The Senior Project/Program Manager leads and manages enterprise-scale projects, ensuring they meet business objectives, milestones, and quality standards. They are responsible for resource allocation, risk mitigation, budget tracking, and facilitating cross-functional collaboration across the organization.
The Account Manager serves as the lead liaison for key clients, managing the development and execution of account strategies to drive retention and revenue growth. They are responsible for consulting with clients on benefit products, presenting renewals, and analyzing financial and utilization reports to meet segment goals.
The Manager, Claims oversees end-to-end service models, claims processing, and financial reporting to ensure business targets and contractual obligations are met. They lead teams to streamline operations, manage financial recovery, and serve as a subject matter expert for ASO performance monitoring.
The BI Analyst serves as a strategic partner to the Special Investigations Unit and Payment Integrity teams by delivering actionable business intelligence and financial reporting. They are responsible for designing analytical solutions, developing dashboards, and performing statistical sampling to identify fraud, waste, and abuse in healthcare claims.
Lead pricing strategies and actuarial initiatives for business segments while evaluating care management models and designing insurance products. Provide strategic thought leadership to improve processes, reduce risks, and manage external partnerships with vendors and regulators.
Leads the development and execution of market-based pricing strategies and Target Market Price (TMP) methodologies across the EBS and CDS portfolio. Partners with cross-functional leaders to optimize portfolio profitability, monitor competitive trends, and establish pricing governance frameworks.
Consult with ASO clients on pharmacy benefits and pricing while analyzing data to identify cost-savings and utilization trends. Drive healthcare redesign and partnership strategies to improve member outcomes and align with growth objectives.
Lead the research and development of predictive, prescriptive, and Generative AI solutions to drive organizational decision-making. Design and implement self-learning ML/DL systems and collaborate with business partners to integrate these technologies into production environments.
