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 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 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 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.
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 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.
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.
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 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 will document existing processes, create standardized SOPs and DLPs, and develop process maps for CX functional areas. They will also collaborate with cross-functional teams to identify inefficiencies and ensure documentation aligns with organizational best practices.
You will design, develop, and test application software while creating technical documentation and functional specifications. You will also act as a bridge between architects and developers to ensure design requirements are met and project objectives are achieved.
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 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 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 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 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, audit preparation, and maintaining account security plans while fostering relationships with suppliers and clients.
Design, develop, and maintain Java/Spring Boot applications and REST APIs while leveraging AI-assisted tools to accelerate development and testing. Collaborate with cross-functional teams to deliver healthcare solutions and ensure code quality, security, and performance.
The Principal Project Manager creates and implements complex project definitions, schedules, and budgets while managing stakeholder expectations and project deliverables. They also oversee project teams, identify risks, and develop mitigation strategies to ensure project success and client satisfaction.
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 Internal Audit Professional will execute risk-based audits of business processes and operational activities to evaluate control effectiveness. They will also document audit findings, provide recommendations for process improvements, and monitor the implementation of corrective actions.
The Portfolio Manager will define program goals, long-term strategy, and execution roadmaps while coordinating multiple related projects. They are responsible for overseeing end-to-end delivery, managing stakeholder expectations, and driving operational excellence through continuous improvement.
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 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 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 developer will design, code, test, and document web-based applications while supporting existing systems and resolving production issues. They will also collaborate on innovative solutions to improve health and human services outcomes for clients.
Deliver engaging and interactive training sessions to call center agents and other departments while facilitating virtual programs. Design effective training materials and assess learner outcomes through feedback and performance metrics.
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 Certified Pharmacy Technician supports pharmacy operations by managing prior authorizations, pharmacy claims, and benefit inquiries for members and providers. They are responsible for researching and resolving medication-related concerns while maintaining accurate documentation in a high-volume environment.
Deliver engaging and interactive training sessions to call center agents and various departments while designing visually appealing training materials. Collaborate with subject matter experts and leadership to assess training outcomes and provide ongoing support to learners.
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 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 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 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 role involves leading small to medium-sized projects by managing scope, budget, schedules, and risks while ensuring adherence to project management standards. You will oversee project teams, facilitate communication, and manage stakeholder expectations to drive successful project delivery.
The representative will handle inbound and outbound calls regarding healthcare services, Medicaid, claims, and billing while documenting interactions accurately. They are responsible for assessing customer needs, researching inquiries using system tools, and escalating complex issues as necessary.
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 is responsible for aligning the project management team and overseeing complex project definitions, schedules, and budgets. They act as the primary point of contact for clients while managing risks and ensuring architectural and release alignment.
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 Mainframe Developer will design, build, and maintain complex business programming applications while ensuring system requirements are met throughout the lifecycle. They will also collaborate with team members to develop project schedules and perform ongoing maintenance, testing, and debugging of applications.
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 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 Senior Transformation Manager is responsible for operationalizing and governing the testing transformation strategy across enterprise programs. This includes defining roadmaps, ensuring process compliance, and driving continuous improvement through data-driven insights and cross-functional coordination.
The Senior Transformation Manager is responsible for operationalizing and governing the testing transformation strategy across the organization. This role involves defining roadmaps, coordinating cross-functional initiatives, and ensuring the consistent implementation of quality processes and automation frameworks.
The Senior Developer will design, develop, and maintain healthcare administration applications while collaborating with technical teams and clients to gather specifications. They are responsible for coding, testing, debugging, and providing ongoing production support for batch processing environments.
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.
The role involves administering, supporting, and maintaining enterprise SharePoint and Project Server environments hosted on AWS. You will collaborate with cross-functional teams to ensure system availability, security, and performance while executing cloud migrations.
Design, develop, and deploy advanced AI and Generative AI solutions for healthcare technology platforms. Collaborate with software engineers to integrate models while ensuring compliance with healthcare regulations and performance optimization.
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.
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 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 Senior Technical Writer researches, writes, and edits complex technical documentation, including manuals, procedures, and online help files. They also coordinate project plans and collaborate with technical personnel to translate complex information into user-friendly content.
The Business Analyst will analyze, design, and document business processes to support 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 Inpatient Coding Auditor performs audits of medical records to ensure the accuracy of diagnosis and procedure codes according to regulatory guidelines. They also provide mentorship and training to new auditors while maintaining productivity and quality standards.
The Business Analyst will collaborate with teams to translate client business needs into technical requirements and document system processes. They will also assist in verifying system designs against client requirements through test case execution and technical reviews.
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 supervisor will lead a remote team in a healthcare contact center, overseeing daily operations, performance metrics, and customer outreach activities. They are responsible for coaching staff, managing escalations, and ensuring compliance with program requirements and quality standards.
The Information Security Officer serves as a trusted advisor to align security practices with client objectives and regulatory requirements. They lead security governance, manage risk, and coordinate audit preparation and incident reporting across assigned accounts.
