Handle inbound calls from members and providers to provide accurate information regarding healthcare benefits, eligibility, and services. Document interactions clearly in multiple systems while meeting quality and productivity standards.
The Release Manager ensures that configuration items are correctly assembled and deployed to environments in a repeatable, timely manner. They act as a liaison between application and operations teams while managing release schedules and project deliverables.
The role involves managing multiple Coordination of Benefits (COB) projects and leading large project management teams to drive implementation growth. You will be responsible for project planning, tracking, budget management, and communicating project status to leadership while mitigating risks.
The representative will handle inbound and outbound member interactions to support the Customer Engagement Verification program. They are responsible for providing accurate information, documenting customer activity, and resolving routine inquiries while adhering to program requirements.
The Modifications Manager will lead the planning, governance, and delivery of the Wisconsin Medicaid modifications portfolio, ensuring alignment with client expectations and organizational objectives. This role involves overseeing system enhancements, managing budgets and resources, and serving as a key liaison between DHS and internal leadership teams.
This role supports program leadership by managing client inventory, validating deliverables, and ensuring operational performance and client satisfaction. The analyst collaborates with cross-functional teams to perform quality assurance reviews, troubleshoot implementation issues, and apply data analysis to identify trends.
The Senior QA Analyst will lead quality strategies for the Medicaid Drug Rebate solution, ensuring compliance and guiding junior team members. They will collaborate with cross-functional teams to perform testing, configuration, and maintenance while providing business process expertise.
The Functional Test Engineer will support the full testing life cycle by reviewing requirements, developing test plans, and executing manual functional tests. They will also collaborate with cross-functional teams to log defects, retest fixes, and document test results to ensure software quality.
Lead security governance and operational compliance, including remediation, incident management, audits, risk exceptions, and adherence to regulatory, contractual, and security standards. Maintain account security plans, manage client and supplier relationships, resolve and escalate security issues, and deliver security metrics and reporting.
Oversees the development, budgeting, and scheduling of large, complex global programs while ensuring alignment with client requirements. Manages project teams, identifies risks, and implements mitigation strategies to maintain program quality and productivity.
Lead enterprise and client architecture for secure, scalable cloud, Kubernetes, platform engineering, and healthcare technology solutions, while setting architecture standards and guiding modernization and operational excellence. Mentor technical teams, advise on complex architecture decisions, and support client solutioning, proposals, roadmaps, and implementation.
The Incident Responder oversees the development and implementation of corporate-wide application security procedures to ensure compliance with government and company regulations. They also investigate security violations, manage access controls, and provide leadership to security administrator teams.
Design, develop, and deploy advanced AI and Generative AI solutions across healthcare technology platforms to improve outcomes and operational efficiency. Collaborate with software engineers to integrate models while ensuring compliance with HIPAA and other regulatory standards.
Lead end-to-end CX client launch initiatives for contact centers and back-office operations from scope definition through go-live. Drive cross-functional execution by managing integrated project schedules and ensuring alignment across various internal departments.
The Senior Business Analyst will coordinate business analyst team activities, define business requirements, and serve as a liaison between clients and technical staff. They are responsible for analyzing business processes, validating test results, and supporting operational readiness through documentation and mentoring.
The Batch Developer will code, test, debug, and document programs to support healthcare administration products. They will also assist in resolving production support problems and conduct quality assurance activities like peer reviews.
The Systems Manager is responsible for the performance, availability, and modernization of systems supporting the Medicaid Management Information System. This role leads technical operations, enforces IT service management maturity, and acts as the primary liaison for client stakeholders.
Help design, develop, test, document, and deploy application software, including server, client, and web components. Define project requirements and solution designs, support technical architecture and integration, and collaborate with architects, developers, and clients.
Develop, test, debug, implement, and document moderately complex programs, and analyze existing systems to design solutions and write program specifications. Collaborate with clients, management, and development teams on technical requirements, estimates, quality assurance, and issue resolution, while leading a small developer sub-team when needed.
Develop, test, debug, implement, and document moderately complex programs for the Provider Portal, and analyze requirements to design systems and write specifications. Collaborate with clients, management, and development teams to resolve technical issues, support quality assurance, lead small sub-teams, and delegate component responsibilities.
The Director of Rx Engineering leads product development, modernization, and technical strategy while fostering a culture of continuous improvement and automation. They are responsible for managing global teams, overseeing solution delivery within budget, and collaborating with product management to align technology with client outcomes.
The Program Manager serves as a strategic partner to the Customer Experience organization, overseeing portfolio governance, project execution, and stakeholder alignment. They are responsible for managing demand, prioritizing initiatives, and ensuring that CX investments deliver measurable business value.
The Systems Manager is responsible for the performance, availability, and modernization of systems supporting the Medicaid Management Information System. This role leads IT service management processes, drives technical delivery excellence, and acts as a primary liaison for client stakeholders.
The role involves managing inbound and outbound calls to process prior authorization requests and address provider inquiries. You will ensure all data handling remains compliant with HIPAA regulations while collaborating with cross-functional teams to improve service delivery.
Oversees large, complex, multi-account programs to ensure they meet cost, performance, and quality objectives. Acts as the primary point of contact for clients while managing project schedules, budgets, and risk mitigation strategies.
The analyst is responsible for daily posting and reconciliation of medical and pharmacy claims, ensuring accurate financial reporting and invoice generation. They also collaborate with client engagement teams to document business requirements and resolve discrepancies within healthcare payment systems.
The Senior Business Analyst is responsible for posting medical and pharmacy claims, reconciling accounts receivable, and resolving discrepancies. They also collaborate with client engagement teams to gather business requirements and communicate them to technical personnel.
The role acts as a liaison between business stakeholders and technical teams to gather, document, and translate reporting and data requirements. Responsibilities include supporting SSRS/SSIS development, performing data analysis, and coordinating user acceptance testing.
The Application Architect defines and executes the architecture strategy, roadmap, and modernization vision for Medicaid accounts. They serve as a senior technical advisor to state agencies while ensuring alignment with regulatory requirements and enterprise standards.
The Information Security Officer oversees the development and implementation of corporate-wide application security procedures to ensure compliance with government and company regulations. They also manage security administrator teams, conduct security education programs, and investigate security violations to recommend corrective actions.
The Application Architect defines and executes the architecture strategy, roadmap, and modernization vision for large-scale Medicaid accounts. They serve as a senior technical advisor to state agencies, ensuring solutions are scalable, secure, and compliant with regulatory requirements.
Design, develop, and maintain web applications using the .NET framework while managing AWS cloud infrastructure. Ensure system security, monitor performance, and collaborate with cross-functional teams to resolve technical incidents.
Provide daily leadership, coaching, and support to customer service representatives to ensure performance and quality expectations are met. Collaborate with cross-functional teams to resolve escalations and improve the overall customer experience.
The role involves designing, coding, testing, and documenting highly complex data programs and systems to meet business needs. Additionally, the engineer will provide technical leadership, conduct quality assurance, and support enterprise production environments.
Lead and manage the Medicaid Management Information Systems (MMIS) data and analytics team to deliver high-quality solutions for public sector clients. Collaborate with cross-functional leaders to drive integrated reporting initiatives while ensuring compliance with data governance and security standards.
The analyst will lead the development and maintenance of rate-setting models for complex Medicaid long-term care programs. They will also evaluate the financial and operational impacts of policy changes on Managed Care Organizations and provide actionable recommendations to leadership.
