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Position Overview We are seeking a highly technical, hands-on operational executive to serve as our Senior Director of MSO – Claims Operations & Provider Configuration. This position requires candidates to be based in Southern California. This role requires a true Subject Matter Expert (SME) with deep, end-to-end expertise in claims operations within a fully delegated, full-risk Medicare Advantage environment. Direct, hands-on EZCAP experience is required. This is not a high-level oversight position. The ideal candidate can speak in detail about adjudication logic, denial trends, provider configuration dependencies, and the operational issues they have personally resolved. This leader will own claims accuracy, configuration integrity, financial alignment, and measurable KPI performance across the MSO. Key Responsibilities End-to-End Claims Operations Ownership • Oversee the full claims lifecycle: intake, validation, adjudication, pricing, payment, adjustments, reprocessing, and reporting, • Ensure high first-pass adjudication rates and CMS-compliant turnaround times, • Monitor denial trends and implement structured root cause corrective actions, • Serve as executive escalation point for complex claims and systemic issues, • Own provider configuration within EZCAP, including:, • Demographics, • Contract terms, • Fee schedules, • Risk arrangements, • Delegation indicators, • Effective dates and terminations, • Establish configuration QA, validation, and change control governance, • Prevent mispricing, claims leakage, and downstream financial exposure, • Improve measurable KPIs including:, • First-pass adjudication rate, • Claims accuracy rate, • Turnaround time (clean vs. non-clean), • Rework percentage, • Configuration error rate, • Conduct root cause analysis on systemic operational issues, • Design and operationalize scalable, sustainable solutions, • Ensure claims payments align with contract terms and value-based arrangements, • Mitigate overpayment, underpayment, and compliance risk, • Lead audit readiness for CMS and health plan delegation oversight, • Lead managers and SMEs across claims and configuration teams, • Build a metrics-driven, high-accountability culture, • Coach leaders on technical problem-solving and escalation management, • Must be based in Southern California, • 10+ years of healthcare claims operations experience, • 5+ years in senior leadership managing managers and complex teams, • Direct, hands-on EZCAP experience (required), • Demonstrated expertise in:, • Claims adjudication logic, • Provider configuration and fee schedules, • Delegated Medicare Advantage models, • CMS regulatory requirements, • Proven experience in a fully delegated, full-risk Medicare Advantage environment, • Strong root cause analysis and process optimization background, • Master’s degree (MBA, MHA, or related field), • Multi-state IPA/MSO experience, • Experience supporting rapid growth, new market expansion, or M&A integrations, • Deep technical and operational expertise (not surface-level oversight), • Financial and analytical acumen, • Strong executive judgment and escalation management, • Ability to translate complexity into scalable execution When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first: • Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan., • Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe., • Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future., • Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work., • Career Development: Tuition reimbursement to support your education and growth.

Pre-IPO Healthcare Company This Jobot Job is hosted by: Milan Kacar Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. Salary: $130,000 - $150,000 per year A bit about us: Fast Growing Healthcare Company Why join us? • Generous 401K match, • Superb Medical and dental insurance, • 3 Weeks PTO to start, • Stability during economic downturns Job Details Responsibilities: Accounting & Financial Operations • Assist the Controller in managing the accounting department in the daily accounting operations, including general ledger, accounts payable/receivable, payroll, and cash management., • Prepare and review journal entries, reconciliations, and financial schedules., • Prepare internal management reports and support external financial reporting., • Assist with timely CMS and state regulatory filings., • Assist Controller to support annual external audits and regulatory examinations by preparing schedules and responding to requests., • Assist Controller to support the annual budgeting and periodic forecasting process., • Provide variance analysis on administrative costs, medical expenses, and PMPM trends., • Supervise and mentor accounting staff, ensuring accuracy and adherence to deadlines., • Provide training and development opportunities to build team skills., • Bachelor’s degree in Accounting or Finance; CPA or CPA-track preferred., • Strong knowledge of GAAP and at least 5 years of progressive accounting experience, ideally within managed care, insurance, or healthcare., • Strong Excel skills., • Demonstrated leadership or supervisor experience in previous work history. Interested in hearing more? Easy Apply now by clicking the "Apply" button. Jobot is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity and all qualified candidates receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Jobot also prohibits harassment of applicants or employees based on any of these protected categories. It is Jobot’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions. Sometimes Jobot is required to perform background checks with your authorization. Jobot will consider qualified candidates with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the Los Angeles Fair Chance Initiative for Hiring and the San Francisco Fair Chance Ordinance. Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Jobot, and/or its agents and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here: jobot.com/privacy-policy

