Job DetailsLevel: ExperiencedJob Location: Fresno - Fresno, CA 93721Position Type: Full TimeSalary Range: $21.00 - $29.00 HourlyJob Shift: DayJob Category: InsuranceMUST LIVE IN ANAHEIM, BAKERSFIELD, OR FRESNO, CA AREA Who We Are To empower our senior participants to age at home with dignity through personalized, comprehensive care plans that deliver high-quality health and human services along with strong community support. Benefits 401(k) Dental insurance Employee assistance program Employee discount Flexible spending account Health insurance Health savings account Life insurance Paid sick time Paid time off Referral program Retirement plan Vision insurance Job Summary The Claims Analyst is responsible for accurate and timely processing, auditing, and reconciliation of medical and ancillary claims for services provided to PACE participants. The analyst ensures compliance with federal and state regulations, including 42 CFR Part 460 (PACE Regulations), as well as organizational contracts and policies. This position supports PACE’s mission by ensuring that provider payments are accurate, participants’ services are properly accounted for, and financial data is reliable for reporting and capitation management. Essential Job Functions Duties include, but are not limited to: Serve as the first point of contact for claims intake, reviewing submitted claims to ensure accuracy and completeness. Address and resolve intake issues, including missing information, coding errors, or eligibility concerns, and coordinate with providers and internal departments to facilitate timely claims processing. Assist with all other activities in the claims process, including provider setup to ensure accurate rates and terms in the claims system, supporting provider education, coordinating with the electronic clearinghouse to confirm claim receipt, processing claim adjudication, communicating denied claims, and helping to resolve provider disputes (PDRs). Analyze and audit claims to ensure compliance and provide solutions to resolve claims errors. Support encounter data validation and submission to regulatory agencies. Support monthly financial close activities by reconciling paid claims with general ledger data. Provides feedback and justification of denied claims to providers, as needed. Aids providers on how to submit claims and verification of participant’s eligibility. Conducts contract review and sets rates within the claim adjudication system. Collaborates with other departments in the organization. Conducts follow-up activity for claims held until the claim and/or PDR is closed. Ensure claims are supported by appropriate authorizations and documentation per PACE regulatory guidelines. Support encounter data validation and submission to regulatory agencies. Conducts coordination of benefits, insuring that claims impact primary and secondary insurance, as appropriate. Review and analyze claims loss, expense reserves and reconcile claims reports with authorizations. Assist in preparation for audits and compliance reviews by Centers for Medicare & Medicaid Services (CMS), California Department of Health Care Services (DHCS), or internal auditors. Prepare periodic claims reports for management, identifying payment errors, turnaround time, and cost trends. Assists Claims Manager to identify exposures to the company and reports to senior-level management on pending claims and litigation that may have an adverse impact on corporate goals. Verify pricing of claims through contracted rates and Medicare/Medicaid fee schedules. Demonstrate workplace behavior that promotes organizational core values of honesty and integrity, respect for others, encouragement, high quality care and patient-centeredness. Attend and participate in staff meetings, in-services, projects, and committees as assigned (Some travel may be required based on organizational needs). Adhere to and support the organization’s practices, procedures, and policies including assigned break times and attendance. Accept assigned duties in a cooperative manner; and perform all other related duties as assigned. Ability to work independently and meet deadlines in a fast-paced environment. May be required to use personal vehicle, if applicable. If using a personal vehicle, a valid California Driver’s License is required. QualificationsKnowledge, Skills and Abilities Proficient in computer applications with demonstrated ability to use Microsoft Word, Excel, and related systems effectively. Strong organizational and time-management skills with the ability to prioritize multiple tasks, manage shifting priorities, and meet deadlines in a fast-paced environment. Exceptional attention to detail and accuracy when reviewing, processing, and analyzing information. Excellent written and verbal communication skills, including strong grammar, reading comprehension, and the ability to present information clearly in both one-on-one and group settings. Ability to communicate professionally and confidently with internal and external stakeholders. Demonstrated critical thinking, self-initiative, and sound judgment in problem-solving and decision-making. Ability to quickly learn and apply department policies, procedures, goals, and services. Self-motivated and disciplined, with the ability to work independently and manage responsibilities effectively, including in a remote or hybrid environment. Working Conditions and Physical Demands The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to access all areas of the center throughout the workday. Ability to lift a minimum of 35 occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance from another qualified employee when attempting to lift or transfer objects over 50 pounds. Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling. Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment. Primarily sedentary work with prolonged computer use. Primarily remote work; must be able to work effectively in a virtual team setting. Experience 2+ years of professional experience processing and analyzing claims for PACE, Medicare Advantage, or Medicaid Managed Care is strongly preferred. Experience with institutional (UB-04), professional (CMS-1500), and dental (ADA) claims. Experience with ICD-10, CPT, and HCPCS coding. Understanding of physiology, medical terminology, and disease processes (strongly preferred). Experience with the QuickCap claims system (preferred). Understanding of PACE reimbursement policies, encounter data, and provider contracting (preferred). Education A minimum of an associate’s degree required (experience in lieu of degree may be considered). Bachelor’s degree is preferred. Certificate in Medical Billing, preferred Core Values CARE is central to what we do, prioritizing the well-being, dignity, and independence of our senior participants. COMPASSION in every interaction, ensuring kindness, empathy, and understanding guide our care. CULTURE that reflects the diverse backgrounds of those we serve and fosters a workplace where every team member feels supported, valued, and empowered to grow. COMMUNITY that fosters connection, belonging, and support for participants and their families. COMMITMENT to quality improvement, innovation, and delivering healthier outcomes. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Job Description Distributed Technology Application Support Analyst - Título universitario en Ingeniería de Sistemas, Ciencias de la Computación, Tecnología de la Información o campo relacionado; se considerará experiencia equivalente. - Analista de soporte de aplicaciones responsable de brindar soporte a entornos productivos distribuidos, asegurando la estabilidad, disponibilidad y correcto funcionamiento de aplicaciones críticas del negocio. - Será responsable del diagnóstico y resolución de incidentes técnicos, realizando análisis de causa raíz y aplicando soluciones efectivas bajo estándares ITIL. - Deberá trabajar bajo presión manejando múltiples incidentes y tareas de manera simultánea, manteniendo un alto enfoque en servicio al cliente y calidad. - Tendrá interacción constante con equipos técnicos y stakeholders no técnicos, garantizando una comunicación clara y documentación adecuada de incidentes y soluciones. - Requiere experiencia previa en roles de soporte a producción, familiaridad con procesos ITIL y disposición para trabajar en turnos extendidos, fines de semana y esquemas de guardia (on-call) en entornos 24/7. - Conocimientos sólidos en tecnologías distribuidas, con dominio de .NET, SQL, IIS Web Services y certificación ITIL. - Experiencia trabajando con Jira y familiaridad con Angular, Azure, DevOps y Java. - Se valoran conocimientos en la industria de seguros, metodologías ágiles, OpenText AppWorks y principios de arquitectura de TI. - Modalidad remota. Tu carrera en Capgemini - Al trabajar en un ambiente de equipo, nuestros consultores se enfocan en el análisis, diseño y desarrollo de soluciones basadas en tecnología para los clientes de Capgemini. - Trabajarás en conjunto con equipos globales de soporte, desarrollo y calidad para asegurar la continuidad operativa de las aplicaciones y la rápida resolución de incidentes productivos. - Contribuirás de una manera responsable y oportuna con la satisfacción del cliente, manteniendo altos estándares de calidad, comunicación y cumplimiento de SLA. - Capgemini ofrece una compensación competitiva y beneficios superiores a los de Ley. - Nuestras oficinas centrales están en París, Francia y tenemos presencia en más de 40 países. - Capgemini ha desarrollado metodologías propias a nivel global: Collaborative Business Experience y Rightshore. Te encantará trabajar en Capgemini porque: - Ofrecemos una experiencia única de reclutamiento y onboarding, y te ayudamos a construir las bases de tu carrera y habilidades profesionales. - Proveemos un ambiente de trabajo colaborativo basado en nuestros 7 valores: Honestidad, Audacia, Confianza, Libertad, Espíritu de Equipo, Modestia y Diversión.

