing budget vs. actual Identify data sources that we can leverage to improve analytical capabilities Support Accounting team with miscellaneous projects Participate in the M&A process to help evaluate acquisition targets Position Requirements A Bachelor's degree in accounting, or a Bachelor's degree in business with emphasis in accounting, is required. Degree(s) must be from a credible college or university Excellent technology and communication skills Ability to work independently to manage time and prioritize tasks efficiently. Be a motivated self-starter who can make thoughtful, deliberate decisions with minimal assistance. The desire to be an enthusiastic, cooperative team player who is always seeking ways to improve processes. Compensation The salary for this position generally ranges between $170,000-$180,000. This range is an estimate, based on candidate qualifications and operational needs. The position will also be eligible for up to a 15% annual bonus. Perks & Benefits 401(k) with Employer Match Health Insurance (with HSA option) Dental Insurance Vision Insurance Life Insurance Flexible Paid Time Off Policy Flexible Spending Account (FSA) Healthy Work/Life Balance Maternity/Paternity Leave Policy Remote Work Opportunity About World Investment Advisors As part of World Insurance Associates, World Investment Advisors is a nationally recognized financial services firm dedicated to providing the industry's premier wealth management and retirement plan investment advisory services to individuals, high net worth families and employers. Collectively, WIA and its affiliates advise pm $76B assets 1 across 65 offices and 310 team members. Stimulating Environment At World Investment Advisors, we strive to provide a challenging, stimulating environment for the best and brightest in the industry. We believe our employees can best serve our clients and advisors in an atmosphere where individuals are treated fairly, where professional growth is fostered and encouraged, and where a healthy balance between work and home life is respected and preserved. We promote a friendly and collaborative work environment. We are motivated by team camaraderie and are obsessed with doing the right thing for our plan sponsor clients and their plan participants. Team-Oriented Professionals typically work together in teams with multiple people from different departments to meet our clients' needs. Our junior staff works with their team members to develop the skills and knowledge to succeed and assume more senior level positions as they progress at our firm. We welcome team members from different backgrounds with different perspectives to help us innovate and make a difference for our customers and our communities. Why World? Great company culture with an awesome team-oriented atmosphere! Mentorship Opportunities Ability to serve on different internal steering committees (Charitable Giving, DEI, Social, etc.) Professional growth opportunities Friendly and collaborative work environment Employee perks including fun team building opportunities, yoga/wellness, charitable giving/volunteering World Investment Advisors is an equal opportunity employer. We believe the most effective way to attract, develop and retain a diverse workforce is to build an enduring culture of inclusion and belonging. World is committed to equality and deeply believes in diversity in sexual orientation, gender, race, religion, ethnicity and other qualities that makes us all different. 1 As of December 31, 2023, the WIA network of advisors and firms collectively provides support to over $55.4 billion in assets across a variety of channels including investment management and retirement plan consulting services. This includes regulatory assets under management (AUM) of over $24.5 billion TO EXECUTIVE SEARCH FIRMS AND STAFFING AGENCIES: World does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's property, and World will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting World's Human Resources Talent Department.