Position title: Assistant Adjunct Professor Salary range: The posted UC salary scales set the minimum pay determined by rank and/or step at appointment. See Table(s) 1: The salary for this position is $89,400 annually. See campus compensation page for additional information. Open date: October 21, 2025 Most recent review date: Monday, Dec 1, 2025 at 11:59pm (Pacific Time) Applications received after this date will be reviewed by the search committee if the position has not yet been filled. Final date: Tuesday, Jun 30, 2026 at 11:59pm (Pacific Time) Applications will continue to be accepted until this date, but those received after the review date will only be considered if the position has not yet been filled. The Department of Mathematics at the University of California, Los Angeles, invites applications for E.R. Hedrick Assistant Adjunct Professorships. Appointments are for two years, with the possibility of renewal for a third year. Applicants must possess a Ph.D. in a relevant area by June 2026 and should show evidence of excellence in teaching and research. Preference will be given to applicants whose research connects to faculty interests in the department or who can address specific teaching needs. The teaching load for Hedrick Assistant Adjunct Professors is typically four courses per year. Apart from the standard Hedrick Assistant Adjunct Professorship line, there are three specializations that address particular research and teaching needs in the department. Applicants hired for one of these specializations must be willing to primarily teach courses in these areas. Specialization in Computational and Applied Mathematics (CAM): The teaching load for these positions is normally reduced by research funding to two one-quarter courses per year. Specialization for Program in Computing (PIC): Applicants for this specialization must show strong promise as instructors for courses in computing. Specialization in Financial Instruction (FAM): Applicants for this specialization should have expertise in financial and actuarial mathematics (FAM). We will also consider candidates with other mathematical backgrounds such as probability or statistics if they are willing to master the relevant FAM content for instructional purposes. This position is well suited for candidates without FAM background who are interested in a future career in this area. Applicants for Hedrick Assistant Adjunct Professorships interested in one or several of the specializations should indicate the corresponding acronym (CAM, PIC, FAM) as the primary topic under "Specialization" in their application on UC Recruit. Applicants not interested in these specializations can leave this field blank. All applicants should indicate the AMS Subject Classification that most accurately represents their research area. As a campus with a diverse student body, we encourage applications from women, minorities, and individuals with a history of mentoring underrepresented minorities in the sciences. The preferred candidate will also demonstrate a commitment to mentoring students from underrepresented and underserved populations in the sciences, or demonstrate an interest in campus-wide or departmental programs that provide research and professional development opportunities for a diverse student body. The annual salary for this position is $89,400. Appointments will be effective July 1, 2026 or later. Applications will be accepted until all positions are filled. For fullest consideration, all application materials should be submitted on or before December 1, 2025. REQUIRED DOCUMENTS • Curriculum Vitae - Your most recently updated C.V., • Cover Letter, • Statement of Research, • Statement of Teaching, • UCLA Mission Statement, • 3 letters of reference Department: Basic qualifications PhD. degree in Mathematics (or related field) or expected to complete their PhD. by June 2026 Document requirements * Curriculum Vitae - Your most recently updated C.V. * Cover Letter * Statement of Research * Statement of Teaching * Reference check authorization release form - Complete and upload the reference check authorization release form * UCLA Mission Statement - As the nation's premier public research university, UC's mission is the creation, dissemination, preservation and application of knowledge for the betterment of our global society. We have a particular responsibility to the people of the state of California which we express in the excellence of the education we provide, the impact of the research we do, the comprehensive, life-saving medical services we provide, and the public service mission we are devoted to. The University of California promotes the social mobility of its students, equips them with the tools and experience that furthers their ambitions, and regards their accomplishments across the life span as evidence of the profoundly positive impact of higher education. The UCLA campus has expressed these goals in its strategic plan as follows: Deepen our engagement with Los Angeles Expand our reach as a global university Enhance our research and creative activities Elevate how we teach Become a more effective institution Prompt for candidates for recruitment: Reflecting on your personal and professional experiences, highlight your past contributions and future commitments to advancing UCLA's mission as embodied in the 2023-28 strategic plan. These accomplishments and ambitions may be discussed in the context of describing your teaching, scholarship, and service Reference requirements As a University employee, you will be required to comply with all applicable University policies and/or collective bargaining agreements, as may be amended from time to time. Federal, state, or local government directives may impose additional requirements. The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law. As a condition of employment, the finalist will be required to disclose if they are subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct. • "Misconduct" means any violation of the policies or laws governing conduct at the applicant's previous place of employment, including, but not limited to, violations of policies or laws prohibiting sexual harassment, sexual assault, or other forms of harassment, discrimination, dishonesty, or unethical conduct, as defined by the employer., • UC Sexual Violence and Sexual Harassment Policy, • UC Anti-Discrimination Policy for Employees, Students and Third Parties, • APM - 035: Affirmative Action and Nondiscrimination in Employment Los Angeles, CA