The Prior Authorization Pharmacist facilitates the review of clinical documentation and medication therapy to ensure appropriate utilization management. They also collaborate with medical providers and internal staff to provide clinical consultations and refine intervention strategies.
The Technical Analyst bridges business needs with technical execution by translating requirements into technical specifications and data models. They also serve as a liaison between business users, developers, and QA teams to ensure system solutions are data-driven and aligned with architecture.
The specialist will lead the development, negotiation, and administration of complex contracts while managing contractual risks and ensuring regulatory compliance. They will collaborate with cross-functional teams to support organizational objectives and maintain accurate contract records throughout the lifecycle.
The Internal Audit Advisor leads complex internal audit and risk initiatives with a primary focus on SOX readiness and internal control environment enhancement. They evaluate business processes, identify financial and operational risks, and partner with leadership to remediate control gaps and improve documentation standards.
The Advisor Business Analyst leads requirements analysis, design validation, and the development of acceptance criteria for large-scale healthcare implementation projects. They serve as the primary liaison between business, technical, and client teams to ensure alignment, traceability, and quality throughout the project lifecycle.
The Business Intelligence Analyst will partner with stakeholders to define reporting requirements and develop automated dashboards and visualizations. They will also analyze business performance data to identify trends and provide actionable recommendations to operational leaders.
The Integrated Delivery Program Manager leads complex product solution implementations by coordinating between business stakeholders and internal development teams. This role oversees planning, execution, risk management, and status reporting to ensure projects are delivered on time and within scope.
The DAPO Specialist is responsible for reviewing, validating, and updating provider and pharmacy-related records to ensure accuracy and compliance with state Medicaid requirements. They will process work items, document actions, and partner with internal teams to maintain data integrity across operational systems.
The Director of Implementations will lead delivery planning and transformation for technology and services, acting as a primary liaison between Sales and internal stakeholders. They are responsible for managing the implementation pipeline, overseeing capacity planning, and ensuring smooth handoffs while establishing scalable delivery frameworks.
Design and govern data architectures for large-scale Medicaid system implementations and modernizations. Collaborate with cross-functional teams to ensure data integrity, scalability, and alignment with CMS requirements.
Lead large project teams and oversee planning, staffing, schedules, budgets, deliverables, and project metrics to ensure timely, high-quality implementation. Support Payment Integrity growth by accelerating implementation, preparing statements of work, and contributing to proposals and business development.
Advise assigned accounts on information security and lead governance activities to align customer environments with contractual, regulatory, and industry requirements. Maintain system security plans and coordinate security reporting, audits, remediation, and the management of incidents, risks, exceptions, threats, and vulnerabilities.
Review provider appeals and redeterminations using clinical and coding guidelines, assess supporting documentation, and clearly document appeal decisions. Prepare case files and summaries, participate in hearings with the Medical Director, support reviewer training, and maintain current clinical and coding knowledge.
Create, update, and maintain technical manuals, system guides, release notes, online help, and developer documentation for healthcare products, using MadCap Flare and consistent templates. Manage documentation versions, review content for accuracy and compliance, conduct usability testing, and improve documentation processes in collaboration with cross-functional teams.
Lead enterprise IAM transformation programs from planning through implementation and operational transition, overseeing platform implementations, integrations, governance, and delivery. Coordinate large-scale application onboarding and ServiceNow workflows while managing scope, schedules, risks, resources, and cross-functional stakeholder decisions.
The Informatica Developer will design, develop, test, and support data integration solutions for Medicaid systems using Informatica PowerCenter and Oracle. They will also collaborate with architects to define project requirements and provide ongoing production support and incident resolution.
The analyst will collaborate with stakeholders to define business metrics and architect data pipelines to build effective dashboards. They are also responsible for maintaining data infrastructure and providing documentation to support data-driven decision-making.
The Business Analyst will support Medicaid Buy-In operations by answering member inquiries regarding coverage, eligibility, and enrollment. They will also research and resolve complex coordination-of-benefits issues while coordinating with state agencies and internal teams.
The Data Entry Clerk is responsible for accurately entering, reviewing, and processing information from source claim documents in a fast-paced environment. They must maintain data integrity, meet productivity standards, and ensure the confidentiality of sensitive information.
The manager is responsible for developing and executing strategies to drive operational excellence in Medicaid claims processing, including mailroom and data entry workflows. They will lead cross-functional initiatives to optimize the claims lifecycle, improve accuracy, and reduce manual processing through data-driven process improvements.
The developer will maintain and support multiple applications while conducting code reviews, testing, and implementing programs based on specifications. They will also provide technical support to end-users and participate in release management processes.
The role acts as the primary point of contact for the Project Management Office and manages project governance, service level agreements, and client correspondence. It also involves overseeing project management personnel, managing resource allocation, and ensuring project deliverables meet client expectations.
Support callers in a healthcare-related service environment, using professional communication and call center skills to help address their needs. Work remotely while maintaining focus, handling multiple tasks, and contributing independently and as part of a team.
The Senior Account Manager is responsible for leading client engagements, managing contracts, and ensuring operational performance meets contractual obligations. They also drive revenue growth by identifying upsell opportunities and collaborating with internal teams to deliver successful project outcomes.
The Application Business Analyst acts as a liaison between technical teams and business areas to align IT solutions with business goals. They are responsible for documenting requirements, designing business processes, and executing system tests to ensure client needs are met.
The Provider Enrollment Specialist is responsible for processing Medicaid provider enrollment and revalidation applications in accordance with state and federal guidelines. They will perform outreach to providers via phone and email to ensure accurate documentation and collaborate with clients to obtain necessary approvals.
The Senior Population Health Management Analyst leads complex business and data analysis to translate client intent into sustainable population health solutions. They coordinate across stakeholders to define requirements, manage project milestones in Jira, and ensure data integrity for clinical and operational outcomes.
The Technical Functional Area Lead will provide hands-on technical leadership for assigned healthcare applications, batch processes, and interfaces. They will partner with cross-functional teams to translate business needs into technical designs, development tasks, and production support solutions.
The Business Analyst supports requirements management activities by gathering, documenting, and maintaining business, functional, and technical requirements throughout the project life cycle. They collaborate with stakeholders and cross-functional teams to ensure requirements are clear, traceable, and aligned with business objectives.
Perform clinical reviews to determine the necessity of services based on medical records and established clinical criteria. Assist in the appeal process for independent medical reviews and provide training and mentorship to new reviewers.
The Advisor Information Systems Architect is responsible for designing, implementing, and governing enterprise-wide ServiceNow solutions while ensuring architectural integrity. This role involves leading platform evolution, managing integrations, and optimizing CMDB health in collaboration with cross-functional teams.
Act as a liaison between clients and technical teams to define business requirements and translate them into functional specifications. Support data analysis, process improvements, and validation activities throughout the software development lifecycle.
Provide senior technical leadership for secure, scalable applications supporting Medicaid DDI and modernized Provider Plus delivery. Lead application design and implementation standards while mentoring engineers and communicating technical decisions across product teams.
Lead end-to-end pharmacy testing across various stages including SIT, UAT, and production validation to ensure quality delivery of PBM and Medicaid solutions. Manage test strategies, governance, and cross-functional coordination to ensure timely issue resolution and alignment with regulatory guidelines.
The Lead Application Architect provides architectural oversight for complex applications and integrates components while ensuring technical governance and compliance. They act as a liaison between vendors and the company, lead the Architecture Review Board, and drive operational improvements through root cause analysis.
The Business Analyst will analyze, design, and document business processes to support client technological goals while bridging the gap between clients and technical teams. They are responsible for defining business requirements, creating test scenarios, and ensuring project changes align with client intent.
