Los Angeles, California, United States · On-site
$102k–$163k/yr
Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-i…
Skills: Fraud Investigation Management, Staff Supervision, Project Management, Business Process Improvement, KPI Tracking
Los Angeles, California, United States · On-site
$70k–$72k/yr
Salary: 69500-72000 Pay Grade: 11 Different perspectives make us better. We’re committed to creating an equal opportunity and fair treatment environment, where learning and growing together is just part of our every day.…
Skills: Culinary leadership, Food presentation, Kitchen management, Cost control, Purchasing
Los Angeles, California, United States · Hybrid
$88k–$92k/yr
Omni Los Angeles Hotel From sunny beaches to world-class entertainment, the city of Los Angeles is a great place to live, work and play. The four-diamond Omni Los Angeles Hotel is located in downtown’s cultural dis…
Skills: Group Selling, Revenue Management, Contract Negotiation, Outbound Solicitation, Client Relationship Management
Los Angeles, California, United States · On-site
$75k–$90k/yr
Cosm is a global technology company that brings experiences to life in immersive environments. We help our partners create spaces and content that blur the lines of real and virtual across three primary markets: Sports a…
Skills: Apache Spark, DataFrame API, Python, SQL, Databricks
Los Angeles, California, United States · On-site
$29/hr–$34/hr
Where You’ll Work Founded in 1955, Dignity Health - Northridge Hospital Medical Center is a 394-bed, acute care, nonprofit hospital located. Serving over 80,000 patients annually, the hospital offers a full complement of…
Skills: Specimen Processing, Phlebotomy, Labeling, Centrifuging, Aliquoting
Los Angeles, California, United States · On-site
$120k–$155k/yr
Cosm is a global technology company that brings experiences to life in immersive environments. We help our partners create spaces and content that blur the lines of real and virtual across three primary markets: Sports a…
Skills: UX Design, Information Architecture, Product Thinking, Figma, System Design
Los Angeles, California, United States · On-site
$29/hr–$34/hr
Where You’ll Work Founded in 1955, Dignity Health - Northridge Hospital Medical Center is a 394-bed, acute care, nonprofit hospital located. Serving over 80,000 patients annually, the hospital offers a full complement of…
Skills: Specimen Processing, Phlebotomy, Labeling, Centrifuging, Aliquoting
Los Angeles, California, United States · On-site
$18/hr–$18/hr
Create an outstanding customer experience through exceptional service. Establish and maintain a safe and clean environment that encourages our customers to return. Demonstrate the company's core values of respect, honest…
Skills: Customer Service, Effective Communication
Los Angeles, California, United States · On-site
Per Diem Psychiatric Social Worker (Weekend Coverage) Mission Community Hospital is seeking two (2) Per Diem Psychiatric Social Workers to join our Behavioral Health team. This position is ideal for candidates who are av…
Skills: Psychosocial Assessment, Discharge Planning, Crisis Intervention, Therapeutic Groups, Family Consultation
Los Angeles, California, United States · On-site
Job Description DOMINO’S PIZZA – GENERAL MANAGER WANTED An exciting opportunity to grow with a fast paced brand! Are you a natural leader who thrives in a fast-paced environment? Do you love coaching a team, delivering a…
Skills: Leadership, Team Coaching, Restaurant Management, Inventory Management, Scheduling
Los Angeles, California, United States · On-site
$16/hr–$21/hr
Job Description Cash Paid NIGHTLY! At Domino's Pizza, our most important ingredient is our People! Take the first step in joining our team, and you'll find opportunities you won't find anywhere else in the industry! You'…
Skills: Driving, Navigation, Customer Service, Communication, Basic Math
Los Angeles, California, United States · On-site
Job Description At Domino's Pizza, Our Most Important Ingredient is Our People! We offer employment opportunities within our franchise stores. Take the first step in joining our team, and you'll find opportunities you wo…
Skills: Customer Service, Communication, Basic Math, Logic Skills, Multitasking
Los Angeles, California, United States · On-site
Job Description DRIVER Deliver orders to guest locations Able to count change back to guest Give great guest service at the door Help take orders inside location when needed Able to read delivery ticket Help others when …
Skills: Delivery Driving, Customer Service, Cash Handling, GPS Navigation, Food Preparation
Los Angeles, California, United States · On-site
Job Description ABOUT THE JOB You were born to be the boss. We know. You get up in the morning and you make sure everyone else in the house is doing what they need to do. Then you go to work and you make sure that everyo…
Skills: Judgment, Mathematics, Multitasking, Cost Control, Inventory Control
Los Angeles, California, United States · On-site
$22/hr–$24/hr
WinnCompanies is seeking an Assistant Property Manager to join our team at Sereno Hills, a 117-unit Low-Income Housing Tax Credit (LIHTC) residential community located in Los Angeles, CA. In this role, you will support t…
Skills: Leasing, Accounts Receivable, Accounts Payable, Customer Service, Rent Collection
Los Angeles, California, United States · On-site
Job Description Job Duties • Operate all equipment. • Stock ingredients from delivery area to storage, work area, walk-in cooler. • Prepare product. • Receive and process telephone orders. • Take inventory and complete a…
Skills: Driving, Customer Service, Inventory Management, Order Processing, Basic Mathematics
Los Angeles, California, United States · On-site
Job Description ABOUT THE JOB You were born to be the boss. We know. You get up in the morning and you make sure everyone else in the house is doing what they need to do. Then you go to work and you make sure that everyo…
Skills: Judgment, Mathematics, Multitasking, Cost Control, Inventory Control
Los Angeles, California, United States · On-site
$24/hr–$26/hr
Warby Parker is searching for skilled and enthusiastic Opticians to join our growing team of in-house optical all-stars and play an integral part in what we're all about-helping people see! In this role, you'll become an…