Specialty/Competency: Guidewire Industry/Sector: Insurance Time Type: Full time Travel Requirements: Up to 60% At PwC, our people in business application consulting specialise in consulting services for a variety of business applications, helping clients optimise operational efficiency. These individuals analyse client needs, implement software solutions, and provide training and support for seamless integration and utilisation of business applications, enabling clients to achieve their strategic objectives. As a Guidewire consulting generalist at PwC, you will specialise in providing consulting services for Guidewire software solutions. You will apply an in-depth knowledge of Guidewire applications to assist clients in optimising operational efficiency through analysis, implementation, training, and support specific to Guidewire software. Enhancing your leadership style, you motivate, develop and inspire others to deliver quality. You are responsible for coaching, leveraging team member's unique strengths, and managing performance to deliver on client expectations. With your growing knowledge of how business works, you play an important role in identifying opportunities that contribute to the success of our Firm. You are expected to lead with integrity and authenticity, articulating our purpose and values in a meaningful way. You embrace technology and innovation to enhance your delivery and encourage others to do the same. Examples of the skills, knowledge, and experiences you need to lead and deliver value at this level include but are not limited to: * Analyse and identify the linkages and interactions between the component parts of an entire system. * Take ownership of projects, ensuring their successful planning, budgeting, execution, and completion. * Partner with team leadership to ensure collective ownership of quality, timelines, and deliverables. * Develop skills outside your comfort zone, and encourage others to do the same. * Effectively mentor others. * Use the review of work as an opportunity to deepen the expertise of team members. * Address conflicts or issues, engaging in difficult conversations with clients, team members and other stakeholders, escalating where appropriate. * Uphold and reinforce professional and technical standards (e.g. refer to specific PwC tax and audit guidance), the Firm's code of conduct, and independence requirements. The Opportunity As part of the P&C Technology Guidewire team you manage projects related to systems configurations within the P&C Insurance industry. As a Manager you supervise, develop, and coach teams, manage client service accounts, and drive client engagement workstreams by solving and analyzing complex problems to develop impactful deliverables. You leverage your broad knowledge of Guidewire applications and your ability to build meaningful relationships with clients to deliver exceptional work and cultivate meaningful client relationships. Responsibilities * Manage projects related to systems configurations within the Insurance industry * Supervise, develop, and coach teams to achieve top-quality deliverables * Analyze and solve complex problems to drive client engagement workstreams * Utilize broad knowledge of Guidewire applications to deliver exceptional work * Build and maintain meaningful relationships with clients * Cultivate meaningful client relationships through clear communication * Leverage team strengths to meet client service expectations * Confirm adherence to project timelines and quality standards What You Must Have * Bachelor's Degree * 5 years of experience What Sets You Apart * Preferred degree in Actuarial Science, Business Administration/Management, Commerce, Computer and Information Science, Computer Applications, Computer Engineering, Computer Engineering & Accounting, Data Processing/Analytics/Science, Economics, Electrical Engineering, Engineering, Engineering and Business, Finance, Information Technology, Management Information Systems, Mathematics, Mechanical Engineering, Operations Management/Research, Risk Management, Software App, Statistics * Guidewire and Scrum Master Certification preferred * Managing projects in Insurance industry systems configurations * Experience with Guidewire PolicyCenter, BillingCenter, ClaimCenter, ContactManager, Portal * Proficiency in GOSU, Java, XML coding * Experience with ANT, MAVEN, code repositories * Building reliable client relationships * Leading engagement and project teams * Creative thinking and problem-solving skills The salary range for this position is: $99,000 - $232,000. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. All hired individuals are eligible for an annual discretionary bonus. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation, personal and family sick leave, and more. To view our benefits at a glance, please visit the following link: As PwC is an equal opportunity employer, all qualified applicants will receive consideration for employment at PwC without regard to race; color; religion; national origin; sex (including pregnancy, sexual orientation, and gender identity); age; disability; genetic information (including family medical history); veteran, marital, or citizenship status; or, any other status protected by law. PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: . Learn more about how we work: For only those qualified applicants that are impacted by the Los Angeles County Fair Chance Ordinance for Employers, the Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, San Diego County Fair Chance Ordinance, and the California Fair Chance Act, where applicable, arrest or conviction records will be considered for Employment in accordance with these laws. At PwC, we recognize that conviction records may have a direct, adverse, and negative relationship to responsibilities such as accessing sensitive company or customer information, handling proprietary assets, or collaborating closely with team members. We evaluate these factors thoughtfully to establish a secure and trusted workplace for all. Applications will be accepted until the position is filled or the posting is removed, unless otherwise set forth on the following webpage. Please visit this link for information about anticipated application deadlines:

