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.
Lead product strategy for Medicaid claims-related domains by translating complex business and clinical needs into clear product roadmaps. Partner with cross-functional teams to modernize core adjudication capabilities and drive platform transformation.
The Program Manager is responsible for managing client relationships and overseeing the delivery of services in accordance with contract requirements. They will monitor project progress, manage budgets and revenue targets, and provide leadership to internal teams to ensure successful program outcomes.
The Senior Business Analyst will support pharmacy benefit management implementations and configurations while collaborating with clinicians to optimize pharmacy systems. They will also act as a bridge between technical staff and clients to define business requirements and validate system performance.
The role involves reviewing and processing pharmacy prior authorization requests while resolving inquiries from members, providers, and pharmacies. Additionally, the technician will serve as a subject matter resource to support team training, coaching, and quality improvement initiatives.
The Clinical Pharmacist will participate in all aspects of the Connecticut Medicaid pharmacy program, including prior authorization criteria development and preferred drug list management. They will also provide clinical leadership and mentorship to account-based pharmacy staff to ensure consistent clinical decision-making and program alignment.
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 Real-Time Analyst monitors live operational performance, queue volumes, and agent adherence to ensure service levels are met. They execute intraday workforce actions and collaborate with cross-functional teams to address staffing risks and operational issues.
The Senior Workforce Management Scheduler develops and optimizes workforce schedules to balance forecasted demand, staffing availability, and operational service goals. They collaborate with cross-functional teams to identify coverage risks and implement data-driven adjustments to improve workforce efficiency.
The Proposal Operations Specialist manages proposal production, operational processes, and editorial support throughout the pursuit lifecycle. They also coordinate work planning, maintain proposal templates, and support the implementation of AI-enabled tools to enhance efficiency.
The Registered Nurse Consultant reviews and adjudicates prior authorization requests for Medicaid services to ensure medical necessity and compliance with state policies. They also serve as a clinical subject matter expert, providing guidance to providers and collaborating with internal teams to improve program outcomes.
Review and adjudicate Medicaid prior authorization requests for behavioral treatment services to ensure medical necessity and eligibility. Provide clinical guidance to providers and maintain accurate documentation within the Medicaid Management Information System.
The physician will provide clinical oversight and medical expertise for utilization management and prior authorization activities within a Medicaid-focused environment. Responsibilities include conducting medical necessity reviews, participating in peer-to-peer discussions, and ensuring care decisions align with program guidelines.
The Solution Delivery Lead provides principal-level leadership for complex Provider DDI initiatives, orchestrating functional, technical, and operational workstreams to ensure successful client outcomes. This role manages integrated delivery plans, schedules, budgets, and readiness gates while advising leadership on strategy and risk mitigation.
The role involves managing inbound and outbound communications via phone, email, and chat to assist members and providers with inquiries. Responsibilities include researching claims, verifying insurance coverage, and documenting all interactions accurately within the CRM system.
The Senior Transformation Manager operationalizes and governs the testing transformation strategy by translating roadmaps into actionable plans across delivery teams. This role drives execution discipline, monitors performance metrics, and ensures consistent implementation of processes, automation, and ALM tools across enterprise programs.
The RN Consultant reviews Medicaid prior authorization requests to determine medical necessity based on state policy guidelines. They also serve as a clinical subject matter expert to support providers and internal stakeholders in ensuring program integrity and quality outcomes.
The Internal Medicine Physician serves as a clinical subject matter expert responsible for medical oversight, utilization management, and evidence-based medical necessity determinations. They collaborate with multidisciplinary teams to ensure program compliance, improve healthcare outcomes, and support quality improvement initiatives.
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.
The physician serves as a senior clinical subject matter expert providing medical oversight and review for behavioral health services, specifically focusing on Autism Spectrum Disorder and ABA therapy. They collaborate with clinical and operational teams to ensure medical necessity determinations are evidence-based and compliant with Medicaid regulations.
Design, develop, and maintain robust ETL/ELT pipelines using Databricks to transform raw data into high-quality datasets. Create performance-optimized Power BI dashboards and semantic models to deliver actionable business insights.
The representative will support the Business Process Services team by processing claims in accordance with established policy guidelines. They are responsible for evaluating claim errors and making adjudication decisions while meeting production and quality standards.
The representative will review and input enrollment data using multiple websites and systems while ensuring compliance with contract requirements and business rules. They are expected to maintain high levels of productivity, punctuality, and focus within a remote work environment.