This posting is for one position and will be filled as either a Business Systems Analyst I or Business Systems Analyst II or a Business Systems Analyst III depending on the candidate qualifications and experience. FLSA Status: Exempt Department: Information Technology Reports To: Manager, Business Systems Location: San Jose, CA Salary: Business Systems Analyst I - $85,740 - 128,610 Business Systems Analyst II - $98,601 - 147,902 Business Systems Analyst III - $111,168 - 172,310 Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521. GENERAL DESCRIPTION OF POSITION We are looking for a BSA candidate who possesses strong technical skills with a focus on reporting and data analysis. The candidate should be skilled in SQL and have an understanding of programming languages to support code review and interpretation. The position will require adept critical thinking and problem-solving skills. The position will be responsible for developing and maintaining regulatory reports related to Case Management, Utilization Management, Claims, Members, Grievances, and Appeals. Business Systems Analyst I - The Business Systems Analyst I acts as a liaison between the business units, internal and external, including software development, production support teams, vendors and trading partners; develops and reviews small scale, basic business requirements, functional specifications, and business processes; participates in basic validation and testing of applications and reports, and provides support in the maintenance and improvement of SCFHP information management systems in support of SCFHP objectives and regulatory compliance. Business Systems Analyst II - The Business Systems Analyst II acts as a liaison between the business units, internal and external, including software development, production support teams, vendors and trading partners; develops and reviews small to medium scale, basic to moderate business requirements, functional specifications, and business processes; participates in basic to moderate validation and testing of applications and reports, and provides support in the maintenance and improvement of SCFHP information management systems in support of SCFHP objectives and regulatory compliance. Business Systems Analyst III - The Business Systems Analyst III acts as a liaison between the business units, internal and external, including software development, production support teams, vendors and trading partners; develops and reviews small to large scale, basic to complex business requirements, functional specifications, and business processes; participates in basic to complex validation and testing of applications and reports, and provides support in the maintenance and improvement of SCFHP information management systems in support of SCFHP objectives and regulatory compliance. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. * Business Systems Analyst I - Project and task management for small scale projects including: facilitate stakeholder and project team meetings, track actionable items, send regular project communications to team members and stakeholders, and escalate identified risks. Business Systems Analyst II - Project and task management for small to medium scale projects including: facilitate stakeholder and project team meetings, track actionable items, send regular project communications to team members and stakeholders, and escalate identified risks. Business Systems Analyst III - Project and task management for small to large scale projects including: facilitate stakeholder and project team meetings, track actionable items, send regular project communications to team members and stakeholders, and escalate identified risks. * Business Systems Analyst I - Troubleshoot small scale, basic production system issues, including: thoroughly reviewing the initial service request, efficiently gathering additional information as needed from the service requester and subject matter experts, performing comprehensive critical thinking to identify root cause, documenting findings and resolution, and working with manager to determine appropriate escalation path, if applicable. Business Systems Analyst II - Troubleshoot small to medium scale, basic to moderate production system issues, including: thoroughly reviewing the initial service request, efficiently gathering additional information as needed from the service requester and subject matter experts, performing comprehensive critical thinking to identify root cause, documenting findings and resolution, and working with manager to determine appropriate escalation path, if applicable. Business Systems Analyst III - Troubleshoot small to large scale, basic to complex production system issues, including: thoroughly reviewing the initial service request, efficiently gathering additional information as needed from the service requester and subject matter experts, performing comprehensive critical thinking to identify root cause, documenting findings and resolution, and working with manager to determine appropriate escalation path, if applicable. * Business Systems Analyst I - Process improvement and documentation for small scale, basic projects and components of medium scale projects; writing formal requirements and functional specifications following industry standards and departmental templates; creating process flow diagrams; overseeing implemented changes; communicating impact to affected business areas. Business Systems Analyst II - Process improvement and documentation for small to medium scale, basic to moderate projects and components of large scale projects; writing formal requirements and functional specifications following industry standards and departmental templates; creating process flow diagrams; overseeing implemented changes; communicating impact to affected business areas. Business Systems Analyst III - Process improvement and documentation for small to large scale, basic to complex projects; writing formal requirements and functional specifications following industry standards and departmental templates; creating process flow diagrams; overseeing implemented changes; communicating impact to affected business areas. * Responsible for following the SCFHP Project Life Cycle, Software Development Coding Standards, and Change Control Management policies and procedures. * Perform data validation on both inbound and outbound data sources. Document test cases and results. * Act as a resource for IT staff and business units ensuring quality, testing, and documentation. * Create and maintain basic to moderate SQL based reports to support business processes and initiatives. * Business Systems Analyst III - Train, mentor and educate business systems analyst staff as needed on IT or healthcare topics. * Generate basic to complex source to target mapping documentation that clearly defines the data mapping and business rules applied between two systems. * Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Bachelor's Degree in Healthcare, Information Systems, or related field, or equivalent experience, training, or coursework. (R) * Business Systems Analyst I - Experience in healthcare. (D) Business Systems Analyst II - Minimum two years of experience as a business analyst. (R) Business Systems Analyst III - Minimum four years of experience, training, or coursework. (R) * Business Systems Analyst I - Knowledge of healthcare management information systems. (D) Business Systems Analyst II - Minimum one year of experience with healthcare management information systems. (R) Business Systems Analyst III - Minimum of three years of experience with healthcare management information systems. (R) * Business Systems Analyst I - Ability to identify, troubleshoot, and resolve small-scale, basic business and systems issues. (R) Business Systems Analyst II - Ability to identify, troubleshoot, and resolve small to medium scale, basic to moderate business and systems issues. (R) Business Systems Analyst III - Ability to identify, troubleshoot, and resolve small to large scale, basic to complex business and system issues. (R) * Ability to organize work and present results in a professional manner. (R) * Business Systems Analyst I - Knowledge of healthcare business processes. (D) Business Systems Analyst II - Minimum one year of experience working with healthcare business processes. (R) Business Systems Analyst III - Minimum three years of experience working with healthcare business processes. (R) * Business Systems Analyst I - Knowledge of healthcare analytics and standard reporting measures. (D) Business Systems Analyst II - Minimum one year of experience working with healthcare analytics and standard reporting measures. (R) Business Systems Analyst III - Minimum three years of experience working with healthcare analytics and standard reporting measures. (R) * Business Systems Analyst I - Knowledge of project management standards and functions. (R) Business Systems Analyst II - Minimum two years of experience utilizing project management guidelines and best practice. (R) Business Systems Analyst III - Minimum four years of experience utilizing project management standards and functions. (R) * Business Systems Analyst I - Ability to analyze data for the purpose of informing business decisions. (D) Business Systems Analyst II - Minimum two years of experience analyzing data for the purpose of informing business decisions. (R) Business Systems Analyst III - Minimum four years of experience analyzing data for the purpose of informing business decisions. (R) * Business Systems Analyst I - Ability to document business requirements and processes following industry guidelines and best practice. (R) Business Systems Analyst II - Minimum two years of experience creating industry standard business requirements and process documentation. (R) Business Systems Analyst III - Minimum four years of experience creating industry standard business requirement and process documentation. (R) * Working knowledge of and the ability to efficiently operate all applicable computer software including a working knowledge of computer applications such as Outlook, Word and Excel. (R) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, providers and outside entities over the telephone, in person or in writing. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with SCFHP's policies and procedures. (R) * Ability to perform the job safely with respect to others, to property, and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)

Title: Customer Service Claims Processor Department: Customer Service Union: OPEIU 29 Grade: 17 The Customer Service Claims Processor is focused on providing customer service via call handling to participants, beneficiaries, union locals and providers regarding eligibility, benefits and claims status in conjunction with claims processing as business needs dictate. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Provides written, verbal or face-to-face customer service to members by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits. Resolves customer inquiries and complaints in a timely and accurate manner. Escalates issues as appropriate. Processes routine medical, dental, life, Medicare, Medicaid and/or hospital claims in accordance with assigned Plan(s). Conducts research in relation to member/client/management inquiries and documents findings. Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions. Consistently meets established performance quotas, including quantity and quality claims processing standards. Utilizes multiple operating platforms and portals for research and claims processing. Performs other related duties as assigned. Minimum Qualifications High School Diploma or GED. One year of experience working on the Customer Service or Claims teams. Proficiency with MS Office tools and applications. Preferred Qualifications Proficiency with conference software such as Zoom or Webex. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $27.00/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

World Insurance Associates is a unique insurance organization offering top products and services from major providers, combined with attentive service from local agents. Founded in 2011, World is the second fastest-growing insurance broker in the U.S. We specialize in personal and commercial insurance lines, surety and bonding, employee benefits, financial and retirement services, and human capital management solutions. Position Overview The Receptionist at World Insurance Associates is responsible for managing calls coming into the main phone line, receiving, and distributing mail, as well as additional administrative duties to support the office. Essential Duties and Responsibilities First line of contact to receive and distribute a high volume of calls coming into phone line Distribute faxes via the agency management system Responsible for keeping inventory of all office supplies and placing approved orders for replenishment as needed Performs all other general administrative related duties as assigned Responsible for receiving, processing and distribution of physical and electronic mail as needed Assist in any processing for Commercial Lines and Personal Lines departments Qualifications Work experience with customer service responsibilities Computer savvy and proficient in MS Office including Power Points, Word, Excel, Outlook, Adobe. Excellent verbal communication skills Ability to multi-task in a fast paced and deadline driven environment Must be able to maintain professionalism and a positive service attitude Can handle sensitive information with the highest degree of integrity and confidentiality Strong attention to detail and excellent organizational skills required Exceptional customer service skills, over the phone and in person, with our customers and internal departments Sense of urgency and problem-solving skills Compensation This position is located in Illinois. The base salary for this position at the time of this posting may range from $20,000 to $40,000. Individual compensation varies based on job-related factors, including business needs, experience, level of responsibility, and qualifications. We offer a competitive benefits package and variable pay programs, please visit ************************************** for more details. Equal Employment Opportunity At World Insurance Associates (WIA), we celebrate and support our differences. We know employing a team rich in diverse thoughts, experiences, and opinions allows our employees, our products, and our community to flourish. WIA is honored to be an equal opportunity workplace. We are dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, WIA makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of our business. #LI-MF1