Job Description Position Overview We are seeking a highly technical, hands-on operational executive to serve as our Senior Director of MSO – Claims Operations & Provider Configuration. This position requires candidates to be based in Southern California. This role requires a true Subject Matter Expert (SME) with deep, end-to-end expertise in claims operations within a fully delegated, full-risk Medicare Advantage environment. Direct, hands-on EZCAP experience is required. This is not a high-level oversight position. The ideal candidate can speak in detail about adjudication logic, denial trends, provider configuration dependencies, and the operational issues they have personally resolved. This leader will own claims accuracy, configuration integrity, financial alignment, and measurable KPI performance across the MSO. Key Responsibilities End-to-End Claims Operations Ownership • Oversee the full claims lifecycle: intake, validation, adjudication, pricing, payment, adjustments, reprocessing, and reporting, • Ensure high first-pass adjudication rates and CMS-compliant turnaround times, • Monitor denial trends and implement structured root cause corrective actions, • Serve as executive escalation point for complex claims and systemic issues, • Own provider configuration within EZCAP, including:, • Demographics, • Contract terms, • Fee schedules, • Risk arrangements, • Delegation indicators, • Effective dates and terminations, • Establish configuration QA, validation, and change control governance, • Prevent mispricing, claims leakage, and downstream financial exposure, • Improve measurable KPIs including:, • First-pass adjudication rate, • Claims accuracy rate, • Turnaround time (clean vs. non-clean), • Rework percentage, • Configuration error rate, • Conduct root cause analysis on systemic operational issues, • Design and operationalize scalable, sustainable solutions, • Ensure claims payments align with contract terms and value-based arrangements, • Mitigate overpayment, underpayment, and compliance risk, • Lead audit readiness for CMS and health plan delegation oversight, • Lead managers and SMEs across claims and configuration teams, • Build a metrics-driven, high-accountability culture, • Coach leaders on technical problem-solving and escalation management, • Must be based in Southern California, • 10+ years of healthcare claims operations experience, • 5+ years in senior leadership managing managers and complex teams, • Direct, hands-on EZCAP experience (required), • Demonstrated expertise in:, • Claims adjudication logic, • Provider configuration and fee schedules, • Delegated Medicare Advantage models, • CMS regulatory requirements, • Proven experience in a fully delegated, full-risk Medicare Advantage environment, • Strong root cause analysis and process optimization background, • Master’s degree (MBA, MHA, or related field), • Multi-state IPA/MSO experience, • Experience supporting rapid growth, new market expansion, or M&A integrations, • Deep technical and operational expertise (not surface-level oversight), • Financial and analytical acumen, • Strong executive judgment and escalation management, • Ability to translate complexity into scalable execution When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first: • Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan., • Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe., • Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future., • Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work., • Career Development: Tuition reimbursement to support your education and growth.