Assist members via phone with inquiries regarding healthcare benefits, eligibility, and services. Accurately document all customer interactions and resolutions within company systems.
The Team Lead will manage daily enrollment operations, including queues, applications, and inbox activities while resolving complex issues. They are responsible for leading, training, and mentoring team members to ensure operational efficiency and high-quality client service.
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 Chiropractic Consultant will adjudicate Medicaid prior authorizations based on medical necessity and state policy guidelines. They will also provide clinical guidance to providers and offer recommendations for process improvements within the dental program.
You will design, develop, and maintain enterprise content management solutions using IBM FileNet and related technologies. The role involves system integration, platform administration, and providing production support across the ECM ecosystem.
The role involves leading the development, negotiation, and administration of complex U.S. state and commercial contracts. You will collaborate with legal and business stakeholders to manage contractual risks and ensure compliance with healthcare regulations.
The RN Consultant reviews Medicaid prior authorization requests to determine medical necessity based on state policy guidelines. They also serve as a clinical subject matter expert to support providers and internal stakeholders in delivering cost-effective healthcare services.
The Chiropractic Consultant will adjudicate Medicaid prior authorizations based on medical necessity and state policy guidelines. They will also provide clinical guidance to providers and offer recommendations for process improvements within the dental program.
The consultant will review and adjudicate prior authorization requests for Personal Care Services and Private Duty Nursing to ensure medical necessity and compliance with Medicaid guidelines. They will also serve as a clinical subject matter expert, providing guidance to providers and stakeholders while maintaining accurate records in the Medicaid Management Information System.
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 strategic business goals.
The Senior Batch Developer will design, develop, and maintain data processing applications while collaborating with technical teams and clients to gather specifications. They are responsible for coding, testing, debugging, and implementing complex programs while ensuring system performance and production stability.
The Lead Coding Auditor performs itemized bill reviews, chart reviews, and coding validations to ensure accurate documentation and reimbursement. They also manage the appeals process, participate in hearings, and provide training and mentorship to other coding auditors.
The Senior Coding Auditor performs itemized bill reviews, chart reviews, and coding validation to ensure billed services are accurate and documented. They also assist management with training, mentoring, and monitoring new auditors while maintaining current knowledge of coding guidelines.
The Director, Pharmacy Program Strategy is responsible for the design, development, execution, and performance of pharmacy programs and solutions. They will lead market surveillance, financial analysis, and business growth strategies while collaborating with executive leadership and state sector teams.
The developer will design, develop, and maintain complex batch processing applications within Linux and Unix environments to support Medicaid operations. They will also provide technical leadership by mentoring teams and collaborating with stakeholders to implement scalable technical solutions.
The role involves supporting enterprise content and document management initiatives by performing business and data analysis. You will collaborate with stakeholders to gather requirements, map solutions, and ensure quality through testing and change management.
The role involves gathering and documenting business requirements while performing data analysis to support enterprise content and document management initiatives. You will collaborate with stakeholders and technical teams to map end-to-end solutions and ensure operational readiness through rigorous testing and auditing.
The Internal Audit Advisor leads complex internal audit and SOX readiness initiatives to enhance the company's internal control environment. They evaluate business processes, identify financial risks, and partner with leadership to remediate control gaps.
The Internal Audit Advisor leads complex internal audit and risk initiatives with a primary focus on SOX readiness and the enhancement of internal control environments. They evaluate business processes, identify financial risks, and partner with leadership to remediate control gaps and improve operational efficiency.
The agent provides bilingual technical support to healthcare providers by assisting with portal navigation, account management, and claims-related inquiries. They are responsible for researching issues, documenting interactions accurately, and ensuring compliance with privacy and security standards.
The Business Analyst acts as a domain subject matter expert to translate Medicaid policy into system requirements and design artifacts. They lead requirements sessions, support configuration activities, and ensure operational readiness through testing and collaboration with cross-functional teams.
The Clinical Quality Auditor performs ongoing quality assurance audits of clinical and coding staff to ensure accuracy in DRG assignment and documentation. They also identify quality trends, develop educational content, and mentor staff to maintain high-quality documentation standards.
The Senior Manager, Engineering leads the Maintenance & Operations tower, ensuring the stability, reliability, and continuous improvement of enterprise platforms. They oversee large-scale migration and modernization programs while providing strategic leadership for engineering teams and managing operational functions.
