Why This Role is Important to Us The Sr. Director of Internal Audit position is a key member of the Commonwealth Care Alliance's Internal Audit team responsible for the successful completion of external regulatory compliance audits including, external regulatory compliance audits. The position advises the Audit and Compliance leadership on key risks, provides directions t

Under the supervision of the Enrollment Director, the Supervisor, Enrollment provides leadership for, and direct supervision of, the Enrollment Specialists, Retention Specialists, and Reconciliation Specialists. They are responsible for overall day to day operations of the Enrollment department, ensuring accurate processing and maintenance of membership enrollment records

Why This Role is Important to Us To promote Commonwealth Care Alliance's (CCA) and CCA CA health products to individuals, responsible parties, and groups at a variety of settings. Responsible for executing our marketing and enrollment strategies, cultivating relationships with contracted sites and health providers (CA), community organizations, senior centers, and elderly

Why This Role is Important to Us The Clinical Director, Hospital to Home, is responsible for leading CCA's engagement with acute care hospitals and developing strategies and partnerships to support CCA members through transitions across care settings. The position provides supervision and leadership to a team of facility based providers (medical and behavioral health) as

Member Contact Center Provider Contact Center Contact Center Training and Quality Member Communications Consumer Experience Operational functions Corporate Ombudsman and Service Recovery Programs Enterprise wide Project Leadership (ad hoc) Working Conditions Standard office conditions. What We're Looking For Education Required Bachelor's Degree or equivalent experience Ed

Why This Role is Important to Us The Senior Manager, IT Quality Assurance is part of the Business Solutions team responsible for QA testing, product management and solutions delivery. This role is the primary owner for the QA Managed Services program and will be critical in the definition and implementation of our Enterprise QA program to supports CCA's ability to serve o

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

The FWA Investigator Coder Sr. Associate is an integral part of the Fraud, Waste & Abuse (FWA) Special Investigation Unit (SIU). The position reports directly to the Sr. Director, Fraud, Waste & Abuse. This position utilizes a variety of FWA investigative tools and techniques to complete activities required to identify compliance with state and federal results, regulation

Why This Role is Important to Us The Privacy Analyst will play a key role in building, operationalizing and sustaining an effective and robust Privacy Program. Reporting to the Manager, the role will ensure that the organization complies with relevant and applicable privacy laws, regulations, contractual requirements, and standards. The role will be responsible for develo

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

The Director, Quality & Control Assurance reports to the VP of Quality & Control Assurance is responsible for providing strategic leadership and oversight for the Quality & Control Assurance within CCA's Compliance department. This position designs, continually matures, promotes, & develops a program that adheres to all applicable federal, state, and contractual requireme

System Administrator for GRC System System Administrator for GRC System Develop reports within the system for distribution among the organization Identify and scope needed system enhancements Work with vendor to correct identified issues Oversee the development and maintenance of system process documentation Work with training specialist to develop user tools Become subje

Why This Role is Important to Us The Senior Vice President, Internal Audit & Enterprise Risk Management (Remote) will lead the company's Internal Audit Program and activities as well as the organization's Enterprise Risk Management (ERM) Program and activities. The Internal Audit Program will employ a risk based approach in focusing audit resources on the highest risks wh