Design, develop, and deploy advanced AI and Generative AI solutions across healthcare technology platforms. Collaborate with software engineers to integrate models while ensuring compliance with HIPAA and regulatory standards.
The Site Inspector conducts onsite provider inspections and program integrity reviews to verify operational readiness and compliance with Medicaid requirements. This role involves documenting findings, preparing detailed reports, and collaborating with the Wisconsin Department of Health Services to prevent fraud, waste, and abuse.
The Senior Manager oversees a team of 30+ staff to ensure the stability, performance, and operational efficiency of Medicaid Management Information Systems. This role manages incident, problem, and change management processes while ensuring compliance with federal and state healthcare regulations.
The analyst provides comprehensive support to FraudCapture client users, including troubleshooting technical issues and conducting user training. They act as the primary point of contact for clients, managing requirements and ensuring service delivery.
The Business System Architect is responsible for eliciting, analyzing, and documenting business requirements while acting as a bridge between stakeholders and technical teams. They will support the software development lifecycle, manage project impacts, and provide guidance to junior team members.
The Nurse Reviewer performs clinical reviews of medical records to determine the necessity and appropriateness of care based on established guidelines. They are responsible for documenting findings, processing prior authorizations, and supporting team members through training and mentoring.
The role involves planning, executing, and refining quality strategies for the Medicaid Drug Rebate solution while providing business process expertise to stakeholders. You will also oversee test-plan development, manage quality assurance documentation, and analyze defect metrics to ensure product excellence.
The Client Services Analyst I is responsible for the timely and accurate delivery of solutions across multiple product lines while ensuring client objectives are met. They will perform first-level data analysis, build internal and external relationships, and collaborate with project teams to ensure data alignment and quality.
The Prior Authorization Pharmacist reviews medication requests to ensure alignment with clinical guidelines and the Preferred Drug List. They also collaborate with medical providers and internal teams to support utilization management and improve pharmacy program efficiency.
Develop, test, debug, implement, and document programs, including modifications to products and client or internal systems. Analyze requirements, write specifications and test plans, support production issue resolution, conduct quality assurance reviews, and keep technical knowledge current.
The developer will code, test, debug, and document programs while assisting in the modification of systems to meet client needs. They will also conduct quality assurance activities and research industry technical trends to maintain current skills.
Handle high-volume inbound calls from members, providers, and other stakeholders, resolving questions about healthcare services, eligibility, and claims or escalating complex cases. Document interactions accurately, meet quality and productivity standards, and collaborate with colleagues to improve processes and customer experience.
Supervise claims program administration and billing activities to ensure compliance with laws, regulations, and contractual arrangements. Oversee the investigation, settlement, and resubmission of claims while mentoring and evaluating staff performance.
Assist with planning and coordinating small to medium-sized projects, including schedules, budgets, resources, cross-functional teams, dependencies, and releases. Monitor project progress through the software development lifecycle, report status, maintain project documentation, and escalate significant risks or issues.
The Clinical Policy Specialist develops and enhances itemized bill review clinical and coding solutions while serving as the primary subject matter expert for audit strategies. This role collaborates with cross-functional teams to identify billing vulnerabilities, monitor program performance, and ensure alignment with regulatory requirements.
The Pharmacy Technician will support members and medical providers by handling inquiries regarding pharmacy benefits, claims, and prior authorizations. They will manage incoming and outgoing calls while accurately documenting interactions across various communication channels.
The specialist will review and correct out-of-state healthcare claims while coordinating provider enrollment activities for the Medi-Cal program. They will also collaborate with internal teams and the California Department of Health Care Services to resolve discrepancies and maintain accurate records.
The Lead Business Analyst is responsible for leading business analyses that align IT solutions with strategic goals for complex accounts. This role involves modeling business processes, facilitating stakeholder workshops, and overseeing the development of training content to ensure operational readiness.
The Lead Business Analyst will govern and validate AI-generated requirements while ensuring alignment with business rules and data mappings. They will also coordinate team activities, mentor junior staff, and act as a bridge between clients and technical teams to ensure project objectives are met.
The Lead Business Analyst will align information technology solutions with strategic goals by facilitating requirements analysis, business process modeling, and documentation. Additionally, the role involves mentoring junior analysts and managing the development of training materials, including eLearning and operational procedures.
Provide strategic legal advice to HR and business leaders on a wide range of employment law issues and policies. Manage employment disputes and litigation, including overseeing outside counsel and representing the company in legal proceedings.
The Advisor Healthcare Systems Analyst collaborates with teams to develop program specifications, mapping documents, and data transformation requirements. They also perform research, validate test plans, and present design recommendations to stakeholders, clients, and vendors.
The Senior Business Analyst serves as the functional lead for the Children's Long-Term Support (CLTS) program, managing a portfolio of maintenance activities and projects. They act as the primary liaison between business stakeholders, technical teams, and the client to define requirements and ensure successful delivery of business outcomes.
The Healthcare Test Manager leads complex system and network testing across all phases, including integration, interoperability, and customer acceptance. They design test processes, resolve operational issues, and provide leadership to team members while partnering with clients on requirements.
The Client Engagement Manager is responsible for managing client contracts, relationships, and ensuring operational performance meets contractual commitments. They also drive revenue growth through upselling services and monitoring financial expectations for assigned accounts.
The role provides principal-level leadership for business solution architecture and integrated Provider DDI delivery, ensuring alignment across business, technical, and operational workstreams. It involves managing delivery plans, defining future-state capabilities, and acting as a deputy to the Engagement Lead to drive client outcomes.
The Quality Improvement Specialist will apply methodologies like Lean and Six Sigma to support population health initiatives and QAPI program activities. They will also collaborate across departments to monitor quality initiatives and maintain essential program documentation.
The specialist is responsible for managing subrogation cases, including asset investigation, court filings, and negotiating settlements for Medicaid beneficiaries. They must ensure all processes comply with HIPAA and government security requirements while maintaining accurate documentation and case progress.
The UI Developer will code, test, debug, and implement moderately complex programs while analyzing requirements to design system components. They will also provide technical consulting to clients and lead a small sub-team of developers as needed.
The Systems Manager is responsible for the operational continuity, performance, and modernization of systems supporting the Medicaid Management Information System. This role leads technical delivery, enforces ITSM processes, and acts as a primary liaison between technical teams and client stakeholders.
The Director of Product Development defines and executes the strategic vision for innovative products while managing cross-functional teams and project roadmaps. They also foster key client relationships and ensure high standards for engineering, quality, and data governance across the organization.
The representative will answer incoming calls to provide professional assistance while accurately documenting interactions and resolving customer inquiries. They are also responsible for following quality guidelines and collaborating with team members to improve workflows and the customer experience.
The representative acts as a liaison between Gainwell, state Medicaid programs, and healthcare providers to manage enrollment and revalidation initiatives. They provide education, resolve inquiries, and ensure providers remain compliant with regulatory requirements.
The Senior Business Analyst will govern and validate AI-generated requirements while ensuring alignment with business rules and data mappings. They will also coordinate team activities, mentor junior staff, and act as a bridge between clients and technical teams to ensure project objectives are met.
The Associate Manager supervises the Prior Authorization quality review program to ensure clinical accuracy, regulatory compliance, and operational efficiency. This role leads a team of auditors, monitors performance metrics, and drives improvement initiatives based on audit findings and clinical trends.