The role involves managing inbound and outbound communications via phone, email, and chat to assist members and providers with claims and insurance inquiries. You will be responsible for documenting interactions in a CRM, ensuring compliance with healthcare regulations, and meeting performance metrics.
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 Business Analyst will bridge the gap between clients and technical teams to define, document, and validate business requirements for healthcare technology projects. They will also lead quality initiatives, perform fit/gap analysis, and ensure developed products meet client needs.
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 Business Analyst will support enterprise content and document management initiatives by gathering requirements and mapping end-to-end solutions. They will collaborate with stakeholders and technical teams to ensure quality, compliance, and operational readiness through data analysis and testing.
Create clear, accurate, and user-friendly documentation including manuals, API guides, and release notes for software products. Collaborate with developers, product managers, and UX teams in an Agile environment to produce in-app assistance and training materials.
The Business Analyst will support Medicaid financial operations by analyzing business requirements, documenting functional designs, and enabling process improvements. They will collaborate with stakeholders to translate business needs into actionable objectives and ensure alignment with quality standards.
The specialist will adjudicate behavioral health prior authorizations based on medical necessity and state policy guidelines. They will also enter outcomes into the Medicaid Management Information System and provide education to the provider community.
The analyst is responsible for performing full claim overpayment analysis by auditing paid claims data against state and federal regulations. They collaborate with clinical staff and stakeholders to identify overpayment trends and document audit findings for client approval.
The specialist will lead the development, negotiation, and administration of complex commercial and government contracts while managing contractual risks. They will collaborate with cross-functional teams to ensure regulatory compliance and provide guidance on contract governance across the enterprise.
Design, build, and deploy advanced AI and Generative AI solutions across healthcare technology platforms. Ensure model performance, scalability, and compliance with healthcare industry regulations like HIPAA.
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 EDI Helpdesk Representative serves as the primary point of contact for healthcare providers, managing inbound calls and resolving EDI-related inquiries. They are responsible for troubleshooting provider issues, processing updates, and ensuring all documentation meets accuracy and compliance standards.
The representative will handle call center operations to support healthcare clients and their members. They are responsible for providing innovative solutions while maintaining professional communication and focus.
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 Senior Cloud IAM Engineer will lead the design, implementation, and governance of identity and access management solutions across AWS and Azure platforms. Responsibilities include automating provisioning workflows, auditing configurations for compliance, and collaborating with security teams to enforce least privilege access.
The Senior Project Coordinator leads medium-sized project management teams to deliver innovative healthcare technology solutions. They are responsible for overseeing project lifecycles, managing budgets, mitigating risks, and maintaining clear communication with clients and internal leadership.
The specialist will lead the development, negotiation, and administration of complex contracts while ensuring regulatory compliance across the enterprise. They will collaborate with legal, procurement, and business stakeholders to manage contractual risks and support organizational objectives.
The Contract Management Lead will draft, review, and negotiate a wide variety of complex commercial and government healthcare contracts. They will also analyze contractual risks, ensure regulatory compliance, and collaborate with cross-functional teams to manage the full contract lifecycle.
The role involves designing, developing, and deploying advanced AI and Generative AI solutions for healthcare platforms while ensuring system integration and performance optimization. You will work with large datasets, implement security guardrails, and collaborate with cross-functional teams to automate workflows.
The Senior Software Engineer will design, develop, and support enterprise integration solutions, including secure APIs, microservices, and cloud-native services. They will collaborate with cross-functional teams to implement system integrations and support Medicaid modernization initiatives.
The Information Security Officer oversees the development and implementation of corporate-wide application security procedures to ensure compliance with government and client regulations. They also manage security administrator teams, conduct security education programs, and investigate security violations to recommend corrective actions.
The Invoice Business Analyst is responsible for preparing monthly, quarterly, and milestone-based invoices while maintaining billing trackers and documentation. This role also involves reconciling billing data, verifying source documents, and supporting account-related administrative duties.
The Nurse Reviewer performs clinical reviews of medical records to determine medical necessity and appropriateness of care based on established criteria. They are responsible for documenting findings, processing prior authorizations, and supporting team members through training and mentoring.
The Senior Professional Business Analyst will lead requirements discovery and end-to-end traceability for Medicaid DDI programs and modernized provider capabilities. They will partner with cross-functional teams to translate complex policy and business rules into clear, testable specifications for cloud-native solutions.
Design, build, test, and operate secure, scalable software for Medicaid DDI programs and Provider Plus capabilities. Develop React/TypeScript micro-frontends, .NET microservices, and cloud-native AWS workloads while maintaining automated CI/CD pipelines.