FLSA Status: Exempt Department: Quality Improvement Reports To: Manager, Process Improvement The Accreditation Program Manager is responsible for developing work plans, gap analyses, conducting internal audits, reviewing documentation for compliance, and facilitating stakeholder collaboration for all program planning and work stream facilitation in support of National Committee for Quality Assurance (NCQA) accreditation survey readiness. The Accreditation Program Manager is responsible for working collaboratively and cross-functionally with internal and external stakeholders, including consultants, auditors and surveyors to create efficiencies and improvements to meet accreditation standards at Santa Clara Family Health Plan (SCFHP). In addition, the Accreditation Program Manager is responsible for projects assigned, including providing ongoing support to organizational initiatives by leading the analysis and implementation of accreditation related medium to large scale projects and efforts. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. * Lead and organize all accreditation activities to achieve and maintain plan accreditation in Medicare and Medi-Cal lines of business including creating, monitoring and executing project work plans and deliverables with business units. * Serve as accreditation liaison, working collaboratively and cross-functionally with internal and external stakeholders to ensure NCQA compliance, including delegates. * Serve as the primary point of contact with NCQA for policy clarification questions, administrative maintenance, payment of invoices, survey preparation and any other communication. * Lead and facilitate medium to large scale quality and process improvement projects by providing direction for project framing, organization, business case analysis, implementation, and outcome/success measurement related to accreditation requirements. * Conduct routine internal audits to assess business unit readiness for document review and onsite file review. Work alongside project managers to facilitate workgroups and track standards deliverables progress. * Drive adoption of continuous improvement across the organization by supporting and coordinating business change initiatives and activities associated with process improvements and system changes to ensure smooth transitions for stakeholders related to accreditation requirements. Partner with Compliance department to streamline internal and external audit and oversight requirements of accreditation. * Define organization standards for consistent approach to accreditation work and coach business partners on application of the standards * Develop and maintain all appropriate accreditation project documentation, including timelines, project scope, decision logs, work plans and internal website presence. This includes development of process documents including, policies/procedures, process maps, workflows, desktop procedures, and deliverable templates. * Maintain accreditation program documentation for annual committee review schedules and workgroup membership. Where revisions are needed, work directly with business units to adjust. * Identify, research, and resolve accreditation project issues and escalate critical issues, problems, and delays to management and executive leadership, as needed. * Conduct an annual review of revisions to accreditation standards and ongoing evaluation and interpretation of quality standards and accreditation standards to ensure compliance, including impact to existing delegation agreements. * Develop and maintain training materials for new and existing staff to help interpret and understand requirements and the impact of changes. * Develop and distribute timely accreditation project communications and status updates. * Maintain a thorough knowledge of NCQA requirements to ensure compliance and understand the impact on various areas of operations. * Work collaboratively with peers, executives and front line staff to drive improvements in existing operations, and develop/implement initiatives to improve efficiency and effectiveness. * Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Bachelor's Degree in Management, Business, Healthcare, or a related field, or equivalent experience. (R) * Minimum three years of experience in health and/or managed care with responsibility for accreditation including one year of serving as subject matter expert or main point of contact. (R) * Minimum two years of project management experience. (R) * Ability to effectively facilitate meetings and deliver information/presentations. (R) * Ability to organize, plan, direct and manage medium to large scale, complex, cross-functional, multi-departmental projects. (R) * Strong organizational skills; able to adapt to changing environment, work independently, and manage multi-task responsibilities. (R) * Ability to work with a high level of independence with strong collaboration and relationship management skills. (R) * Strong analytical and problem solving abilities (R) * Knowledge of operational areas, quality improvement, IT, and health services in a health plan or integrated delivery system. (D) * Project management certification. (D) * Working knowledge of process improvement methodologies (R) * Lean or Six Sigma certification (D) * Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as such as MS Word, Excel, Power Point, Visio, Project and Outlook. (R) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when interacting with internal and external stakeholders over the telephone, in person or in writing. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely and with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels.

FLSA Status: Exempt Department: Information Technology Reports To: Director, Infrastructure and Systems Support Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521 The Systems Database Administrator is responsible for database security, integrity, performance, availability, and recoverability of databases, database servers, and related systems. In addition, the Systems Database Administrator is responsible for installing, configuring, and maintaining database servers, databases, related objects, and related software and for database security in support of SCFHP objectives and regulatory compliance. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. * Provide technical management and support for the organization's database environments to ensure database security, integrity, performance, availability and recoverability of databases, database servers, and related systems. * Develop, implement, and periodically test backup and recovery plan for the production of critical databases to ensure the business continuity plan is accurate and effective. * Ensure database security by controlling access to databases through authentication and authorization and performing auditing of database usage and active users. * Audit database security and user access to ensure HIPPA regulatory law reporting requirements are met. * Monitor database server resources to ensure production environments meet performance and availability requirements. * Install, test, secure and maintain new versions of database software, patches and other associated software application changes or upgrades. * Provide storage and capacity planning, long and short term, to ensure adequate space is available for all database environments. * Document database architecture, including developing and maintaining database installation and configuration procedures, data governance program, change control deployment procedures, and SQL coding guidelines. * Work with the application development team to ensure that appropriate and efficient SQL is coded and tested prior to production deployment. * Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Bachelor's Degree in Computer Science, or related field, or equivalent experience, training or coursework. (R) * Minimum three years of experience serving as a systems database administrator in a Microsoft SQL Server environment with versions currently supported by Microsoft. (R) * Microsoft Certified Solutions Expert (MCSE). (D) * Minimum three years of experience maintaining multiple database environments and regions to support production, development and test areas of business systems; including managing database security, database tuning, query optimization, and application code deployment. (R) * Minimum three years of experience SQL Scripting and Command Shell scripting. (R) * Minimum three years of experience with any of the following applicable languages/platforms: .NET, PERL, Java, SAS, VB, C++, or other modern programming language or related software. (R) * Minimum three years of experience with MS SQL Business Intelligence tools (SSRS, SSIS, SSAS) or other enterprise business intelligence software. (R) * Experience maintaining a data warehouse database environment, including managing and enforcing data governance and coding best practice. (R) * Ability to create and maintain documentation of source code, application installation processes, technical specifications, and data governance program. (R) * Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word and Excel. (R) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, providers and outside entities over the telephone, in person or in writing. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with SCFHP's policies and procedures. (R) * Ability to perform the job safely with respect to others, to property, and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels.