Job Description Commercial Lines Underwriter - Large Growing Insurance Carrier - Base Salary to 120k/year - Anaheim, CA • Apply company underwriting guidelines, actuarial information, and industry best practices., • Manage renewals and new business submissions, ensuring proper documentation and approvals., • Evaluate, underwrite, and manage commercial P&C accounts, including reviewing submissions, assessing exposures, and recommending terms and pricing., • 5+ years of Property and Casualty (P&C) underwriting experience in Commercial Auto., • Strong understanding of Property & Casualty insurance principles and risk evaluation., • Proficient with Microsoft Office and underwriting systems., • Base salary in the 110k - 120k/year range, • Medical, dental, vision, and life insurance covered 100% by the company., • 401k with up to 4% company match., • Hybrid schedule after 1 year of service with 3 days in office and 2 days remote., • Business hours: Monday – Friday / 8:30 AM – 5:30 PM #INDALL

Job DescriptionDescriptionAstrana Health is seeking a Sr. Director of Medical Economics to lead advanced medical cost analytics and drive strategic insights across our risk-based business. This leader will help identify cost drivers, evaluate financial performance, and partner with clinical, operational, and finance leaders to improve performance across health plan contracts and provider networks. This role requires a hands-on leader who can translate complex healthcare data into actionable insights and influence decisions across the organization. What You'll Do • Lead medical cost and utilization analysis across Medicare Advantage, Managed Medicaid, and Commercial populations, • Identify key drivers of medical expense trends and develop actionable recommendations to improve performance, • Partner with clinical and operational leaders to improve utilization and reduce avoidable costs, • Monitor and analyze specialty cost trends and capitation performance, identifying cost drivers and partnering with clinical and operational leaders to improve performance across risk-based contracts, • Support financial forecasting and performance tracking for risk-based and capitated contracts, • Develop and monitor key performance metrics including cost trends, utilization, and margin performance, • Lead analyses to support payer contracting, rate negotiations, and network performance evaluation, • Oversee development of dashboards and reporting to support executive decision-making, • Present insights and recommendations to senior leadership, • 14+ years of experience in medical economics, healthcare analytics, actuarial analysis, or healthcare finance, • Strong experience working with risk-based or capitated healthcare models, • Deep understanding of medical cost drivers, utilization metrics, and healthcare financial performance, • Experience analyzing claims data and population health performance, • Demonstrated experience leading analytics or medical economics teams, • Strong business judgment and ability to translate data into strategic insights, • Experience working cross-functionally with clinical, operational, and finance teams, • Advanced Excel and data analysis skills required, • Advanced experience with SQL or BI tools required, • This position is remotely based in the U.S. However, strong preference for candidates who can work hybrid in Los Angeles, Las Vegas, or Houston. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Job Description Position Summary The Provider Configuration Supervisor is responsible for leading and overseeing all day-to-day provider and contract configuration activities within the claims adjudication system (EZCAP) for a fully delegated IPA/MSO operating under Full-Risk Medicare Advantage and Value-Based Care contracts. This role ensures that providers, facilities, contracts, fee schedules, DOFRs (Delegated Organization Financial Responsibility), benefit configurations, and claims payment rules are configured accurately, timely, and in alignment with executed contracts, delegation agreements, and financial models. The Supervisor leads configuration analysts, enforces configuration standards, mitigates downstream claims risk, and ensures claims are clean, payable, and audit-defensible. This is a mission-critical role: configuration errors directly result in incorrect provider payments, financial leakage, disputes, regulatory exposure, and provider dissatisfaction. Core Accountability Own the integrity, accuracy, and operational readiness of all provider and contract configuration within EZCAP to support clean claims adjudication under full-risk, delegated value-based contracts. Key Responsibilities 1. Claims System Configuration Leadership (EZCAP) • Lead and supervise all provider, contract, and financial configuration activities within EZCAP., • Ensure accurate setup and maintenance of:, • Providers (PCPs, Specialists, Facilities, Ancillaries), • Provider hierarchies and affiliations (TIN, billing NPI, rendering NPI), • Payor contracts and sub-contracts, • DOFRs (Delegated Organization Financial Responsibility), • Provider Fee Schedules / Fee Sets, • Capitation arrangements, • Risk pools, withholds, and bonus configurations, • Global and partial delegation logic, • Own configuration logic that determines who pays whom, how much, and under what rules. 