The representative will handle inbound and outbound member interactions to support the Customer Engagement Verification program. Responsibilities include documenting customer activity, updating account information, and resolving routine inquiries while adhering to program requirements.
Provide senior technical leadership for secure, scalable applications supporting Medicaid and Provider Plus delivery. Lead application design, mentor engineering teams, and oversee the implementation of CI/CD, cloud infrastructure, and integration standards.
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.
The role involves overseeing the development and implementation of corporate-wide application security procedures to ensure compliance with government and client regulations. Additionally, the incumbent will lead security administrator teams, conduct security education programs, and investigate security violations to recommend corrective actions.
The AI Engineer will design, develop, and deploy advanced AI solutions, including Generative AI, across healthcare technology platforms. This role involves integrating models into existing systems, ensuring performance optimization, and maintaining compliance with healthcare regulatory standards.
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 Mainframe Developer designs, develops, and maintains complex business programming applications throughout the entire system lifecycle. They collaborate with team members to ensure system requirements are met while providing ongoing maintenance, debugging, and technical support.
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.
The Reporting Analyst will develop and maintain reporting and analytics solutions to help leadership make data-driven decisions. They will partner with cross-functional teams to define performance metrics and translate complex data into actionable insights.
The Business Analyst will coordinate policy research, design implementation strategies, and manage user acceptance testing for healthcare medical policies. They will also liaise between operational and development teams to ensure project requirements are met and documentation is maintained.
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 Business Analyst will analyze, plan, and document business processes to support client technological goals while acting as a bridge between clients and technical teams. They are responsible for defining business requirements, creating test scenarios, and ensuring the intent of change is maintained throughout the project lifecycle.
The Healthcare Product Solutions Manager will lead Medicaid claims-related product domains and define the strategy for modernizing core adjudication capabilities. This role involves collaborating with cross-functional teams to translate complex program needs into scalable product roadmaps and measurable outcomes.
The Advisor Business Analyst leads business process modeling and requirements analysis to align IT solutions with strategic objectives. They also oversee training material development and provide mentorship to junior team members across multiple complex accounts.
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 Process Writer will document existing processes, create Standard Operating Procedures (SOPs) and Desk Level Procedures (DLPs), and develop process maps for CX functional areas. They will also collaborate with cross-functional teams to identify inefficiencies, conduct gap analyses, and ensure documentation standards are maintained.
The Business Analyst will translate client business needs into technical requirements and monitor call center queues and reports. They will also document system requirements, build process models, and verify system design through test case execution.
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.
You will design and deliver scalable Medicaid Drug Rebate applications while optimizing complex workflows and business processes. You will also collaborate with cross-functional teams to maintain solution standards and provide technical expertise throughout the product lifecycle.
Handle inbound calls from members and providers to provide accurate information regarding healthcare benefits, eligibility, and services. Document customer interactions clearly in multiple systems while meeting quality and productivity standards.
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.
Design, develop, and deploy advanced AI and Generative AI solutions for healthcare platforms while ensuring system integration and performance optimization. Collaborate with cross-functional teams to automate workflows and maintain compliance with healthcare industry regulations.
Design, develop, and maintain Amazon Connect solutions for voice and digital customer interactions. Collaborate with cross-functional teams to integrate CRM platforms and ensure system stability through production support.
You will design, develop, and integrate scalable Amazon Connect solutions to enhance customer contact experiences across voice and digital channels. Additionally, you will collaborate with cross-functional teams to troubleshoot production issues and ensure seamless integration with CRM and enterprise applications.
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.
Lead, coach, and develop a team of quality assurance professionals to monitor customer interactions and maintain compliance standards. Analyze performance data and quality trends to provide actionable insights that improve customer experience and operational efficiency.
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 Senior Software Developer will design, develop, troubleshoot, and analyze software programs while coordinating with departments to resolve significant software matters. They will also provide first-level on-call support and maintain communication with management and customers regarding project status.
The Clinical Quality Nurse Reviewer performs ongoing quality assurance audits, clinical claims reviews, and coding audits to ensure alignment with medical records and regulatory guidelines. They also identify quality trends, provide remediation training, and support management in mentoring new reviewers.
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.
The Senior Business Analyst will coordinate team duties on IT projects and act as a bridge between clients, project managers, and technical staff to define business requirements. They will also analyze and document business processes while validating test results to ensure project objectives are met.