Skills: Optical Dispensing, Customer Service, Eyewear Fitting, Prescription Interpretation, Frame Styling
Los Angeles, California, United States · On-site
Job Description Job Duties • Operate all equipment. • Stock ingredients from delivery area to storage, work area, walk-in cooler. • Prepare product. • Receive and process telephone orders. • Take inventory and complete a…
Skills: Customer Service, Order Processing, Inventory Management, Basic Mathematics, Verbal Communication
Los Angeles, California, United States · On-site
Job Description ABOUT THE JOB Right now Domino's is looking for qualified drivers to staff stores in your area. We're growing so fast it's hard to keep up, and that means Domino's has lots of ways for you to grow (if tha…
Skills: Driving, Navigation, Customer Service, Inventory Management, Order Processing
Los Angeles, California, United States • On-site
Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
Oversees the Special Investigations Unit by managing staff, processes, and claims platforms to identify and mitigate health insurance fraud. Collaborates with law enforcement and legal partners while driving operational improvements and tracking performance metrics.
Requires a Bachelor's degree and at least 5 years of experience managing fraud investigations, including 3 years of supervisory experience. Proficiency in MS Office and experience in healthcare claim adjudication are highly preferred.
Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Manager of Special Investigations Unit (SIU) oversees multi-level staff and processes across multiple lines of business, and multiple claim platforms. In addition, this position works closely with external law enforcement officials, internal and external legal or compliance partners on escalated investigations or issues. Day to day management includes employee development, expense management, project management, business process improvement and identifying new investigation opportunities by collaborating with our internal/external analytics partners. This position supports, manages and escalates identification of additional suspected fraud of health insurance claims and ensures claims are accurately handled. This team member will also be responsible for providing operational support in reporting, process improvements, coaching, internal quality, day to day Key Performance Indicators (KPI’s) and ensuring we meet and/or exceed performance metrics. The Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.
Provide leadership to investigators and be accountable for tracking KPI’s, metrics, recovery and savings, etc., provides feedback to staff on performance, resolves problems, provides guidance to team members when needed and takes necessary steps to address poor performance including corrective action up to termination.
Manage the day to day operations of the SIU by leading team of investigators, driving key initiatives across the team to improve processes and generate incremental F&A opportunities, and executing the overall strategic direction of the SIU.
Create, implement and improve operational changes through documentation and process flows that anticipate needs and help in development of solutions to ensure all needs and issues are addressed promptly.
Work with multiple cross-functional LA Care teams and serve as the key resource on complex and critical issues.
Provide input to forecasting and planning activities for future state of the business staffing needs, adapt department plans and priorities based on operational needs of the business.
Direct team members in the area of ideation and vetting new concepts for building additional investigation opportunities or clearer review guidelines for cases.
Partner with compliance and regulators to make new policy or edits to mitigate fraudulent behavior.
Work with Law Enforcement and regulators to appropriately support federal and state investigations or provide expert testimony during court proceedings.
Drive process improvement and automation initiatives to enhance quality and productivity of outputs.
Manage staff, including, but not limited to: hiring staff, monitoring of day to day activities of staff, monitoring of staff performance, performance reviews, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, disciplinary matters for direct reports, among others.
Perform other duties as assigned.
Required:
At least 5 years managing fraud investigations.
At least 3 years leading staff or supervisory/management experience.
Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.
Preferred:
Prior experience in a leadership role directly managing a team.
Experience in health care claim adjudication.
Required:
Demonstrated ability to manage multiple projects/initiatives and drive to completion.
Strong written and verbal communication skills and ability to communicate effectively with a client audience.
Intermediate working knowledge of MS Excel, Word, PowerPoint, SharePoint. Basic knowledge of MS Visio.
Moderate level of metrics and performance, reporting and understanding of trends and changes.
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
Elevating health care for all of L.A. County
L.A. Care’s mission is to provide access to quality health care for L.A. County’s low-income communities, and to support the safety net required to achieve that purpose. As a publicly operated health plan, L.A. Care Health Plan serves more than 2.6 million members in Los Angeles County, making it the largest publicly operated health plan in the country. L.A. Care offers four health coverage plans including Medi-Cal, L.A. Care Covered™, L.A. Care Medicare Plus and the PASC-SEIU Homecare Workers Health Care Plan, all dedicated to being accountable and responsive to members. L.A. Care prioritizes quality, access and inclusion, elevating health care for all of L.A. County. For more information, follow us on X, Facebook, LinkedIn, Instagram and YouTube. To learn more, visit www.lacare.org. *For urgent inquiries: 1-888-4LA-CARE (1-888-452-2273)
Offices: 1200 W 7th St, Los Angeles, California 90017, US