2. DOFR & Financial Responsibility Configuration • Configure and maintain DOFR structures reflecting:, • IPA vs Health Plan responsibility, • PCP vs Specialist responsibility, • In-network vs out-of-network scenarios, • Facility vs professional claim logic, • Ensure DOFR logic aligns with:, • Delegation agreements, • Health plan contracts, • Provider contracts, • Internal financial models and actuarial assumptions, • Partner with Finance and Actuarial teams to validate financial accuracy. 3. Provider Fee Set & Contract Configuration • Oversee configuration of:, • Fee-for-service schedules, • Case rates, • Percent-of-charge models, • Flat fee arrangements, • Custom carve-outs, • Ensure fee sets align precisely with executed provider contracts and amendments., • Manage retroactive configuration changes with appropriate impact analysis and documentation. 4. Team Leadership & Supervision • Supervise configuration analysts and specialists including:, • Work assignment and prioritization, • Training and onboarding, • Quality control and peer review, • Performance management, • Establish configuration standards, SOPs, and naming conventions., • Serve as escalation point for complex configuration scenarios and claims issues. 5. Cross-Functional Coordination • Partner closely with:, • Credentialing (provider readiness), • Contracting (interpretation of provider and payor contracts), • Claims Operations (claims outcomes and issue resolution), • Finance / Actuarial (payment accuracy and financial modeling), • Provider Disputes (root cause resolution), • Compliance (audit and delegation oversight), • Translate contract language into executable system logic. 6. Claims Readiness & Issue Resolution • Support claims production by ensuring configuration is:, • Complete prior to provider go-live, • Tested and validated, • Participate in claims triage for:, • Underpayments, • Overpayments, • Misrouting of financial responsibility, • Perform root-cause analysis of configuration-driven claims defects and implement corrective actions. 7. Audit, Compliance & Delegation Readiness • Ensure configuration is audit-defensible for:, • Health plan delegation audits, • Internal compliance reviews, • CMS or regulatory inquiries, • Maintain documentation for configuration decisions, overrides, and exceptions., • Support Corrective Action Plans (CAPs) related to configuration findings. 8. Change Management & Configuration Governance • Establish and enforce configuration change control processes., • Review and approve:, • New provider builds, • Contract amendments, • Retroactive configuration changes, • Maintain configuration logs and version tracking., • Ensure changes are communicated to downstream teams (claims, finance, provider relations). 9. Reporting & Performance Oversight • Track and report configuration KPIs including:, • Provider build turnaround time, • Contract configuration cycle time, • Configuration defect rate, • Claims rework attributable to configuration Education • Bachelor’s degree in Healthcare Administration, Business, Finance, Information Systems, or related field preferred., • 6+ years of healthcare claims configuration experience in an IPA, MSO, or health plan., • 3+ years of hands-on EZCAP configuration experience required., • 2+ years of supervisory or lead experience strongly preferred., • Deep experience in delegated, full-risk Medicare Advantage environments required., • Advanced EZCAP configuration knowledge:, • Provider builds, • Contract loading, • DOFR logic, • Fee schedules, • Strong understanding of:, • Medicare Advantage delegation models, • Claims adjudication workflows, • Provider payment methodologies, • Exceptional attention to detail, • Strong systems and financial logic thinking, • Ability to interpret contracts into executable system rules, • Leadership and coaching capability, • High accountability and ownership mindset, • Strong cross-functional communication, • Claims paid correctly on first pass, • Configuration error rate, • Provider build and contract setup turnaround time, • Reduction in configuration-related disputes, • Audit findings related to configuration When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first: • Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan., • Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe., • Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future., • Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work., • Career Development: Tuition reimbursement to support your education and growth.