Design, develop, install, test, and document application software including server, client, and web components. Coordinate with application architects to define project requirements and ensure technical solutions meet client needs.
The Senior Business Analyst is responsible for posting medical and pharmacy claims, reconciling accounts receivable, and resolving payment discrepancies. They also collaborate with client engagement teams to gather business requirements and communicate them to technical personnel.
The Senior Professional, HRBP provides daily HR support to managers and employees while partnering with business leaders to implement HR programs. This role manages employee relations, performance management, and talent processes while ensuring compliance with employment regulations.
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 Senior Associate performs audits of inpatient medical records to ensure the accuracy of diagnosis and procedure coding according to regulatory guidelines. They also provide mentorship and training to other auditors while maintaining productivity and quality standards.
Lead end-to-end pharmacy testing across SIT, UAT, and regression cycles while ensuring compliance with Medicaid regulations. Manage cross-functional coordination and provide leadership reporting on quality metrics, risks, and test progress.
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 SME will review and evaluate CPT, HCPCS, and ICD-10 coding updates to ensure compliance with Wisconsin Medicaid Long-Term Care programs. They will also lead cross-functional projects, facilitate stakeholder discussions, and maintain centralized documentation for coding and reimbursement policies.
Manage and support Identity and Access Management processes including user provisioning, access reviews, and role management. Design and maintain Microsoft Entra ID, CyberArk PAM, and Saviynt IGA solutions while ensuring compliance with security standards.
Manage and support Identity and Access Management (IAM) processes, including user provisioning, access reviews, and role management. Design and maintain IAM solutions while collaborating with IT teams to ensure appropriate access controls and compliance.
The Batch Developer will code, test, debug, and document low to moderately complex programs while designing systems to meet business needs. They will also collaborate with management to validate requirements, develop test plans, and conduct quality assurance activities.
The analyst will perform daily financial operations including accounts payable, accounts receivable, bank reconciliations, and 1099 activities. They will also utilize SQL and reporting tools to analyze financial data, support audits, and collaborate with cross-functional teams to resolve discrepancies.
The analyst is responsible for full claim overpayment analysis by auditing paid claims data against state and federal regulations. They collaborate with cross-functional teams to identify, validate, and recover overpaid claims while recommending process improvements.
The Clinical Policy Specialist develops and enhances itemized bill review clinical and coding solutions while serving as a subject matter expert for audit strategies and reimbursement methodologies. This role collaborates with cross-functional teams to identify billing vulnerabilities, optimize program performance, and ensure compliance with industry standards.
The Vice President of Delivery is responsible for ensuring that Pharmacy implementation projects meet contractual specifications and drive competitive delivery strategies. This role oversees program management, financial performance, and cross-functional collaboration to ensure high-quality delivery across global networks.
The Associate Manager leads the training team in designing, developing, and delivering learning solutions that improve employee performance and operational readiness. They are responsible for managing training execution, facilitator readiness, curriculum quality, and stakeholder partnerships across various business units.
The representative will provide knowledgeable responses to client inquiries and resolve issues while adhering to service level agreements. They will also collaborate with team members to improve workflows and cross-train new staff on customer service processes.
Lead and develop quality assurance teams to ensure contact center interactions meet compliance and service expectations. Analyze operational data to identify trends and partner with cross-functional teams to implement actionable business improvements.
The Associate Manager, Training leads the planning, execution, and evaluation of learning solutions to improve employee performance and operational readiness. This role manages training operations, facilitator readiness, and curriculum quality while partnering with business leaders to align training with organizational goals.
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 goals for assigned accounts.
The supervisor will oversee a call center team, managing hiring, training, and performance evaluations to ensure service level agreements are met. They are responsible for researching and resolving inquiries while monitoring and improving call center processes.
The supervisor will lead a team responsible for drug claims auditing and adjudication while ensuring compliance with PBM and Medicaid guidelines. They will also manage audit workflows, monitor performance metrics, and partner with internal teams to resolve complex claims issues.
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 Senior Principal Solution Architect will lead Medicaid claims-related product domains and define the portfolio-level transformation roadmap. This role involves shaping enterprise product strategy and aligning cross-functional teams to modernize core adjudication capabilities.
The CX Associate Professional Quality is responsible for monitoring and evaluating voice and non-voice interactions to ensure compliance with regulatory and company standards. This role involves conducting daily audits, facilitating calibration sessions, and providing data-driven recommendations for process improvements.