The role involves coding, testing, debugging, and documenting programs to meet client needs while assisting in production support and system enhancements. You will also design programs, develop test plans, and conduct quality assurance activities to ensure system reliability.
Lead organizational change management activities for complex healthcare and technology transformation initiatives. Partner with business leaders to assess change impacts, develop engagement strategies, and facilitate readiness assessments to ensure successful adoption.
The Integrated Delivery Program Manager leads complex product solution implementations by coordinating across multiple internal development teams. This role oversees planning, execution, risk management, and stakeholder alignment to ensure projects are delivered on time and within scope.
The Integrated Delivery Program Manager leads complex product solution implementations by coordinating between business stakeholders and internal development teams. This role oversees planning, execution, risk management, and status reporting to ensure projects are delivered on time and within scope.
The role involves creating, assigning, and optimizing schedules to support forecasted demand and operational service goals. It requires close partnership with forecasting, operations, and quality teams to ensure schedule accuracy and compliance with business rules.
Deliver engaging and interactive training sessions to call center agents and other departments while facilitating virtual programs. Design visually engaging training materials and assess learning outcomes through feedback and performance metrics.
The Business Analyst will collaborate with teams to translate client business needs into technical requirements and document system processes. They will also verify that client requirements are met through system design and basic test case execution.
Lead end-to-end customer experience launch initiatives across contact center, mailroom, and back-office operations. Drive cross-functional alignment and operational readiness to ensure successful service delivery and performance outcomes.
The Senior PMO will support governance, resource management, and compliance activities across multiple projects while maintaining project schedules and baselines. They will also assist project managers in tracking risks, issues, and dependencies while facilitating cross-team alignment and operational reporting.
You will design, develop, test, and maintain ETL processes and data integration solutions using Informatica, Oracle, and SQL. Additionally, you will provide production support, perform root cause analysis, and collaborate with architects to deliver high-quality healthcare system solutions.
The role involves coding, testing, debugging, and documenting programs to meet client needs while assisting in the resolution of production support problems. The analyst will also design programs, develop test plans, and conduct quality assurance activities to ensure system integrity.
Develop, maintain, and support high-quality application solutions while participating in all phases of the Software Development Lifecycle. Collaborate with cross-functional teams to analyze requirements, resolve technical issues, and ensure system reliability and performance.
The role involves managing inbound and outbound communications via phone, email, and chat to assist members and providers with claims and insurance inquiries. Responsibilities also include documenting interactions in a CRM system and ensuring compliance with healthcare regulations.
The Business Analyst will prepare and distribute daily posting reports while performing payment reconciliation and research activities. They will also identify process improvement opportunities and provide support for resolving missing check issues.
The role involves identifying security risks and vulnerabilities while managing firewalls, intrusion detection systems, and network security infrastructure. Additionally, the engineer will develop security policies, oversee user access, and provide technical leadership to ensure the integrity of enterprise systems.
The Associate Manager oversees daily operations for a multidisciplinary team of coders and nurse reviewers, ensuring productivity and quality metrics are met. They are responsible for staff hiring, performance management, and analyzing production data to identify opportunities for process improvements.
The Black Belt Business Process Consultant leads complex, cross-functional process improvement initiatives to enhance operational performance and efficiency. They serve as a subject matter expert, providing strategic guidance and data-driven insights to stakeholders while mentoring teams in continuous improvement methodologies.
The Program Manager is responsible for building and managing client relationships while overseeing operational and financial performance through data-driven tracking. They will lead project teams, manage deliverables, and implement risk mitigation strategies to ensure successful service delivery.
The Senior Project Manager will lead medium-sized project management teams to deliver innovative healthcare technology solutions while overseeing project metrics and budgets. They are responsible for identifying and mitigating risks, preparing statements of work, and ensuring project deliverables meet quality and timeline standards.
Develop, edit, and maintain technical documentation including manuals, release notes, and guides for healthcare products. Collaborate with cross-functional teams while ensuring documentation accuracy, version control, and compliance with company standards.
The PMO Specialist will support project governance, resource allocation, and compliance activities across multiple software development projects. They are responsible for maintaining project plans, tracking risks and issues, and providing operational reporting to leadership.
Perform quality assurance and audit activities across healthcare financial operations, including accounts receivable, payable, and cost settlements. Utilize SQL to query and analyze data while maintaining audit procedures and ensuring compliance with financial controls.
The Business Analyst will analyze, plan, and document business processes to support client technological goals while serving as a bridge between clients and technical teams. They are responsible for defining business requirements, creating test scenarios, and ensuring the intent of changes is maintained throughout the project lifecycle.
The Provider Enrollment Lead monitors daily enrollment operations, reports, and workloads to ensure service-level requirements are met. They also train and mentor staff, research complex provider questions, and improve enrollment policies and workflows.
The role involves coordinating IT project workstreams to align solutions with client business priorities and serving as a liaison between technical and non-technical teams. You will also oversee the documentation of system requirements and validate test results to ensure project success.
The Senior Medicaid Business Analyst translates state and federal Medicaid policy into system requirements, configuration, and design artifacts for MMIS and pharmacy environments. They act as a domain subject-matter expert, collaborating with cross-functional teams to ensure successful implementation, testing, and operational readiness.
The role involves answering inbound customer calls, resolving inquiries, and accurately recording account history. Additionally, the agent will perform data entry and ensure all service level agreements are met.
The Provider Enrollment Specialist is responsible for supporting the maintenance and renewal activities for the WV Medicaid program. Primary duties include reviewing and processing enrollment applications according to federal and state guidelines.
The CX Associate Professional Quality is responsible for monitoring and evaluating voice and non-voice interactions to ensure compliance with federal and state policies. They will conduct daily audits, facilitate calibration sessions, and use data-driven insights to recommend process improvements.
The Senior Business Analyst will coordinate team duties on IT projects and serve as a bridge between clients and technical staff to define business requirements. They are responsible for analyzing and improving business processes while validating that technical solutions meet client objectives.
The analyst supports operational performance, reporting, and process improvement initiatives for Medicaid and SNAP programs. They serve as a subject matter expert, collaborating with cross-functional teams to identify trends, enhance service delivery, and ensure compliance.
Provide knowledgeable responses to client inquiries and resolve issues while maintaining accurate account history. Collaborate with team members and management to improve workflow efficiency and meet production targets.
The Compliance Advisor serves as a subject matter expert for security procedures, audit compliance, and threat management. They oversee security administrator teams, conduct identity access reviews, and ensure all systems adhere to government and corporate security regulations.
The Black Belt Business Process Consultant leads complex process improvement and operational readiness initiatives across business, technology, and operations teams. They serve as a subject matter expert to drive sustainable results, facilitate workshops, and mentor staff in continuous improvement methodologies.
The Principal Application Architect provides architectural oversight for complex applications and integrates components while ensuring technical governance and compliance. They also lead the Architecture Review Board, manage technical roadmaps, and mentor team members to drive operational improvements.
The Professional Field Representative acts as a liaison for Wisconsin Medicaid providers, providing education, operational support, and issue resolution. They are responsible for analyzing complex claims-related issues and ensuring effective communication between providers and the organization.
Process provider enrollment cases and update provider information within internal systems. Collaborate with team members to ensure quality assurance and deliver exceptional customer service to providers and clients.
Design and develop data mining concepts to identify improper payments and improve claims accuracy across dental, medical, and pharmacy billing. Collaborate with cross-functional teams to drive innovation and support client payment integrity strategies.
The Business Analyst - Services Coordinator acts as a liaison between clients and internal teams to gather requirements and manage service requests. They are responsible for coordinating issue resolution, maintaining operational documentation, and supporting project implementation activities.