Objective, Typical Duties and Responsibilities We're currently seeking a Compliance Specialist to support the firm's Compliance Program. You will report to Manager-Compliance Operations Develop and manage a Compliance Department activity reporting system. Represent the compliance department in resolving issues involving new accounts set up with Operations and Accounting departments. Monitor general department email inboxes and/or department ticketing system reports to assure timely response or escalation if necessary to inquiries and information received. Provide support, education, and guidance to Financial Representatives and their staff as it relates to business processes, firm policies and procedures, industry rules, and other general inquiries. Assist management and other compliance personnel with the completion of various projects and testing. Other duties as assigned. Position Requirements Bachelor's degree (B.A./B.S.) in a related discipline required. Minimum two (2) years of Compliance and/or regulatory experience within both RIA and broker-dealer business segments., Series 7, 24 (or 26), 63, 65 (or 66), Series 53 (or 51), and Life, Health, & Variable Annuity Insurance Licenses (or the ability to obtain within 120 days of hire). Strong working knowledge of both brokerage and investment advisory business concerning the regulatory framework in which they operate. A deep understanding of industry rules governing supervision, suitability, and registrations. Excellent technology and communication skills Ability to work independently to manage time and prioritize tasks efficiently. Be a motivated self-starter who can make thoughtful, deliberate decisions with minimal assistance. The desire to be an enthusiastic, cooperative team player who is always seeking ways to improve processes. Preference Given to Candidates with the Following Qualifications: Have previous experience with and a thorough understanding of regulatory requirements under Reg-BI and PTE 2020-02. Already hold a Life, Health, & Variable Annuity license. Compensation The salary for this position generally ranges between $75,000-90,000. This range is an estimate, based on candidate qualifications and operational needs. The firm also has a bonus program. Perks & Benefits 401(k) with Employer Match Health Insurance (with HSA option) Dental Insurance Perks & Benefits (continued) Vision Insurance Life Insurance Flexible Paid Time Off Policy Flexible Spending Account (FSA) Healthy Work/Life Balance Maternity/Paternity Leave Policy Remote Work Opportunity About World Investment Advisors As part of World Insurance Associates, LLC World Investment Advisors is a nationally recognized financial services firm dedicated to providing the industry's premier wealth management and retirement plan investment advisory services to individuals, high net worth families and employers. Stimulating Environment At World Investment Advisors, we strive to provide a challenging, stimulating environment for the best and brightest in the industry. We believe our employees can best serve our clients and advisors in an atmosphere where individuals are treated fairly, where professional growth is fostered and encouraged, and where a healthy balance between work and home life is respected and preserved. We promote a friendly and collaborative work environment. We are motivated by team camaraderie and are obsessed with doing the right thing for our plan sponsor clients and their plan participants. Team-Oriented Professionals typically work together in teams with multiple people from different departments to meet our clients' needs. Our junior staff works with their team members to develop the skills and knowledge to succeed and assume more senior level positions as they progress at our firm. We welcome team members from different backgrounds with different perspectives to help us innovate and make a difference for our customers and our communities. Why World? Great company culture with an awesome team-oriented atmosphere! Mentorship Opportunities Ability to serve on different internal steering committees (Charitable Giving, DEI, Social, etc.) Professional growth opportunities Friendly and collaborative work environment Employee perks including fun team building opportunities, yoga/wellness, charitable giving/volunteering World Investment Advisors is an equal opportunity employer. We believe the most effective way to attract, develop and retain a diverse workforce is to build an enduring culture of inclusion and belonging. World is committed to equality and deeply believes in diversity in sexual orientation, gender, race, religion, ethnicity and other qualities that makes us all different. To Executive Search Firms and Staffing Agencies: World does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's property, and World will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting World's Human Resources Talent Department. #LI-GP1 #LI-REMOTE

FLSA Status: Non-Exempt Department: Health Services Reports To: Director, Behavioral Health The Behavioral Health Services Personal Care Coordinator is responsible for supporting and coordinating internal and external resources for members referred to case management programs for all lines of business in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. * Work with case managers to assist members navigating the healthcare delivery system and home and community-based service to facilitate access related to medical, psychosocial and behavioral health benefits and services. * Monitor and respond to inbound case management inquiries and referrals and escalate to clinical staff, as appropriate. * Provide outreach to members to facilitate timely completion of Health Risk Assessments (HRA's) by telephone, mail or in person, as needed. * Support the coordination of member care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers and other stakeholders to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community. * Assist with coordinating the involvement of the interdisciplinary care team (ICT) members including the member and/or their family/responsible party to implement the individualized care plan (ICP). Oversee correspondence related to care plans. Document ICT meetings following SCFHP policies and procedures. * Support successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance and by facilitating utilization review. Assist to ensure follow up for psychiatric hospitalizations for members to obtain psychiatric/behavioral health care. * Follow UM policies and procedures for new authorization requests. May conduct data entry into the authorization software application system and determination notification to member and/or provider in accordance with regulatory timeframes. * Produce and distribute internal reports that may include QI reports, member admission and discharge reports and external stakeholder reports, as appropriate. * Follow established Health Services policies and procedures and use available resources to respond to member and/or provider inquiries and resolve any concerns in an accurate, timely, respectful, professional and culturally competent manner. * Maintain knowledge of current resources in communities served by our members to support case management goals. * Develop effective and professional working relationships with internal and external stakeholders and partners. Communicate effectively with members and providers orally and in writing. * May support and conduct non-clinical training in accordance with training guidelines and protocols; provide input and develop training and reference materials. May develop Behavioral Health department orientation binder and assist with onboarding of new employees. * Identify issues and trends (data, systems, member, provider, other) as well as general departmental questions/concerns; report relevant information to management; and make recommendations to improve operations. * Collaborate with team members on improvement efforts across-departments regarding quality improvement projects, optimization of utilization management, and member satisfaction. * Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training, coaching sessions and external stakeholder meetings. * Understanding of Behavioral Health and 1115 Waiver programs, including Alcohol and Drug Services and assess members for appropriate referrals into these programs. May be required to facilitate Behavioral Health Treatment (BHT) services, including identification of providers, timely access to assessment and treatment. * Perform other duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Bachelor's Degree in a health related field or equivalent experience, training or coursework. (R) * Minimum three years of relevant experience in a healthcare or community setting providing care coordination of health and/or social services. (R) * Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) * Knowledge of Medicare and/or Medi-Cal benefits, community resources and principals of case management. (D) Knowledge of medical terminology. (D) * Knowledge of Santa Clara County Health and Social Services. (D) * Proficient in adapting to changing situations and efficiently alternating focus between telephone and non-telephone tasks to support department operations as dictated by business needs. (R) * Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) * Ability to work within an interdisciplinary team structure. (R) * Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R ) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely and with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels

FLSA Status: Non-Exempt Department: Grievance and Appeals Reports To: Supervisor, Grievance and Appeals Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521 The Grievance and Appeals Coordinator is responsible for the beginning-to-end process of receiving, researching and resolving of new and existing member and provider grievance and appeals cases for all lines-of-business including any escalated step of the grievance and appeals process in accordance with state and federal regulatory requirements and SCFHP policies and procedures as set forth for each line of business. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. * Act as a back-up to the Grievance and Appeals Intake Specialist during times of high volume work and/or staffing shortages to ensure appropriate intake of new and existing grievance and appeal cases, assessing the priority of each case and routing to the appropriate staff. * Ensure grievance and appeals cases are accurate and include the necessary elements for processing and resolving, giving special attention to those identified as "Expedite". Create clear and concise documentation in applicable system(s). * Use good judgment and department resources to identify all issues and required actions within a case, appropriately categorize cases and identify required actions in accordance with state and federal regulations. * Produce and manage outbound documents, correspondence and reports in a manner that meets required timeframes. * Ensure adherence with state and federal regulatory timeframes for handling cases including acknowledging cases, resolving cases, monitoring effectuation of resolution, completing resolution letters and communicating with members and providers within required timeframes. * Prepare case files for State Fair Hearings, Independent Review Entities or other escalated types of cases, including documentation of the Statement of Position and case narratives. Represent SCFHP in any hearing proceedings. * Develop effective and professional working relationships with internal and external stakeholders and partners. Communicate effectively with members and providers orally and in writing. * Contact members and providers to seek additional information or clarification regarding grievance and appeals cases and review and resolve issues by requesting medical records, notice of action, or any other pertinent information related to grievances and appeals from medical groups, delegated entities and/or providers. * Perform complete, accurate and consistent data entry into system software applications in accordance with policies, procedures and instruction from the Manager of Grievance and Appeals Operations. * Maintain case files by ensuring that they are documented in accordance with state and federal requirements and organized in a manner that adheres to SCFHP standards and audit requirements. * Participate in retrospective audit and review of cases and complete and correct gaps or errors in data. * Identify operational issues and trends with SCFHP, delegates and other external stakeholders. Communicate these issues internally and externally and assist in formulating appropriate remediation plans. * Assist the Manager of Grievance and Appeals Operations and peers with special projects. Work collaboratively and cross-functionally with other departments to facilitate appropriate resolutions. Work as a team to complete departmental tasks to meet deadlines and accomplish department objectives. * Attend and actively participate in Grievance and Appeals Committee meetings, operational meetings and department meetings, trainings and coaching sessions. * Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * High School diploma or GED. (R) * Associate's degree or equivalent experience, training or coursework. (D) * Minimum two years of experience in customer service, provider service, health service, or pharmacy in a managed care or health care environment handling escalated or complex issues. (R) * Knowledge of health plan benefits, processes and operations. (R) * Prior experience with commercial, Medi-Cal and/or Medicare programs and working with the underserved populations. (R) * Work weekends and company holidays as needed based on business regulatory requirements. (R) * Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D) * Detail-oriented with the ability to conduct research and identify steps required to resolve issues and follow through to effectuation.(R) * Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the Grievance and Appeals Department operations as dictated by business needs (R) * Ability to consistently meet grievance and appeals accuracy and timeline requirements by achieving regulatory standards. (R) * Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word and Excel. (R) * Ability to use keyboard with moderate speed and a high level of accuracy. (R) * Excellent communications skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, Members, Providers and outside entities over the telephone, in person or in writing. The ability to remain calm and de-escalate tense situations. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment; (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office and call center conditions. May be exposed to moderate noise levels.