The Claims Resolution Analyst is responsible for researching, resolving, and processing medical and dental claims while ensuring compliance with guidelines. They must collaborate with internal departments to address claim issues and maintain high standards of accuracy and service.
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 durable medical equipment claims, Treatment Authorization Requests, and supporting medical documentation to ensure compliance with program requirements. They will collaborate with clinical and operational teams to document findings and support timely claim adjudication.
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 podiatry-related medical records, claims, and treatment authorization requests to ensure compliance with clinical and program requirements. They will collaborate with multidisciplinary teams to resolve review questions and document clinical findings accurately.
The Medical Reviewer will interpret medical records and clinical documentation to determine the medical necessity and appropriateness of healthcare services. They will also collaborate with healthcare professionals to support accurate medical review determinations and maintain compliance with regulatory requirements.
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 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.
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 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.
The Senior Workforce Management Scheduler is responsible for developing and optimizing workforce schedules to meet forecasted demand and operational service goals. They collaborate with cross-functional teams to identify coverage risks and implement adjustments that improve workforce efficiency and service performance.
The Real-Time Analyst monitors live operational performance, queue volumes, and agent adherence to identify and mitigate intraday staffing risks. They execute workforce actions such as schedule adjustments and overtime to ensure service levels are maintained across global delivery teams.
Develop and maintain short- and long-term workforce forecasts while translating business demand into actionable staffing and capacity plans. Partner with cross-functional teams including Operations, Finance, and Training to identify capacity risks and provide data-driven recommendations.
The Capacity Planner will analyze historical data and business drivers to create accurate workforce forecasts and staffing requirements. They will collaborate with cross-functional teams to identify capacity gaps, operational risks, and provide data-driven insights for business decision-making.
The Program Support Specialist provides administrative, customer service, and operational support to ensure successful service delivery to clients and providers. Responsibilities include managing client relationships, preparing reports, analyzing data, and overseeing provider recoupments.
The Senior Manager leads the strategy, delivery, and operational support of enterprise integration solutions for healthcare data exchange. This role oversees interface architecture, data conversion, and API integrations while partnering with stakeholders to ensure successful program modernization.
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 Claims Examiner Assistant is responsible for entering insurance claims, verifying policyholder information, and investigating claims to determine resolution. They also handle incoming customer calls and coordinate with appropriate sources to obtain necessary information for claim processing.
The Outpatient Coding Auditor performs audits of medical records to ensure the accuracy of diagnosis and procedure codes according to regulatory guidelines. They also assist management with training, mentoring, and providing feedback to new coding auditors.
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 Advisor Project Management leads large project teams to deliver health and human services technology solutions while managing budgets, schedules, and project deliverables. They are responsible for communicating project status to stakeholders, mitigating risks, and supporting business development through proposal efforts.
The specialist will collaborate with providers and insurance carriers to resolve denied or unpaid claims and ensure proper reimbursement. They are responsible for managing aging reports, pursuing appeals, and maintaining accurate documentation within the case management system.
The role involves responding to inbound calls from Medicaid providers and members to verify insurance coverage and coordinate benefits. Additionally, the assistant will process correspondence, maintain accurate records, and perform administrative data entry tasks while adhering to HIPAA regulations.
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.
Translates state and federal Medicaid policy into product features, system configurations, and design artifacts. Acts as a domain subject matter expert to ensure successful implementation and operational readiness across healthcare systems.
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 DRG Nurse Reviewer coordinates and performs appeal-related duties, including analyzing provider appeals and preparing case files for hearings. They also participate in hearings alongside the Medical Director and assist in training new reviewers.
The role involves managing inbound and outbound communications via phone, email, and chat to assist members and providers with inquiries. Responsibilities include researching claims, verifying insurance coverage, and documenting all interactions accurately within a CRM system.
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 Unit Lead provides daily operational support, coaching, and guidance to Healthcare Call Center Representatives to ensure quality and compliance. They also assist with complex escalations, monitor team performance, and collaborate with internal departments to maintain service standards.
The Pharmacy Provider Relations Manager will manage relationships with Ohio pharmacies, oversee contract execution, and ensure network adequacy. This role acts as a liaison between internal teams and pharmacy providers while monitoring performance through operational reporting and audits.
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 program KPIs and SLAs while supporting executive leadership through strategic reporting and stakeholder engagement.
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 role involves producing, validating, and distributing workforce management reports to help leaders understand service performance and operational efficiency. You will also identify meaningful patterns in workforce data and translate these findings into actionable recommendations for stakeholders.
