The role involves evaluating health insurance applications to set competitive premium rates and analyzing claims experience to inform underwriting decisions. The actuary will collaborate with sales teams to develop insurance products and ensure regulatory compliance.
Evry Health
11 Remote Job Openings at Evry Health
Manage the end-to-end lifecycle of member enrollment data, focusing on HIPAA 834 EDI file processing and system validation. Ensure data integrity across health plan systems through SQL queries, audits, and cross-functional collaboration with engineering and claims teams.
Lead the design and implementation of scalable backend systems and RESTful APIs using Node.js and Next.js. Provide technical leadership through mentorship, code reviews, and performance optimization of SQL databases.
Manage the end-to-end provider dispute resolution process and process claim adjustments within a commercial health plan environment. Conduct in-depth research into claim histories and contracts to ensure accurate, compliant, and fair payment outcomes.
Lead the design and implementation of scalable backend systems and RESTful APIs using Node.js and Next.js. Provide technical leadership through mentorship, code reviews, and performance optimization of SQL databases.
Lead the design and implementation of scalable back-end systems using .NET technologies and Azure cloud infrastructure. Provide technical leadership through mentorship, code reviews, and performance optimization to ensure high availability.
Responsible for the end-to-end claims adjudication process, including verification of eligibility and coordination of benefits. The role involves auditing auto-adjudicated claims and maintaining desktop procedures to ensure regulatory compliance.
Lead end-to-end technical implementations and custom integrations of AI tools for enterprise customers. Provide pre-sales technical support and collaborate with product teams to refine the AI roadmap based on customer feedback.
Evaluate and analyze health insurance applications to determine risk and set premium rates. Collaborate with sales teams to develop competitive insurance products and ensure alignment with company goals.
Medical Director for Health Plan (Full-time or Part-time)
Evry Health
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Full Time
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2 months ago
Evry Health
The Medical Director will lead utilization management strategy and medical policy development to ensure the delivery of cost-effective, high-quality healthcare services. They will also collaborate with cross-functional teams to identify care trends, improve clinical quality, and evaluate new patient engagement technologies.
Claims Specialists manage the end-to-end claims adjudication process, including testing configuration, verifying eligibility and coordination of benefits, and finalizing claim determinations based on the health benefits plan. They are also responsible for auditing auto-adjudicated claims for accuracy and ensuring compliance with regulations while developing and maintaining desktop procedures.