Job Description World Insurance Associates (“World”) is a unique financial services organization with a global network of brokers and specialists who empower people to make informed decisions to improve their risk management outcomes, modernize their benefits programs, and help them achieve their long-term financial goals. Founded in 2011, World is one of the fastest-growing, Top 25 insurance brokers in the U.S. with nearly 3,000 employees in more than 300 offices across North America and the U.K. World specializes in personal and commercial insurance, surety and fidelity bonding, employee and executive benefits, investment advisory and retirement plan services, and payroll & HR solutions. Position Summary With some guidance and or direction, leads client service for middle and large accounts. Collaborates closely with senior colleagues on strategy design and renewal messaging. May Independently lead ALL messaging on small without guidance. Primary Responsibilities Create and deliver WIA service plan Prepare for and participate in strategy meeting Reviews exposures against coverages and performs gap analysis Collaborates on mid-market placements and works with Subject Matter Experts to ensure smooth and efficient placement processes, offering insights and recommendations. Review, finalize and participate proposal meeting Document clients order to bind and review binder for accuracy Participates in post renewal meeting Participates in stewardship planning and delivery for large clients Oversight of confirmation of coverage, policies, endorsements, and audits as applicable Other Responsibilities, as applicable Setup and maintain account details, contacts, and policy information in EPIC Summarize loss history Summarize current programs and expiring exposures Draft finance contracts and create premium billing allocations. Review carrier invoices Coordinate and finalize policy check Coordinate audits Position Specific Skills/Qualifications Work Experience Required 3+ years' experience in Property & Casualty with a comprehensive understanding of insurance coverages Professional Licenses/Certifications Required Must hold state Property & Casualty insurance license. Essential Skills/Competencies Maintains effective relationships with clients, co-workers, and colleagues. Viewed as a team player and is cooperative and collaborative. Able to obtain firsthand customer information and use it for improvements in placements and services. Has an understanding of guaranteed cost program design and coverage forms. Able to provide consultation of coverage needs. Strong written, oral, and interpersonal communication skills. Sets to achieve day-to-day objectives within the context of specified solutions. Develops and implements work plans for completing projects. Able to consistently perform/produce quality work, understands the urgency in various tasks, and consistently meets timelines. Proficient in self-serve portals and manages client training and utilization Strong understanding of Excel Follows a well-established set of activities. Able to solve difficult problems that are not routine, but not overly complex. Ability to work in a fast-paced environment with some instruction and a high degree of accuracy and attention to detail. Provides resolution to a diverse range of problems. Uses critical thinking to identify key barriers to resolve complex situations. Able to solve complex problems by taking a new perspective using standard product/service Education Required HS Diploma or equivalent Physical Demands & Working Conditions Office work involves working at a desk most of the time, using a stand-up/sit-down adjustable desk. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects. Typing, grasping, and repetitive motion typically is required every day, and walking and standing are required occasionally. Compensation This position is located in Illinois. The base salary for this position at the time of this posting may range from $60,000 to $80,000. Individual compensation varies based on job-related factors, including business needs, experience, level of responsibility, and qualifications. We offer a competitive benefits package and variable pay programs, please visit ************************************** for more details. Equal Employment Opportunity At World Insurance Associates (WIA), we celebrate and support our differences. We know employing a team rich in diverse thoughts, experiences, and opinions allows our employees, our products, and our community to flourish. WIA is honored to be an equal opportunity workplace. We are dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, WIA makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of our business. #LI-MF1 Powered by JazzHR vEwWy94hJk

Title: Retirement Benefits Processor Department: Pension Union: Teamster 853 Grade: 4 The Retirement Benefits Processor performs technical and administrative duties associated with the processing and verification of participants' retirement benefit inquiries and applications in accordance with Company policies, regulatory requirements, and plan guidelines. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Maintains current knowledge of assigned Plan(s). Processes retirement benefit applications; verifies the accuracy of information, researches or investigates past service, related credits, and insurance deductions. Responds to inquiries from participants, beneficiaries, and union representatives, directly or indirectly, regarding retirement benefits. Determines benefit eligibility and requests necessary documentation from unions, employers, and the Social Security Administration to expedite processing. Initiates and prepares correspondence to participants, beneficiaries, employers and others regarding general account information, retirement benefit history, and monthly retirement benefits. Performs data entry and corrections to update members' information. Updates retirement data in appropriate information systems. Assists with special projects as requested by management. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. Six months experience working in a professional environment. Highly developed sense of integrity and commitment to customer satisfaction. Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations. Ability to communicate clearly and professionally, both verbally and in writing. Strong understanding of discretion and the appropriate handling of sensitive information. Solid organization skills with an attention to detail. Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Computer proficiency including MS Office tools and applications. Preferred Qualifications Bilingual English and Spanish, based on location needs. Prior retirement plan administration experience. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $22.00-26.48/hr Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

This posting is for one position and will be filled as an Application Developer I, Application Developer II or Application Developer III depending on the candidate's qualifications and experience. FLSA Status: Exempt Department: Information Technology Reports To: Manager, Application Development Location: San Jose, CA Salary: Application Developer I - $85,740 - $128,610 Application Developer II - $98,601 - $147,902 Application Developer III - $111,168 - $172,310 Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521. GENERAL DESCRIPTION OF POSITION Application Developer I - Designs, develops, implements and supports small-scale, basic in-house and vendor applications and interfaces, including the accurate data exchange between SCFHP and trading partners in support of SCFHP objectives and regulatory compliance. Application Developer II - Designs, develops, implements and supports small to medium scale, basic to moderate, in-house and vendor applications and interfaces, including the accurate data exchange between SCFHP and trading partners in support of SCFHP objectives and regulatory compliance. Application Developer III - Designs, develops, implements and supports small to large scale, basic to complex in-house and vendor applications and interfaces, including the accurate data exchange between SCFHP and trading partners in support of SCFHP objectives and regulatory compliance. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. * Maintain existing and develop new applications to support organizational business needs. * Utilize data analysis techniques and queries to support internal business functions through the generation of reports. For the Application Developer III this also includes the development and maintenance of data warehouse. * Review existing basic processes (Application Developer I) or basic to moderate process (Application Developer II) or basic to complex processes (Application Developer III), and recommend new or improved solutions that increase efficiency and accuracy and implement those solutions. * Assess and troubleshoot small (Application Developer I) or small to medium scale (Application Developer II) or small to large scale (Application Developer III) production issues related to performance, data errors, and process failures by reviewing error logs, source code, and applicable data to identify, recommend and implement solutions. * Collaborate with business analysts, other developers and business users through the project life cycle to gather and understand requirements, determine best solutions, test solutions and demonstrate functionality end users. * Actively participate in design reviews and provide input to other developers to ensure quality solutions are developed, working with the Application Developer Lead and Manager as needed. * Responsible for following the SCFHP Project Life Cycle, Software Development Coding Standards, and Change Control Management policies and procedures. * Create technical requirements based on review and analysis of requirement specifications supplied by Business Systems Analysts and/or business users. * Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Bachelor's Degree in Computer Science, or related field, or equivalent training/experience. (R) * Application Developer I - One year of experience in application development. (D) Application Developer II - Minimum two years' experience in application development (R) * Application Developer III- Minimum four years' experience in application development (R) * Applicable software development certifications. (D) * Application Developer I - Training or hands-on experience with SQL programming, MS SQL database development, and T-SQL query generation. (R) Application Developer II -Minimum one year of experience with SQL programming, MS SQL database development, and T-SQL query generation. (R) * Application Developer III - Minimum three years' experience with SQL programming, MS SQL database development, and T-SQL query generation. (R) * Application Developer I - Knowledge of MS SQL Business Intelligence tools (SSRS, SSIS, SSAS) or other enterprise business intelligence software. (D) Application Developer II - Minimum one year of experience with MS SQL Business Intelligence tools (SSRS, SSIS, SSAS) or other enterprise business intelligence software.(R) Application Developer III - Minimum three years' experience with MS SQL Business Intelligence tools (SSRS, SSIS, SSAS) or other enterprise business intelligence software. (R) * Application Developer I - Knowledge of any of the following applicable languages/platforms:.NET, PERL, Java, SAS, VB, C++, or other modern programming language or related software. (R) Application Developer II - One year of experience with any of the following applicable languages/platforms: .NET, PERL, Java, SAS, VB, C++, or other modern programming language or related software. (R) * Application Developer III - Three years' experience with any of the following applicable languages/platforms: .NET, PERL, Java, SAS, VB, C++, or other modern programming language or related software. (R) * Application Developer I - Knowledge of, or experience with, healthcare management information systems. (D) Application Developer II - Minimum one year of experience with healthcare management information systems. (R) * Application Developer III - Minimum three years' experience with healthcare management information systems. (R) * Application Developer I - Experience with the design and development of EDI solutions that meet HIPAA X12 standards. (D) Application Developer II/III - Experience with the design and development of EDI solutions that meet HIPAA X12 standards. (D) * Knowledge of database concepts and data processes in order to understand, develop, analyze and support various new projects and make recommendations for improvements to existing processes. (R) * Ability to document code and processes. (R) * Ability to create and follow technical specifications (R) * Ability to analyze data. (R) * Application Developer III - Ability to create and restore database backups, performance monitoring and query tuning. (R) * Knowledge of BizTalk, Sharepoint, ActiveBatch and other core integration tools and services (D) * Working knowledge of and the ability to efficiently operate all applicable computer software including a working knowledge of computer applications such as Outlook, Word and Excel. (R) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, providers and outside entities over the telephone, in person or in writing. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with SCFHP's policies and procedures. (R) * Ability to perform the job safely with respect to others, to property, and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment; * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; * Emotional/Psychological Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail.

