ZipRecruiter

Log In

1

Calaim Jobs in Massachusetts (NOW HIRING)

All JobsCalaim JobsCalaim Jobs in Massachusetts

Calaim information

What are the key skills and qualifications needed to thrive as a California Advancing and Innovating Medi-Cal (CalAIM) program manager, and why are they important?

To thrive as a CalAIM Program Manager, you need expertise in Medi-Cal policy, program implementation, and healthcare administration, often supported by a degree in public health, healthcare management, or a related field. Familiarity with state healthcare systems, data analytics tools, project management software, and regulatory compliance is typically required. Outstanding organizational, leadership, and stakeholder communication skills help drive collaboration and effective program delivery. These skills are crucial for successfully managing complex healthcare initiatives that aim to improve care coordination and outcomes for Medi-Cal beneficiaries.

What are some common challenges faced by professionals working in CalAIM implementation roles, and how can they be addressed?

Professionals working in CalAIM (California Advancing and Innovating Medi-Cal) implementation often encounter challenges such as coordinating care across multiple providers, navigating evolving state guidelines, and managing complex member needs. Success in these roles requires strong communication and collaboration skills, as well as adaptability to policy changes and new workflows. Building effective relationships with community-based organizations and regularly participating in training or knowledge-sharing sessions can help address these challenges and ensure smooth program execution.

What is CalAIM?

CalAIM stands for California Advancing and Innovating Medi-Cal. It is a multi-year initiative by the California Department of Health Care Services (DHCS) to improve and transform the Medi-Cal program. CalAIM aims to streamline services, better coordinate care for individuals with complex needs, and address social determinants of health such as housing and behavioral health. The initiative focuses on whole-person care and integrating healthcare delivery across physical, behavioral, and social services.

What is the difference between Calaim vs Claims Adjuster?

AspectCalaimClaims Adjuster
Required CredentialsCertification in insurance claims processing, relevant licensesInsurance license, certification in claims adjusting often preferred
Work EnvironmentInsurance companies, third-party claims firmsInsurance companies, independent adjusting firms
Industry UsageUsed mainly in insurance claim processing rolesCommonly used in insurance claim assessment and settlement

Both Calaim and Claims Adjuster roles involve evaluating insurance claims, but Calaim typically refers to a specialized certification or platform, whereas Claims Adjuster is a broader job title for professionals assessing and settling claims. Understanding these differences helps job seekers target the right roles and certifications in the insurance industry.

What are popular job titles related to Calaim jobs in Massachusetts? For Calaim jobs in Massachusetts, the most frequently searched job titles are:
What job categories do people searching Calaim jobs in Massachusetts look for? The top searched job categories for Calaim jobs in Massachusetts are:
Calaim jobs near you
Infographic showing various Calaim job openings in Massachusetts as of August 2026, with employment types broken down into 95% Full Time, and 5% Part Time. Highlights an 95% In-person, and 5% Remote job distribution.

Virtual Medical Recepcionist

Anchor Co-Living

Chicopee, MA • On-site

$10 - $13/hr

Full-time

Posted 21 days ago

Job description

This role is the front door and the follow-through. You will be the first voice clients, providers, and referral partners hear when they contact Anchor Co-living, and you will also own the prior authorization workflow from submission to resolution. It is the right fit for someone with healthcare front-desk or administrative experience who is ready to take on more technical responsibility and wants work where both how you communicate and how precisely you execute actually matter.

What You'll Do
  • Answer inbound calls and inbox from members, care coordinators, providers, and referral partners -- handling inquiries, taking messages, scheduling, and resolving requests on the first contact whenever possible.
  • Collect and verify member information, insurance details, and reason for contact at the start of every interaction, documenting accurately in the EHR.
  • Verify Medi-Cal eligibility and MCP enrollment during intake and scheduling calls.
  • Coordinate care-related logistics between members and clinical or operational staff.
  • Prepare and submit prior authorization requests to the correct Medi-Cal health plan using payer portals and internal workflows.
  • Track active authorization requests daily by status (approval, pending, or denial) and keep all documentation current.
  • Investigate denials, identify missing or incomplete documentation, and resubmit requests promptly to minimize delays in member access to care.
  • Build consistent, professional relationships with members and partners who contact Anchor Co-living regularly -- becoming a reliable presence they recognize and trust.
  • Manage a high volume of calls and open authorizations simultaneously, staying organized and accurate across both.
What We're Looking For

We are looking for someone who is naturally calm and professional, while also being warm, outgoing, and very friendly on the phone and equally precise when shifting to authorization paperwork. The strongest candidates move fluidly between high-touch communication and detail-heavy administrative work without losing quality on either side.

Key qualifications:

  • 1+ years of experience in a medical front desk, virtual receptionist, or healthcare administrative role.
  • Experience submitting prior authorizations to U.S. health plans.
  • Professional phone manner with the ability to manage high call volume calmly and consistently.
  • Comfort working in payer portals and EHR systems.
  • Familiarity with ICD-10 codes and basic medical terminology.
  • Experience and understanding of HIPAA privacy and security requirements.
  • Strong multitasking skills -- able to manage open calls, scheduling tasks, and active authorizations without dropping details.
  • Fluent professional and conversational English, both spoken and written.
  • Ability to work full-time during Pacific Time business hours in a remote environment.

Helpful additional experience includes Spanish fluency, direct knowledge of California Medi-Cal or CalAIM Community Supports, experience with denials and appeals, and a background in behavioral health, substance use, or housing-related services.

Pay rate

$10-$13 USD per hour

Employment type

Contractor

Work Location / Schedule

Remote, based in Latin America. Candidates may be located in Mexico, Colombia, Argentina, Peru, Costa Rica, or another LatAm country with stable infrastructure.

Schedule: Monday through Friday, 8:00 AM to 5:30 PM Pacific Time.

Candidates must have a private home office and wired internet of at least 50 Mbps.