Job Description Commercial Lines Actuary - Large Growing Insurance Carrier - Base Salary to 150k/year - Anaheim, CA • Perform actuarial analyses to support pricing, rate indications, profitability, reserve reviews, and loss trend projections for Commercial Auto products., • Build, maintain, and document rating models, assumptions, and actuarial methodologies., • Analyze loss experience, exposure trends, and emerging risk factors to provide actionable insights for business decisions., • Prepare clear, accurate actuarial reports, exhibits, and presentations for senior management and key stakeholders., • Bachelor's degree in quantitative field (Actuarial Science, Mathematics, Statistics, Finance, or related)., • 3+ years of actuarial experience in Commercial Auto Insurance., • Strong analytical and quantitative skills with experience working with large datasets., • Advanced Excel proficiency; exposure to SQL, R, Python, or SAS a plus., • Base salary in the 140k - 150k/year range., • Medical, dental, vision, and 401k., • Hybrid schedule after 1 year, with 3 remote days (in-office on Mondays and Wednesdays), • Business hours: 8:00 AM – 4:30 PM or 8:30 AM – 5:00 PM. #INDALL

Job DescriptionDescriptionAbout the Role We are seeking an Actuarial Manager who thrives on independent thinking and enjoys building models and analyses from the ground up. This role offers the opportunity to leverage your healthcare and actuarial expertise to contribute to our leading position in the value-based care revolution. You will manage a Lead Analyst and report to the Senior Director, Actuary. This position is open for remote work. Our Values: • Put Patients First, • Empower Entrepreneurial Provider and Care Teams, • Operate with Integrity & Excellence, • Be Innovative, • Reserving: Develop and maintain actuarial models to estimate liabilities for Incurred but Not Paid (IBNP) claims across all lines of business (Medicare, Medicaid, and Commercial)., • Earnings Reporting: Assist in quarterly earnings reporting to provide financial clarity for internal and external stakeholders of a publicly traded company., • Financial Planning and Analysis: Support budgeting and forecasting by designing P&L models, forecasting tools, and identifying emerging trends., • Cost Trend Evaluation: Manage the Actuarial Trend Model used in operational and financial decision-making and analyze healthcare utilization patterns and cost trends to identify areas for improvement and opportunities for cost savings., • Actuarial Studies: Develop actuarial studies relating to items such as seasonality, trend, and inventory levels., • Audit and Reporting: Identify, develop, and document audit findings, presenting results to key stakeholders to inform strategic decisions., • Infrastructure Development: Build robust analytical infrastructure, including comprehensive reports and dashboards, to monitor expense experience., • Risk Adjustment: Convert operational risk adjustment data into actionable financial insights., • Cross-Functional Collaboration: Work closely with teams across ACO, Analytics, Data, Finance, M&A, Contracting, Medical Economics, and Operations., • FSA or ASA credentials., • 5+ years of experience in actuarial roles., • 1+ years of experience in VBC or VBC adjacent roles., • Strong reserving skills and background., • Some experience in forecasting/pricing., • Advanced knowledge of Microsoft Excel., • Intermediate knowledge of SQL., • Proficiency and desire to build actuarial models from scratch., • Comfortable working on a small team in a fast-paced environment., • Experience with a variety of different LOBs., • Experience producing public financial reports., • Experience working on the provider side of healthcare., • Risk adjustment experience., • Experience with PowerBI., • Experience in the California healthcare market., • This is a remote role within the United States.

Assesses, analyzes and interprets financial risks and opportunities by applying advanced actuarial methods; and conducting actuarial analyses. Develops and designs advanced actuarial models; assists with the development of alternative assumptions and forecasts using in-house models or actuarial soft

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Technology is at the heart of Disney's past, present, and future.Disney Entertainment and ESPN Product & Technology is a global organization of engineers, product developers, designers, technologists, data scientists, and more – all working to build and advance the technological backbone for D

Administrative Assistant | Westside | Premier Global Organization.If you enjoy Human Resources, event planning, and working in a fast-paced, high-performing environment, this is an exciting opportunity to join an exceptional team.A globally recognized organization is seeking a polished Administrativ