The Service Representative researches and resolves inquiries from providers, County Waiver Agencies, and the Department of Health Services. They also conduct training sessions and maintain strong business relationships while utilizing internal software systems.
Handle inbound and outbound calls regarding healthcare services, Medicaid, and provider inquiries while documenting interactions accurately. Collaborate with team members to resolve issues and identify recurring customer trends to improve service quality.
The candidate will lead data analysis efforts, develop program specifications, and create mapping documents to support ETL and reporting processes. They will collaborate with cross-functional teams to ensure business requirements are met through rigorous testing and design validation.
The Senior Business Analyst will bridge the gap between clients, project managers, and technical teams to define and document business requirements for healthcare technology initiatives. They will also support project management activities, including planning, risk tracking, and status reporting, while mentoring junior team members.
The Workforce Project Manager will lead small project teams to deliver technological solutions while managing project schedules, scope, and budgets. They are responsible for identifying risks, communicating project metrics, and ensuring high-quality deliverables through effective stakeholder management.
Lead and participate in the full software development lifecycle for NCPDP F6 implementation, including analysis, design, coding, and testing. Collaborate with cross-functional teams to translate functional requirements into scalable technical solutions for pharmacy claim transactions.
Lead and participate in the full software development lifecycle for NCPDP F6 implementations, including analysis, design, coding, and testing. Collaborate with cross-functional teams to translate functional requirements into scalable technical solutions for pharmacy claim transactions.
Lead end-to-end pharmacy testing across various environments to ensure quality delivery of PBM and Medicaid solutions. Manage test strategies, governance, and cross-functional coordination to ensure timely issue resolution and alignment with regulatory requirements.
The supervisor will lead, coach, and develop a customer support team to ensure high-quality service delivery and performance standards. They are responsible for managing SLAs, monitoring operational workflows, and implementing quality programs to drive continuous improvement.
The Information Security Officer will lead security operational governance, drive remediation efforts, and ensure adherence to SLAs and SLOs. They are responsible for managing security incidents, facilitating audits, and maintaining account security plans to ensure contractual compliance.
You will lead technical teams in the design, development, and testing of complex database applications while overseeing relationships between architects and developers. Additionally, you will provide technical consulting to clients and mentor less experienced application designers.
The Lead Application Architect will design cloud-native and hybrid architectures while driving application migration and modernization to AWS. They will also provide technical leadership, mentor development teams, and ensure the scalability, resiliency, and security of enterprise solutions.
Design, build, test, and operate secure, scalable software for Medicaid DDI programs and modernized Provider Plus capabilities. Develop micro-frontends and microservices while utilizing cloud-native engineering and AI coding tools to improve delivery speed.
The supervisor will lead a remote team of pharmacy technician support representatives to ensure high-quality customer service and operational efficiency. They are responsible for monitoring performance metrics, resolving escalated inquiries, and implementing process improvements to meet service level agreements.
Manage inbound and outbound calls regarding prior authorization requests and provider inquiries. Accurately process and document authorization requests while ensuring compliance with HIPAA and confidentiality protocols.
The CX Quality Supervisor leads quality assurance operations by monitoring voice and non-voice interactions to ensure compliance and service excellence. They also drive continuous improvement initiatives by analyzing performance data and coaching high-performing teams to meet organizational goals.
The Senior Project Manager will lead medium-sized project management teams to deliver innovative healthcare technology solutions while overseeing staffing, budgets, and project timelines. They are responsible for interfacing with clients and leadership to communicate metrics, mitigate risks, and ensure the quality of project deliverables.
The developer will code, test, debug, and document healthcare administration programs while assisting in the modification of systems to meet client needs. They will also participate in production support activities and conduct quality assurance through peer reviews.
You will design, develop, and maintain scalable database systems to support critical healthcare operations. Additionally, you will monitor performance, automate data processes, and provide technical guidance to junior team members.
Provide senior technical leadership for secure, scalable applications supporting Medicaid and provider delivery systems. Oversee application design, code reviews, and the implementation of automated quality gates and CI/CD pipelines.
Design, build, test, and operate secure, scalable software for Medicaid DDI programs and modernized Provider Plus capabilities. Develop React/TypeScript micro-frontends and .NET/C# microservices while implementing automated tests, CI/CD pipelines, and cloud-native integrations.
The Business Analyst will analyze, design, and document business processes to support technological solutions for healthcare clients. They will act as a bridge between clients and technical teams to define requirements and verify system designs through testing.
Develop and deliver comprehensive training programs for clinical reviewers, coders, and auditors regarding DRG validation and coding guidelines. Serve as a subject matter expert to mentor teams, analyze quality trends, and ensure compliance with industry standards and clinical policies.
The role involves enforcing IAM strategy, architecture, and roadmaps while managing identity lifecycles, access controls, and privileged access management. You will also lead IAM projects, ensure compliance with regulatory frameworks, and mentor team members on identity standards.
Analyze customer interactions, feedback, surveys, and operational data to identify trends, pain points, contact drivers, risks, and root causes across the customer journey. Develop reports and actionable recommendations, and collaborate with business partners to improve customer experience, operational performance, and business outcomes.
The role involves coordinating IT project workstreams to align solutions with client business priorities and acting as a liaison between technical and non-technical teams. You will also oversee the documentation of system requirements and validate test results to ensure project quality and compliance.
The Senior Business Analyst leads business process design and requirements validation to align IT solutions with strategic healthcare objectives. They also manage training material development and provide mentorship to junior team members across multiple complex accounts.
Review and analyze complex medical, psychological, and developmental records to support disability determinations for the Katie Beckett Medicaid program. Independently manage a caseload while collaborating with clinical consultants and partners to ensure timely and accurate decisions.
The Provider Field Representative serves as a primary point of contact for healthcare providers, conducting virtual and onsite visits to deliver training and resolve billing or policy issues. They act as a liaison between providers and internal teams to identify trends and improve the overall provider experience within the Medi-Cal program.
The Provider Field Representative will serve as a primary point of contact for healthcare providers, conducting virtual and onsite visits to provide education and operational support. They will also research billing and claims issues while acting as a liaison between providers and internal teams to ensure program compliance.
The representative serves as the primary liaison between Gainwell, state Medicaid programs, and healthcare providers to manage enrollment and revalidation initiatives. They conduct proactive outreach, resolve provider inquiries, and deliver education to ensure regulatory compliance and prevent reimbursement disruptions.
Lead security governance and operational compliance, including remediation, incident management, audit preparation and follow-up, risk and exception management, and adherence to security standards. Maintain account security plans, coordinate security metrics and reporting, and work with suppliers, clients, and delivery teams to resolve security issues and meet contractual commitments.
Lead technical teams in designing, developing, testing, and installing complex database applications, and coordinate architects and developers to deliver flexible, reusable system components. Produce technical design, coding, and testing documentation, advise clients on complex projects, serve as a subject matter expert, and mentor less experienced designers.
Code, test, debug, implement, and document programs, and modify systems to meet client and end-user needs. Analyze existing systems and requirements, design program enhancements, support production issue resolution, develop test plans, and conduct quality assurance reviews.
Design, develop, maintain, and support complex batch applications for Medicaid pharmacy and healthcare systems, while providing technical leadership, mentoring, and guidance throughout the software development lifecycle. Collaborate with business and technical teams to resolve application and database issues, support releases and deployments, maintain documentation, and advance automation, cloud adoption, and DevOps practices.