The Manager, Pension manages daily operations of multiple teams in accordance with Company guidelines, client needs, and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Provides daily leadership and supervision to team consistent with management values and mission. Assigns, distributes, and monitors quality and quantity of work produced, ensuring employees are held accountable for consistently meeting quality and production requirements. Develops staff through performance management, goal setting, training, and effective employee relations. Communicates and implements changes in policies, procedures, and Plan guidelines. Ensures applicable training is delivered to support operational execution. Oversees the processing of retirement benefit applications, calculations, and payments in accordance with Plan documents and regulatory requirements. Conducts unit meetings on a regular basis to discuss updates and changes that affect operations such as new procedures, policies, or updates to Plan guidelines. Provides status and production reports on processing metrics or applications status, as needed. May perform final quality review of unusual or complicated retirement benefit calculations and balancing of monthly benefit payments. May assist in the resolution of escalated calls or questions. May attend Board of Trustee meetings to provide operational updates. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. Five years of experience working in retirement benefits. Two years of experience in an operations supervisory role. Working knowledge of defined benefit plans, defined contribution plans, 401(k) plans and benefits administration systems. Exceptional team player with the confidence and integrity to earn client and internal team confidence quickly. Proven ability to recruit, lead, and motivate a team to balance staffing strength with profitability and growth. Excellent verbal and written communication skills, including interpersonal skills. Exceptional analytical and problem resolution skills; ability to exercise independent, sound judgment. Strong decision-making and organizational skills, with an attention to detail and the ability to optimize all available resources and deliver on multiple priorities. Ability to effectively manage remote employees in diverse locations and regions. Must be willing to travel as business dictates. Computer proficiency including Microsoft Office tools and applications. Preferred Qualifications College degree in a business-related field. Experience working in a third-party administrator or Taft-Hartley environment. Understanding of ERISA compliance or regulatory procedures. Work experience related to quality control or process improvement. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Regular travel that may be overnight. May be required to work remotely. Must be able to lift up to 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $75,000-$90,000/annually Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

FLSA Status: Non-Exempt Department: Health Services Reports To: Health Services Management Under the guidance and direction of the UM department RN Manager or Director, the Utilization Management Review Nurse (LVN) performs prospective and retrospective clinical review for inpatient and outpatient authorization requests in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and applicable business requirements. Following regulatory or evidence-based guidelines, assesses for medical necessity of services and/or benefit coverage which result in approved determination for services or the need to collaborate with Medical Directors for potential denial considerations. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. * Conduct clinical review to ensure effective and appropriate utilization of benefits and services for prospective, concurrent and retrospective/claims review organization determination authorization requests within regulatory turnaround requirements for all SCFHP lines of business. * Process authorization reviews by applying the appropriate clinical criteria/guidelines, policies and procedures. * Draft and process timely notification of action (NOA) letters for authorization determinations to providers and to members, in member specific language preferences as identified within member demographic information. * Coordinate referrals to appropriate departments or programs for member identified continuity of care needs, such as Case Management, Behavioral Health, Managed Long Term Services and Supports (MLTSS), community resources, Pharmacy and Quality. * Maintain adherence with CMS (Medicare) and DHCS (Medi-Cal) regulatory requirements. * Facilitate appropriate processing of Letters of Agreement with non-contracted Providers for approved medically necessary services. * Perform other duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Active California Board of Nursing Licensed Vocational Nurse License (LVN) without restriction. (R) * Minimum one year of licensed related health care experience. (R) * One year of experience within a Managed Care Health Plan. (D) * Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management. (R) * Knowledge of MediCal and/or Medicare guidelines and regulations. (D) * Knowledge of Milliman/MCG guidelines or other nationally accredited utilization review criteria or standards. (D) * Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) * Ability to pass random quarterly case file reviews in accordance with departmental monitoring standards. * Ability to successfully pass departmental bi-annual inter-rater reliability testing. (R) * Ability to work within an interdisciplinary team structure. (R) * Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R) Working knowledge of and the ability to efficiently operate all applicable computer software including applications such as Outlook, Word, Excel, and specific case management programs. (R) * Ability to use a keyboard with moderate speed and accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing as mandated by nursing scope of practice. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely and with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels.