Front Desk Agent is responsible for checking in and checking out guests of hotel.This team member is here to offer the best experience possible and will also assist with basic duties, such as PBX (phone operator), assisting with guest inquiries which include but are not limited to folio questions, r

Swing Shift / Starting at 2pm or 5pm, working every other weekend.Associate Patient Services Specialist.Our client is seeking an Associate Patient Services Specialist to support critical patient registration activities within a fast-paced Emergency Department environment.This role ensures accurate i

Medical Receptionist | Temp to Hire | $$$ | Room for Growth.This Jobot Consulting Job is hosted by: Ba Tran.Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume.We are currently seeking a dynamic and dedicated individual to join our team as a Consulting A

Beverly Hills, CA - Onsite M-F.Staggered shifts — some days starting at 7:00 AM, others at 10:00 AM (8-hour days).Confidential – Leading Private Equity Firm.We're excited to partner with a.This is a fantastic gateway into the corporate world—perfect for someone eager to.Answer and route incomi

Brio Water Technology | Glendale, CA.Brio Water Technology is a leading provider of innovative water solutions, dedicated to delivering high quality products and exceptional customer experiences.Our team is committed to excellence, collaboration, and creating a professional environment that reflects

Associate Consultant – May 2026 Graduates.Location: West Hollywood, California (Onsite).Compensation: $42,500 base salary + uncapped commission (OTE: $75,000–$95,000 Y1).Lumicity is a specialist recruitment consultancy within the G2V Group, partnering with businesses across Technology, Life Scie

AVID Technical Resources is a national IT recruiting firm with an office in the Mar Vista area.We're expanding our LA team, and we're looking for hard-working, driven people with either a background or interest in sales and a drive to grow! We pride ourselves on creating a team-oriented, work-hard,

We are looking to add a highly motivated, experienced Recruiter to our team at Ignited.We're a lean and high performing agency with the privilege of working with incredible clients in a diverse range of industries.We primarily focus on finance and accounting searches that are often complex and requi

Location: Los Angeles - Onsite.Duration of Assignment: July 31st- temp to hire for the right fit.Front Desk Agent is responsible for checking in and checking out guests.This team member is here to offer the best experience possible and will also assist with basic duties, such as PBX (phone operator)

We are committed to holding defendants accountable and securing justice for our clients.We are seeking a professional and friendly Front Desk Receptionist / Administrative Assistant to join our team in Downtown Los Angeles.This position is ideal for someone who enjoys interacting with people, stayin

Our client, a global chemical manufacturer, is seeking to hire an Administrative Assistant with SAP experience to support their Quality Control Department.Intermediate SAP experience required.Works well in a fast-paced environment.Must be authorized to work in the US and be able to pass a background

We are committed to holding defendants accountable and securing justice for our clients.We are seeking a professional and detail-oriented Administrative Assistant / Intake Specialist to join our law firm.This position is ideal for someone who enjoys client interaction, is highly organized, and can m

D'Leon Consulting Engineers is seeking a Financial Administrative Assistant in Los Angeles, CA.Assist with payroll processing, timekeeping verification, labor allocations, and coordination with payroll providers.Support preparation and distribution of offer letters and employment documentation relat

Omega Law Group is a prestigious personal injury law firm serving California and Texas.We are committed to championing the rights of individuals who have suffered due to negligence or wrongful acts.Our dedicated team is known for delivering exceptional service and winning results for our clients.Thr

Social Project Manager – Services.Our services Marketing team, bringing our offerings to life through storytelling, culture, and creative execution across social platforms.UGC, and creator-led campaigns.This role is all about operational excellence—owning timelines, managing workflows, and keepi

Capstone Partners is seeking an organized and service-oriented Administrative Assistant & Front Desk Coordinator to join our Playa District office.As the first point of contact for clients, visitors, and team members, this role is essential in creating a welcoming, professional, and highly effic

We are seeking a Mechanical Construction Project Manager with experience delivering commercial projects from preconstruction through closeout.This role is responsible for managing HVAC, piping, and plumbing scopes while ensuring projects are completed on time, within budget, and to the highest quali

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