The role involves creating and implementing complex project definitions, schedules, and budgets for high-complexity projects while managing stakeholder expectations. You will also oversee project teams, identify risks, and implement mitigation strategies to ensure project deliverables meet quality and performance standards.
Lead database architecture and management system design, implementation, and integration across complex technical environments. Guide project teams and clients, mentor personnel, support business development, and ensure delivery objectives and client satisfaction.
Analyze, document, and recommend improvements to business processes, translating client needs into requirements and basic data and process models. Develop or analyze test scenarios and participate in technical reviews to ensure intended changes are implemented throughout project phases.
Design, develop, deploy, and optimize AI solutions—including generative AI, NLP, and predictive models—for healthcare platforms, integrating them into existing systems and processing large healthcare datasets. Monitor model performance, apply MLOps practices, ensure regulatory and ethical compliance, and identify opportunities to automate workflows and improve operational efficiency.
Analyze client business needs and processes, document system requirements, and translate technical requirements into clear, non-technical language. Develop basic data and process models, test system requirements against existing plans, and participate in technical reviews to ensure solutions meet client expectations.
Coordinate client and project team meetings, communications, onboarding and offboarding, and maintain accurate project documentation and calendars. Support PMO governance through action-item tracking, project logs, reports, templates, and process improvements, escalating issues when needed.
The Senior Manager will lead a team of over 30 System Operations Managers to ensure the stability, performance, and continuous improvement of Medicaid Management Information Systems. This role oversees operational governance, incident management, vendor performance, and regulatory compliance across integrated healthcare platforms.
The Provider Communications Lead is responsible for planning, developing, and managing provider-facing publications and communications to support Medicaid program operations. This role involves collaborating with subject matter experts and stakeholders to ensure all materials are accurate, timely, and aligned with regulatory requirements.
The Business Analyst supports requirements management activities by gathering, documenting, and maintaining functional and technical requirements throughout the project life cycle. They collaborate with stakeholders and cross-functional teams to ensure requirements are clear, traceable, and aligned with business objectives.
The consultant will lead complex process improvement and operational readiness initiatives by partnering across business, technology, and operations teams. They are responsible for analyzing performance metrics, facilitating improvement workshops, and establishing governance models to drive measurable business outcomes.
Lead process improvement initiatives to enhance operational performance, quality, and customer experience using Lean and Six Sigma methodologies. Facilitate cross-functional problem-solving sessions and develop process designs that align with strategic business objectives.
Lead end-to-end customer experience launch initiatives across contact center, mailroom, and back-office operations. Drive cross-functional alignment and operational readiness to ensure successful service delivery and performance outcomes.
The Lead Associate performs quality audits of itemized medical bills, healthcare claims, and medical records to ensure billing accuracy, regulatory compliance, and proper documentation. This role also provides subject matter expertise, staff mentoring, and identifies opportunities for quality improvement within the billing and reimbursement process.
The Technical Analyst provides hands-on technical analysis, SQL development, and system troubleshooting for Medicaid Management Information Systems. They collaborate with cross-functional teams to ensure solutions are technically sound, scalable, and aligned with system architecture throughout the SDLC.
The Provider/Domain Lead is responsible for the end-to-end delivery of the Provider+ domain, ensuring business requirements are translated into effective solution designs. This role coordinates across cross-functional teams to manage requirements, oversee configuration, and ensure operational readiness for go-live.
The role involves researching, writing, and editing technical documentation such as manuals, procedures, and system specifications. Additionally, the writer will compile online help files and documentation packages to support end users and project teams.
The Financial Cash Control Team Lead coordinates weekly Accounts Receivable operations and ensures the accuracy of financial transactions for the Medi-Cal program. They also research complex financial issues, provide procedural guidance to the team, and collaborate with stakeholders like the DHCS and State Controller’s Office.
The Financial Cash Control Supervisor leads a team responsible for accounts receivable, EFT enrollment, and financial transaction processing for the Medi-Cal program. This role involves managing daily operations, coaching staff, and collaborating with internal teams to improve financial processes and ensure compliance.
The Team Lead monitors suspended Medi-Cal claims inventories to ensure timely resolution and adherence to service standards. They also provide daily guidance, training, and operational support to Claims Examiners while tracking team performance metrics.
Respond to high-volume phone and email inquiries while documenting interactions and resolutions accurately within company systems. Navigate multiple applications to resolve customer issues efficiently while maintaining confidentiality and adhering to established policies.
The Quality Improvement Specialist supports Population Health and Quality Improvement initiatives by applying methodologies like PDSA, Lean, and Six Sigma to drive measurable outcomes. They collaborate across departments to monitor quality initiatives, maintain documentation, and ensure compliance with EQRO requirements.
The Senior Business Analyst is responsible for developing business process models, role-based training content, and process documentation to support enterprise solution implementations. They facilitate stakeholder workshops, analyze process gaps, and ensure alignment between business requirements and operational readiness.
The Business Analyst leads the analysis, design, and optimization of business processes to align technical solutions with strategic Medicaid pharmacy and care management goals. They facilitate stakeholder workshops, develop process models, and oversee the creation of training materials to ensure operational readiness.
Lead and develop multiple reporting and analytics teams to support operational service delivery and business insights. Partner with stakeholders to drive performance improvements, SLA attainment, and modernization initiatives across client accounts.
The role involves acting as a product owner and delivery lead to design and implement advanced data mining and AI-driven analytics solutions for healthcare payment integrity. You will translate complex reimbursement policies into scalable audit algorithms while collaborating with cross-functional teams to safeguard healthcare resources.
The Advisor Data Sciences will design, build, and deploy advanced AI and Generative AI solutions across healthcare technology platforms. This role involves integrating models into existing systems while ensuring compliance with healthcare regulations and optimizing performance for operational efficiency.
The Batch Developer will code, test, debug, and implement programs while assisting in the modification of systems to meet client objectives. They will also research existing systems, design enhancements, and resolve production support problems.
The Process Writer will document existing processes, create standardized SOPs and DLPs, and conduct gap analyses to improve operational efficiency. They will collaborate with cross-functional teams and Lean Six Sigma experts to ensure documentation is accurate, consistent, and aligned with industry best practices.
The Senior Project Manager will lead medium-sized project management teams to deliver innovative healthcare technology solutions while overseeing project metrics, budgets, and schedules. They are responsible for interfacing with clients and leadership to mitigate risks and ensure the timely, high-quality completion of project deliverables.
The SME will architect data pipelines, design dashboards, and collaborate with stakeholders to define key business metrics. They are also responsible for maintaining data infrastructure and providing clear documentation to support data-driven decision-making.
The AI Engineer will design, build, and deploy advanced AI and Generative AI solutions across healthcare platforms to improve outcomes and operational efficiency. This role involves managing end-to-end AI model development, data processing, and system integration while ensuring compliance with healthcare regulations.
The Lead Coding Auditor performs itemized bill reviews, chart reviews, and coding validation to ensure services are accurately documented and reimbursed. They also manage the appeals process, participate in hearings, and provide training and mentorship to other coding auditors.
Lead the validation of business requirements and coordinate IT project workstreams to align technical solutions with client priorities. Act as a subject matter expert and liaison between technical and non-technical stakeholders to streamline workflows and approve test results.
Monitor and evaluate customer interactions in English and Spanish to ensure adherence to quality standards and compliance. Analyze performance trends and collaborate with teams to drive process improvements and service delivery excellence.
