Support value-based strategies, clinical operations, and efforts to improve the quality and cost-effectiveness of member care. Develop partnerships, analyze clinical and performance data, engage providers and community stakeholders, communicate healthcare initiatives, and contribute to payment models and investment decisions.
Prepare and review financial statements and reports, coordinate month-end close activities, analyze complex financial information, and advise management on accounting implications. Maintain and improve accounting processes and controls, support audits and projects, and provide technical guidance and coaching to colleagues.
Lead end-to-end claims operations for assigned customer segments, including claims processing, appeals, refunds, collections, recovery, and financial accounting and reporting. Manage staff and performance, improve processes and accuracy, and serve as the claims subject matter expert and point of contact for ASO clients and internal stakeholders.
The role involves designing specialty pharmacy networks, developing reimbursement models, and implementing cost-reduction strategies to meet affordability goals. The advisor will also analyze market trends and collaborate with internal and external stakeholders to optimize network performance.
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.