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 healthcare regulatory standards like HIPAA.
The Data Analyst is responsible for producing, validating, and governing recurring Workforce Management reports to support operational leaders. They will identify meaningful patterns in workforce data and translate these insights into actionable recommendations for cross-functional teams.
The Account Privacy Officer serves as a subject matter expert for HIPAA and state privacy regulations, conducting risk assessments and managing privacy-related incidents. They are responsible for maintaining compliance documentation, supporting client privacy requests, and fostering a culture of privacy awareness across the organization.
The developer will design, build, and maintain complex business applications while managing the full system lifecycle. They will also collaborate with team members to analyze system requirements and ensure high-quality, compliant software delivery.
The DRG Clinical & Coding Educator develops and delivers comprehensive training programs for clinical reviewers, auditors, and coding staff. This role serves as a subject matter expert to ensure coding accuracy, clinical competency, and compliance with industry standards and payment integrity methodologies.
The Business System Architect is responsible for eliciting, analyzing, and documenting business requirements while acting as a bridge between stakeholders and technical teams. They support the software development lifecycle, manage project impacts, and provide guidance to junior analysts.
The Business Analyst will own the governance and validation of AI-generated requirements and ensure alignment with business rules and data mappings. They will also coordinate team duties, act as a bridge between clients and technical staff, and analyze business processes to support technology goals.
The role involves coding, testing, debugging, and documenting programs to meet client needs while assisting in production support. You will also design program enhancements, develop test plans, and conduct quality assurance activities like peer reviews.
The role involves leading the development, negotiation, and administration of complex commercial and government contracts across the enterprise. You will partner with legal, procurement, and business stakeholders to manage contractual risk and ensure regulatory compliance throughout the contract lifecycle.
The Contract Management Lead will independently manage the full lifecycle of complex commercial, technology, and government contracts. They will collaborate with cross-functional teams to negotiate terms, mitigate contractual risks, and ensure compliance with healthcare regulations and corporate policies.
The specialist will lead the development, negotiation, and administration of complex commercial and government contracts while ensuring regulatory compliance. They will partner with legal, procurement, and business stakeholders to manage contractual risks and drive standardized contract practices.
The Senior Manager oversees the strategy, design, and execution of complex, multi-account pharmacy programs to meet cost, performance, and quality objectives. They collaborate with cross-functional teams to drive business development and ensure programs align with client needs and regulatory requirements.
The Advisor Application Developer will lead the design, development, and deployment of healthcare transaction solutions, specifically focusing on NCPDP F6 processing. They will also collaborate with cross-functional teams to maintain APIs, perform code reviews, and ensure system scalability and compliance.
The Domain Lead is responsible for defining and validating functional requirements, overseeing solution design, and managing configuration activities. They also serve as a functional subject matter expert during testing phases and ensure alignment across all project teams through go-live.
The developer will design, develop, and test software services while investigating and resolving complex technical product integration matters. They will also assist in modifying company products and documenting program requirements to meet client needs.
The developer will perform design, development, and testing activities while supporting the full life cycle of batch development processes. They will also investigate and resolve complex technical product integration matters and assist in technical decision-making.
The Business Analyst will analyze, plan, and document business processes to support client technological goals while acting as a bridge between clients and technical teams. They are responsible for defining business requirements, creating test scenarios, and ensuring the intent of change is maintained throughout project phases.
The developer will design, code, test, and document software programs while supporting the full development life cycle. They will also investigate complex technical integration issues and assist in modifying systems to meet client requirements.
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 representative will answer incoming calls to provide professional assistance while accurately documenting interactions and resolving customer inquiries. They are also responsible for collaborating with team members to improve workflows and meeting established service-level agreements.
The PMO Project Cost Control Manager is responsible for preparing and maintaining project financial forecasts, including labor, hardware, and software costs. They monitor project expenses, investigate budget variances, and provide data-driven insights to project leadership.
Process provider enrollment cases and update provider information within internal systems. Collaborate with team members to ensure quality assurance and provide exceptional customer service to clients and providers.
The developer will design, code, test, and implement complex technical programs while collaborating with clients and management to address business needs. They will also provide leadership and guidance to less experienced team members to ensure the delivery of high-quality healthcare administration products.
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.
Design, develop, and maintain Databricks ETL/ELT pipelines to process complex Medicaid datasets including claims, eligibility, and provider files. Create Power BI semantic models and dashboards to support operational performance monitoring, regulatory reporting, and program integrity.