Your job is more than a job The Systems Analyst performs a variety of technical work associated with analyzing user requirements, procedures and problems to automate clinical functions or to improve existing information technology related systems. Develops the Electronic Medical Record (EMR), ancillary application and inter-related systems to meet use and regulatory standards as well as to meet the needs of the system. Designing and building within assigned application/system to meet the needs of providers, staff, and patients. Assists in developing the tools, the providers and staff need to give health care to the patients while ensuring security and efficiency. Your Everyday IT System Support & Maintenance: - Applies analytical skills and related application knowledge to design, build and install upgrades and/or new implementations. - Troubleshoots application issues to determine best resolution. - Performs necessary maintenance tasks for assigned application(s) as required. - Reviews and test changes in newly released software to ensure integrity. - Maintains necessary documentation to reflect current system state. - Meets all project deadlines. - Effectively communicates with leadership and customers of progress and potential risk. Documentation - Maintains accurate documentation of all system configurations and other required areas. - Prepares detailed programming and/or integration specifications as required. The Must-Haves Minimum: - Required: High School Diploma/GED or equivalent OR 2 years of work experience. - Preferred: 3 years of hands-on experience with the support of LCMC Health’s legacy application systems, programming, and/or system integration support. - Preferred: Bachelor's Degree. WORK SHIFT: Days (United States of America)LCMC Health is a community. Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinary Your extras - Deliver healthcare with heart. - Give people a reason to smile. - Put a little love in your work. - Be honest and real, but with compassion. - Bring some lagniappe into everything you do. - Forget one-size-fits-all, think one-of-a-kind care. - See opportunities, not problems – it’s all about perspective. - Cheerlead ideas, differences, and each other. - Love what makes you, you - because we do You are welcome here. LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law. The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary. Simple things make the difference. 1. To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information. 2. To ensure quality care and service, we may use information on your application to verify your previous employment and background. 3. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed. 4. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.

• Conducts regular check-ins with managers and supervisors to ensure adherence to established customer interaction policies and procedures, as well as to resolve any outstanding issues. • Analyzes macro-level interaction data and utilizes these insights to strategically enhance the overall customer experience. • Leverages dashboard analytics and generates performance reports for leadership and team members to drive enhance customer service metrics. • Leads coaching sessions with supervisors to review team progress and tackle ongoing challenges. • Leads team sessions focused on sharing best practices and cultivating a culture of continuous improvement. • Sends general process reminders to maintain adherence to operational standards and procedures. • Reviews disputed calls, provides detailed findings, and adjusts the scoring model to ensure fairness and accuracy. • Monitors supervisor channels and individual chats to stay informed about team activities and address concerns proactively. • Facilitates huddles with supervisors to discuss team progress, challenges, and opportunities for improvement. • Leads team sessions to reinforce best practices and support continuous improvement initiatives. • Reviews customer interactions findings and delivers agent coaching packages to supervisors for performance development. • Sends weekly process reminders to uphold operational standards across the team. • Reviews, addresses, and closes disputes as needed with technology teams and external vendors, as appropriate. • Develops and articulates actionable coaching plans for supervisors based on data analysis, ensuring they can implement strategies effectively. • Proactively anticipate ways to improve customer experience by leveraging data insights and identifying opportunities for process enhancements. • Drives customer experience coaching tailored to achieving key performance indicators (KPIs), focusing on metrics such as customer satisfaction (CSAT), first call resolution (FCR), and average handle time (AHT). • Informs supervisors of any updates or changes to procedures or operational processes. • Arranges and coordinates calls between internal and vendor technology teams and supervisors to resolve specific issues and support collaborative problem-solving. • Monitors supervisor huddles and coaching sessions to evaluate quality and offer constructive feedback. • Assists with access issues related to data analytics tools dashboards as needed. • Performs other duties as needed.