The Lead Associate performs quality audits of itemized medical bills and institutional claims to ensure accuracy, compliance, and proper billing practices. They also provide subject matter expertise, staff education, and mentoring to support departmental performance goals.
Serve as the primary point of contact for healthcare providers to resolve EDI and provider-related inquiries via phone and written communication. Research, troubleshoot, and process provider requests while maintaining documentation standards and meeting productivity goals.
The Senior Certified Pharmacy Technician serves as a subject matter expert to resolve complex pharmacy benefit inquiries and medication access issues for members and providers. They also support team members with escalated issues, training, and process improvement initiatives across multiple communication channels.
Assist members by phone with inquiries regarding healthcare benefits, eligibility, and available services. Accurately document all customer interactions and resolutions within the company systems.
The PM&R Physician provides senior-level clinical expertise and oversight for rehabilitation programs, including medical necessity determinations and policy development. They serve as a subject matter expert to support utilization management, peer-to-peer consultations, and quality improvement initiatives.
Assist members via phone with inquiries regarding healthcare benefits, eligibility, and services. Accurately document all customer interactions and resolutions within company systems.
The Genetic Testing Physician provides senior-level clinical expertise and oversight for genetics programs, including reviewing complex authorization requests and medical necessity determinations. They serve as a clinical advisor to internal teams and providers to ensure high-quality, evidence-based, and cost-effective healthcare outcomes.
Design and govern data architectures for large-scale Medicaid system implementations and modernizations. Collaborate with cross-functional teams to ensure data integrity, scalability, and alignment with CMS requirements.
The Technical Writer will create, edit, and maintain technical documentation such as manuals, system guides, and release notes for healthcare products. They will collaborate with cross-functional teams including product managers and developers to ensure documentation accuracy and consistency.
The Technical Writer will create, edit, and maintain technical documentation such as manuals, release notes, and online help systems for healthcare products. They will also collaborate with cross-functional teams and manage documentation projects using MadCap Flare while ensuring version control and quality standards.
The Healthcare Data Entry Specialist is responsible for accurately entering, reviewing, and validating claims-related information and healthcare records. They must maintain data integrity and confidentiality while meeting productivity and quality standards within a remote environment.
The Advisor Information Systems Architect is responsible for designing, implementing, and governing enterprise-wide ServiceNow solutions. This role focuses on architectural integrity, platform scalability, and managing complex integrations across the corporate environment.
The Senior Client Services Analyst provides comprehensive support to FraudCapture clients, acting as the primary point of contact for issues and escalations. Responsibilities include conducting user training, maintaining documentation, and collaborating with product teams to gather requirements.
The representative will answer customer inquiries regarding insurance and healthcare programs while maintaining service level agreements. They are also responsible for documenting account history, processing appeals, and collaborating with stakeholders to resolve complex issues.
Assist members by phone with inquiries regarding healthcare benefits, eligibility, and available services. Maintain accurate documentation of interactions and resolve member concerns within a high-volume environment.
The agent is responsible for responding to member inquiries regarding eligibility and benefits via telephone and documenting interactions in a CRM system. They also conduct outbound calls and interface with team personnel to resolve customer service issues.
Assist members via phone with inquiries regarding healthcare benefits, eligibility, and available services. Accurately document all customer interactions and resolutions while maintaining a professional and friendly demeanor.
Handle a high volume of inbound provider calls to assist with billing, policy, and Medicaid-related inquiries. Accurately document all interactions in the system while maintaining performance standards and data integrity.
The AI Engineer will design, develop, and deploy advanced AI solutions, including Generative AI, across healthcare technology platforms. This role involves building machine learning models, integrating them into existing systems, and ensuring compliance with healthcare regulatory standards.
The Project Manager will lead end-to-end customer experience launch initiatives across various operational workstreams including contact centers and back-office functions. They are responsible for defining project scope, managing integrated plans, and ensuring operational readiness through cross-functional alignment.
The Data Engineer will design, develop, and maintain complex database applications and data pipelines using Cloudera and AWS technologies. They will also provide technical consulting, mentor junior staff, and ensure alignment between application architects and developers.
The representative will handle customer calls regarding healthcare services and Medicaid benefits while accurately documenting interactions. They are responsible for researching inquiries using internal systems to provide timely resolutions while maintaining HIPAA compliance.
The analyst will monitor and evaluate customer interactions to ensure compliance with quality standards and client requirements. They will also analyze performance trends and collaborate with teams to drive process improvements and service delivery.
Monitor and evaluate customer interactions to ensure adherence to quality standards, compliance, and performance expectations. Analyze quality results and trends to provide recommendations for process improvements and coaching.
The Healthcare Application Support Analyst codes, tests, debugs, and documents programs to meet client needs while resolving production support issues. They also conduct quality assurance activities and research industry technical trends to maintain system standards.
You will build advanced UI features using React and develop robust integrations using AWS services like Lambda and API Gateway. Additionally, you will design SQL data models and mentor developers to ensure high engineering standards across the contact center platform.
The Long-Term Care Auditor I is responsible for identifying and recovering improper Medicaid payments by auditing provider records and financial data. They serve as a primary liaison for providers, managing a caseload and delivering status reports to management.
The Data Engineer will design, develop, and maintain complex database applications and large-scale data pipelines using Cloudera and AWS technologies. They will also provide technical consulting, mentor junior designers, and oversee relationships between architects and developers.
The Medical Reviewer will evaluate laboratory-related claims, Treatment Authorization Requests, and supporting documentation to ensure compliance with medical policies and coverage requirements. They will collaborate with clinical and operational teams to resolve review questions and document findings accurately.
The Medical Reviewer will evaluate laboratory-related claims, treatment authorization requests, and supporting documentation to ensure compliance with medical policies and program requirements. They will collaborate with clinical and operational teams to resolve review questions and document findings accurately.
The Medical Reviewer will evaluate speech, language, and audiology-related claims, treatment plans, and clinical documentation to ensure compliance with medical necessity and program requirements. They will also collaborate with clinical and operational teams to resolve review questions and document findings accurately.
The Medical Reviewer will evaluate radiology-related claims, treatment authorization requests, and medical records to ensure compliance with clinical standards and medical necessity. They will document findings and collaborate with clinical and operations teams to support healthcare program requirements.
The Medical Reviewer evaluates prosthetic and orthotic device requests, claims, and treatment authorizations to ensure they meet medical necessity and coverage requirements. They also collaborate with clinical and operational teams to document findings and support accurate, timely claim determinations.
The Medical Reviewer will evaluate optometry-related medical records, claims, and treatment authorization requests against clinical standards and policies. They will collaborate with clinical and operational partners to ensure accurate documentation and timely coverage determinations.
The Medical Reviewer will evaluate physical therapy-related medical records, claims, and treatment plans to ensure compliance with clinical and coverage requirements. They will collaborate with healthcare professionals to resolve review questions and document findings accurately.
The Medical Reviewer will perform clinical pharmacy reviews, claim adjudication, and drug utilization reviews to support California healthcare programs. They will collaborate with multidisciplinary teams to ensure compliance with pharmacy policies and regulatory requirements.
Perform physician-level medical reviews of claims, treatment authorization requests, and appeals to ensure clinical accuracy. Collaborate with multidisciplinary teams to support medical policy development and maintain compliance with regulatory requirements.
The Process Writer is responsible for documenting, maintaining, and standardizing Standard Operating Procedures (SOPs) and Desk Level Procedures (DLPs) for the Customer Experience team. They will collaborate with cross-functional teams and Lean Six Sigma experts to map workflows, identify process gaps, and ensure documentation remains accurate and compliant.