The developer will design, develop, and test healthcare administration products while managing batch job automation and system integration. They will also be responsible for resolving technical issues, documenting programs, and conducting quality assurance activities.
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 Systems Manager is responsible for the performance, availability, and modernization of systems supporting the Medicaid Management Information System. This role leads technical operations, enforces ITSM processes, and acts as a primary liaison for client stakeholders.
The Provider Quality Analyst will perform detailed credentialing tasks and support operations to help clients improve healthcare outcomes. The role requires maintaining focus on complex data while adhering to company policies and performance standards.
The Business Analyst will coordinate implementation strategies for healthcare policies and facilitate communication between operational and development teams. They are responsible for defining project scope, managing documentation, and leading provider messaging campaigns.
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 Advisor Product will lead Medicaid claims-related product strategy and domain roadmaps to modernize core adjudication capabilities. They will collaborate with cross-functional teams to translate complex program needs into scalable, data-driven product solutions.
The Business Analyst serves as a liaison between clients, project managers, and technical teams to gather and document business requirements and process flows. They also act as a subject matter expert in Medicaid financial processing while coordinating project milestones and supporting testing activities.
The Engagement Lead is responsible for overseeing complex client implementation initiatives, ensuring they meet scope, schedule, budget, and quality expectations. This role serves as the primary point of accountability, managing cross-functional teams and maintaining senior-level client relationships throughout the program lifecycle.
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.
Oversee multiple complex projects and lead implementation teams to drive payment integrity growth and revenue recognition. Responsible for project planning, budget control, risk mitigation, and communicating project metrics to client and company leadership.
Lead end-to-end pharmacy testing across SIT, UAT, and production validation for PBM and Medicaid solutions. Manage test strategies, defect resolution, and cross-functional coordination among stakeholders and vendors.
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.
Research, resolve, and process medical claims while ensuring accuracy and compliance with established guidelines. Coordinate with internal departments and prepare necessary documentation, such as Return to Provider forms.
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.
Serve as the primary contact for healthcare providers to resolve EDI-related inquiries through inbound and outbound communication. Research and troubleshoot provider issues while maintaining accurate documentation and compliance standards.
The role involves the design, development, and testing of C/Pro*C software components within a healthcare technology context. The developer will act as a liaison between architects and teams to ensure product quality and provide guidance to junior personnel.
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.
Conduct prior authorization, prospective, concurrent, and retrospective reviews to determine the medical necessity and appropriateness of services. Document findings in medical management systems and collaborate with providers and Medical Directors to ensure policy compliance.
Responsible for designing, computing, and validating healthcare quality measures for the Medicaid PCMH program using large-scale datasets. The role involves translating complex technical requirements into audit-ready measures and communicating results to clinical and leadership stakeholders.
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.
Design, code, and document complex programs and scalable ETL/ELT pipelines using Databricks. Provide technical leadership, conduct quality assurance, and collaborate with clients to validate programming requirements.
Serve as the account domain expert providing technology leadership with a focus on cloud-native AWS application architecture. Drive project delivery by translating architectural vision into scalable solutions and guiding application migration and modernization.
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.
Acts as a technical liaison between customers and partners to ensure end-to-end solution delivery for client projects. Responsible for creating technical artifacts, managing security documentation, and overseeing SFTP/MFT implementations.
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.
Lead the planning and development of provider-facing publications and communications to support Medicaid program operations and regulatory compliance. Act as the primary liaison to translate complex healthcare policies into clear, actionable resources for providers.
Lead end-to-end data and analytics delivery for the Provider+ solution, overseeing integrations, reporting, and data conversions. Act as the primary technical advisor to Engagement Leaders to ensure technical design integrity and alignment with client commitments.
Lead the design, implementation, and governance of cloud IAM solutions primarily on AWS and Azure to ensure secure access to healthcare data. Responsibilities include automating provisioning workflows, auditing configurations for compliance, and collaborating with security teams to enforce least privilege.
The Process Writer is responsible for documenting existing processes, creating Standard Operating Procedures (SOPs), and developing process maps for the Customer Experience team. They will collaborate with Lean Six Sigma Black Belts to identify inefficiencies and ensure documentation aligns with industry best practices.
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 role involves leading security operational governance, driving remediation efforts, and ensuring delivery excellence in security tooling while managing supplier and client relationships. Key duties include creating account security plans, managing security incidents from start to finish, and overseeing audit preparation and risk management.
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.