FLSA Status: Exempt Department: Health Services Reports To: Manager, Utilization Management The Supervisor of Utilization Management (UM) is responsible for the direct oversight of daily operations of utilization management activities, providing assistance with the development and implement of new programs and related workflows, policies, procedures for all lines of business, and serving as a resource for internal departments, members, providers, delegates, and community partners. In addition, the Supervisor of UM is responsible for supervising nurses and coordinators to ensure that all administrative UM processes are performed in accordance with all applicable state and federal regulatory requirements, SCFHP policies and procedures and business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. 1. Collaborate with the Manager of Utilization Management to implement and supervise all UM processes for continuous and sustained compliance with all applicable state, federal and NCQA regulatory requirements, SCFHP policies and procedures and general business requirements including key performance indicators of MCAS, HEDIS, and CMS Stars for all lines of business. 2. Monitor and provide continuous analysis and quality monitoring of all policies and procedures to evaluate UM staff and delegate performance and ensure regulatory compliance, including the development and implementation of effective, measurable corrective action plans to meet targeted strategic outcomes. 3. Ensure the integration of UM operations such as prior authorization, concurrent review, Transitional Care Services (TCS), and discharge planning into other internal and external teams/departments including Quality & Process Improvement, Case Management, Community Based Programs, Pharmacy, and Behavioral Health. 4. Perform oversight and assignment of caseload across various utilization management functions including routine and ad hoc audits and monitoring of corrective action plans. 5. Establish and maintain effective interpersonal relationships with all SCFHP staff, members and/or their authorized representatives, providers and other program or agency representatives. 6. Resolve or facilitate resolution of problematic and/or complex issues by escalating to appropriate management/leadership person. 7. Ensure Utilization Management Committee preparedness. 8. Attend off-site meetings, events, or facility census review as necessary. 9. Perform other related duties as required or assigned. SUPERVISORY/MANAGEMENT RESPONSBILITIES Carries out supervisory/management responsibilities in accordance with the organization's policies, procedures, applicable regulations and laws. Responsibilities include: 1. Recruiting, interviewing, and hiring. 2. Developing a high performing department culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives. 3. Effectively assimilating, training and mentoring staff and (when appropriate), cross training existing staff and initiating retraining. This includes coaching to help increase skills, knowledge and (if applicable) improve performance. 4. Setting goals and planning, assigning, and directing work consistent with said goals. This includes responding to employees' needs, ensuring they have the necessary resources to do their work. 5. Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Unrestricted professional RN licensure in the state of California. (R) * Minimum two years of progressively responsible experience in a supervisory or lead capacity in case management, utilization management, discharge planning and/or quality improvement in a managed care related setting. (R) * Understanding and/or experience with Utilization Management. (R) * Must be knowledgeable of DHCS, CMS, DMHC regulations and NCQA Population Health Management standards. (R) * Ability to consistently meet accuracy and timeline requirements to maintain regulatory requirements. * Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R) * Ability to use a keyboard with moderate speed and high level of accuracy. (R) * Excellent written, verbal, and interpersonal communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to think and work under pressure and effectively prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise sound judgment when making decisions within the scope of this position including performing job safely and within respect to others, to property and to individual safety (R) * Maintenance of a valid California Driver's License and acceptable driving record in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels.

Job DescriptionExciting long-term opportunity with strong growth potential for an experienced Commercial Insurance Sales Agent/Producer. For this key role, we are seeking a dynamic and trusted business professional with an entreprenurial spirit and solid client relationship skills that enjoys working in a learning environment to master new concepts. We are looking to expand. The ideal candidate will be readily adaptable to change and direction, able to juggle multiple priorities and meet tight deadlines with an unwavering commitment to delivering excellence. This position offers a high level of responsibility and requires insurance industry experience with the ability to successfully and efficiently manage a high volume of workload. Exceptional problem solving and communication skills are essential. Individual will need strong computer skills and highly organized due to the high level of calls and marketing our agency This is an hourly plus New and Renewal Commission position. Your income is Performance based, which allows you to increase your income based upon your sales skills, work ethic, knowledge of commercial insurance products and your drive to succeed. POSITION SUMMARY Insurance Incorporated offers a dynamic collaborative work environment where individuals operate independently to provide prompt, accurate and courteous results. The Insurance Sales Agent is responsible for; Marketing, Prospecting/Qualifying and Placement of Commercial lines coverage for New Business Prospect Compile Proposals and Rating Selling and Placing of Accounts Developing and Maintaining a pipeline of new business opportunities Cross Selling Existing Accounts Renewal and Claims Reviews Respond to Incoming Sales Calls and Leads Day to day servicing of assigned accounts providing outstanding service to the client, partners, and insurance companies. Must support and promote the company's purpose, vision, and mission; always acting in the best interest of the client and firm. Must uphold and embody the corporate values of integrity, leadership, teamwork, respect, professionalism, and stability.Insurance Incorporated provides a highly competitive compensation structure including medical, dental, vision, 401k, and staff development program designed to provide growth opportunities for employees. MINIMUM QUALIFICATIONS California Fire & Casualty Broker-Agent license Knowledge of AMS360 or familiar with management systems, Acord forms, Insurance carrier rating systems Completion of IIA General Insurance Program, ARM, CPCU and/or other insurance courses highly desirable Ability to participate in continuing education for the maintenance of insurance license and personal development Excellent customer service skills including the ability to communicate effectively by phone or email Ability to work with minimal direction or assistance Proficient in use of personal computers including a strong understanding of Internet usage and the ability to quickly learn various software programs. Experience working in a paperless environment preferred Excellent oral and written English communication and figure aptitude skills as normally acquired through completion of high school level studies; college preferred Must be results-oriented with a strong sense of urgency and accuracy and demonstrate a “can-do” attitude by taking initiative, being enthusiastic, flexible, and dependable. Must be very reliable and punctual. Excellent ability to interact effectively and positively with carrier representatives and individuals at all levels of the organization. Strong organizational skills as demonstrated by the ability to work on several tasks at once with frequent interruptions while meeting sensitive time-frames. Bilingual a plus Insurance Incorporated has been serving consumers and business owners since 1958 with 7 locations throughout California and expanding. We are a Full Service Insurance agency offering Personal Lines coverages such as Home, Auto, Dwelling Fire, RV's, etc. Our Commercial division provides a full line of Commercial insurance products such as General Liability, Workers Compensation Insurance, Property, EPLI, Cyber, Commercial Auto, etc. and have direct appointments with the Nations leading insurance carriers. Our Health and Benefits Department provides Group Health, Individual Health, Dental and Life insurance. As one of the fastest growing agencies in the state, we are looking for top performers with strong goals of growth and possible management of new office in future as the company expands. We believe in STRONG CUSTOMER SERVICE and assisting our agents in growing their income year in and year out. E04JI80079a240038tj