The PMO Lead creates and implements complex project schedules, budgets, and objectives while ensuring alignment with architectural dependencies and release milestones. They also manage a team of project managers and act as the primary point of contact for client project management.
The Integrated Delivery Program Manager leads complex product solution implementations by coordinating across multiple internal development teams. This role oversees planning, execution, risk management, and stakeholder alignment to ensure projects are delivered on time and within scope.
The Project Manager will lead large technological programs, overseeing project planning, staffing, and budget management to ensure timely delivery. They will also communicate project status to stakeholders, manage risks, and support business development through proposal efforts.
The ORR Lead oversees the readiness assessment, demonstrations, and cutover of legacy systems into new Gainwell solutions. They are responsible for maintaining project schedules, managing vendor relationships, and communicating progress to leadership.
The Client Services Analyst II supports client success by ensuring the accurate delivery of data files, reports, and letters while managing operational workflows. They collaborate with cross-functional teams to analyze performance metrics, resolve issues, and drive improvements in service delivery and client satisfaction.
The PMO Lead will establish and oversee project management governance, controls, and delivery processes for a large-scale DDI program. They will drive performance against KPIs and SLAs while facilitating executive reporting and stakeholder communications.
The Principal Data & Analytics Delivery Leader will oversee the delivery of MMIS data and analytics solutions for state and local government clients. This role involves managing a team of analysts and developers while collaborating with cross-functional leaders to drive integrated reporting initiatives and ensure compliance.
The Senior Batch Developer will design, develop, and test complex application software while guiding connections between architects and developers. They will also serve as a technical consultant to senior management for complex projects and application modules.
The Cloud Data Solutions Architect designs and supports strategic technology solutions to drive operational efficiency and business growth. This role collaborates with cross-functional teams and stakeholders to identify business requirements and ensure successful implementation of data-driven solutions.
The Information Security Officer will lead security operational governance, drive remediation efforts, and ensure adherence to SLAs and SLOs. They are responsible for managing security incidents, facilitating audits, and maintaining account security plans while ensuring compliance with regulatory and contractual standards.
The SQL Developer Analyst will analyze, design, and program SQL-based solutions while collaborating with cross-functional teams to meet business requirements. They are also responsible for monitoring system performance, mentoring team members, and providing actionable insights through data mining and modeling.
The Advisor, Program Management oversees the planning and delivery of application development initiatives while ensuring alignment across product, engineering, and business stakeholders. This role drives the end-to-end program lifecycle, including road mapping, execution, risk management, and continuous improvement.
The ISO is accountable for security-related compliance and delivery for assigned customers, acting as a trusted advisor for healthcare industry regulated security requirements. Key duties include managing security risks, reporting on threat and vulnerability management, and coordinating security metrics and incident responses.
Provide application and operations support for cloud-based infrastructure on Azure and AWS, including environment setup and deployment. Collaborate with development teams and end users to troubleshoot issues and apply ITIL principles for service management.
The specialist is responsible for reviewing and processing provider enrollment and revalidation applications for the Nevada Medicaid Program. This includes performing outreach to providers and coordinating with clients to obtain necessary approvals.
The specialist is responsible for accurately entering, reviewing, and validating claims-related information and healthcare records. They must ensure data compliance and maintain the security of sensitive member information while meeting productivity standards.
Acts as the enrollment liaison between Gainwell Technologies, the Idaho Department of Health & Welfare, and the provider community. Responsible for processing initial and maintenance enrollment applications while ensuring adherence to state requirements and SLAs.
Acts as the primary liaison between healthcare providers and Missouri Medicaid by conducting site visits to ensure compliance with state and federal requirements. Delivers education and training on billing practices and policies while resolving complex operational issues for providers.
The Technical Analyst bridges business needs with technical execution by translating requirements into technical specifications and data models for pharmacy claims. They leverage SQL to validate data and collaborate with cross-functional teams to ensure scalable system architecture.
Lead the design, implementation, and governance of enterprise-wide ServiceNow solutions with a focus on platform scalability and architectural integrity. Manage integrations between ServiceNow and external systems while optimizing CMDB health and data integrity.
Research, resolve, and process medical claims while ensuring compliance with established guidelines. Coordinate with internal departments and prepare necessary documentation such as Return to Provider forms.
Respond to member telephone calls regarding eligibility and benefit information using an automated system. Research inquiries, document interactions in a CRM ticketing solution, and conduct outbound calls as needed.
Provide comprehensive support and troubleshooting for FraudCapture client users to ensure retention and system efficacy. Develop training materials and act as the primary point of contact for technical issues and escalations.
Design, develop, and deploy advanced AI and Generative AI solutions to improve healthcare outcomes and operational efficiency. This includes managing end-to-end deployment, data engineering, and ensuring compliance with HIPAA and industry standards.
The Clinical DRG Auditor performs clinical and coding validation reviews of medical records to ensure the accuracy of DRG assignments and documentation. They also assist management by mentoring new staff and maintaining current knowledge of coding guidelines and regulatory mandates.
The representative will answer telephones, respond to basic customer questions regarding insurance and healthcare, and provide consultancy utilizing expertise. This role also involves developing and implementing policies, investigating claim characteristics, and responding to provider appeals.
The representative will handle a high volume of inbound calls from healthcare professionals regarding billing, policy questions, and Medicaid inquiries, aiming to resolve 92% of calls within 3–5 minutes. Key duties include accurately documenting all interactions, maintaining policy knowledge, and ensuring full HIPAA compliance while supporting team goals.
The Medical Claims Auditor reviews and analyzes medical claims and supporting documentation to ensure accuracy, compliance with company policies, and adherence to industry standards, including validating coding accuracy using ICD-10, CPT, and HCPCS guidelines. This role involves identifying discrepancies like upcoding or duplicate claims and communicating findings to recommend corrective actions to the claims processing team or management.
Assist the project team with gathering requirements and designing new methods to improve information processing. Help create or update data/process models based on client requests.
The Healthcare Project Manager creates and implements complex project definitions, schedules, budgets, and objectives for large or multiple high-complexity projects. They manage costs, schedules, and quality by overseeing project deliverables and ensuring that project metrics are met.
The Senior Business Analyst - SAS Coder will perform analysis, development, and evaluation of complex reports related to Medicaid and FoodShare programs. This role involves determining report specifications, meeting with stakeholders, and ensuring compliance with federal and state regulations.
As a GUI Developer, you will design, develop, and maintain responsive and interactive GUIs while integrating them with AI solutions. You will also analyze and modernize legacy GUI components to ensure compatibility with modern frameworks.
The engineer is responsible for designing, building, and maintaining Azure and AWS infrastructure for product demo environments. They will collaborate with cross-functional teams to ensure seamless integration and operational excellence.
Oversee daily operations of the development team for a Medicaid Management Information Systems (MMIS) Contract, ensuring end-to-end delivery of technical solutions. Facilitate operational meetings, monitor processes, and drive improvements to enhance service delivery.
The Claims Manager oversees routine claims processing operations and manages a team responsible for data entry, claims resolution, and reporting. This role involves ensuring compliance with laws and regulations while developing policies for efficient operations.
The Lease Accountant will manage end-to-end lease accounting processes, ensuring compliance with relevant accounting standards. Responsibilities include maintaining lease agreements, performing modifications, and supporting financial reporting and audits.
As a Call Center Project Manager, you will lead project management teams to ensure quality and timely completion of tasks. You will communicate project metrics and status to clients and stakeholders while managing risks and implementing solutions.