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 Senior Business Analyst will lead complex claims and financial processing activities for the DC Medicaid program while analyzing data to identify trends and operational improvements. They will collaborate with stakeholders and management to translate business needs into actionable insights and system enhancements.
The Senior Analyst will support enterprise workforce planning, staffing alignment, and labor utilization across the project portfolio. They will analyze workforce demand and resource allocation to provide actionable insights and drive continuous improvement in operational effectiveness.
Lead workstreams to design, develop, and test complex application software across server, client, and web components. Serve as a technical consultant to senior management while guiding collaboration between architects and developers to ensure project success.
The Project Manager will lead large technological project teams, overseeing project planning, budgeting, and scheduling to ensure quality deliverables. They will also communicate project status to stakeholders, manage risks, and support business development efforts through proposal and SOW creation.
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 CRM Developer will design, develop, and implement Microsoft Dynamics 365 solutions while collaborating with stakeholders to meet business requirements. They are also responsible for providing ongoing application support, maintenance, and technical documentation for the CRM platform.
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 Program Manager is responsible for managing client relationships and overseeing the delivery of services to government clients in accordance with contract requirements. They will also lead project approaches, monitor program progress against business goals, and provide guidance to team members.
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 issues, processing member updates, and ensuring all documentation meets accuracy and compliance 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 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 Pharmacist Advisor provides clinical expertise and strategic guidance to support pharmacy programs, ensuring safe and compliant medication management. Responsibilities include conducting clinical evaluations, performing prior authorization reviews, and supporting quality improvement initiatives.
The Senior Professional Trainer designs, develops, and delivers advanced training programs for management and professional development. They also conduct needs assessments, evaluate training effectiveness, and provide leadership to less experienced personnel.
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 developer will code, test, debug, and document complex programs while analyzing system requirements to develop effective technical solutions. They will also lead a small sub-team of developers and provide technical consulting to clients and management.
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, develop, and test software solutions while supporting the full life cycle of product development. They will also investigate and resolve complex technical integration issues and assist in modifying systems to meet client needs.
The Senior Business Manager is responsible for managing the delivery of operational services, including people, processes, and technology, to ensure contractual obligations and performance stability. They lead teams, drive innovation and cost efficiency, and partner with leadership to optimize client relationships and service delivery.
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 CX Senior Business Manager is responsible for managing operational service delivery, including people, processes, and technology, to ensure contractual obligations and performance goals are met. They lead cross-functional teams, drive process optimization, and partner with leadership to influence financial outcomes and service innovation.
The programmer analyst will develop and maintain healthcare administration products by coding, testing, and debugging complex technical programs. They will also provide on-call support, troubleshoot production issues, and collaborate with clients to validate requirements and recommend system enhancements.
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 PBM Call Center Manager will lead daily operations to ensure service levels, quality, and customer experience goals are met. They will also coach supervisors, monitor performance metrics, and collaborate with stakeholders to resolve escalations and improve processes.
The Product Experience Owner manages the operational roadmap and workflow standardization for the Verint Operations Manager platform. They serve as the primary liaison between technology teams and business stakeholders to ensure platform capabilities align with operational execution needs.
The Senior Data Analyst is responsible for eliciting, analyzing, and documenting business requirements to translate objectives into technical solutions. They act as a liaison between stakeholders and technical teams to ensure software applications meet business needs throughout the development lifecycle.
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.
This role is responsible for configuring and maintaining Verint Operations Manager workflows, queues, and skills to support business operations. It involves executing configuration changes, performing functional testing, and documenting requirements to ensure standardized work orchestration.
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 Healthcare Product Solutions Manager will lead Medicaid claims-related product domains and define the strategy for core adjudication capabilities. This role involves collaborating with engineering, architecture, and business stakeholders to modernize Medicaid systems and improve operational outcomes.
Answer inbound member calls to provide accurate information regarding healthcare benefits, eligibility, and services. Document interactions in the CRM system and collaborate with team members to resolve member concerns.
The AI Governance Principal administers the AI governance operating model, including managing use case intake, maintaining centralized repositories, and ensuring compliance with legal and regulatory requirements. This role also coordinates cross-functional reviews, prepares governance documentation, and supports audit readiness and reporting for leadership.
The analyst will perform complex quality reviews, audits, and reconciliations to support outsourced healthcare services. They are also responsible for identifying workflow improvements, maintaining standard operating procedures, and providing guidance to team members.
The Provider Field Representative will review and input enrollment data across multiple systems while maintaining compliance with contract requirements and regulations. The role also involves answering inbound calls and conducting face-to-face interactions as needed to support healthcare 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 representative serves as a primary point of contact for prescribers and pharmacies to resolve pharmacy claims and prior authorization inquiries. They are responsible for processing requests, documenting interactions, and ensuring compliance with HIPAA and Connecticut Medicaid guidelines.
The COB Claims Trainer is responsible for developing and delivering technical training programs related to Medicaid reclamation, claims processing, and reimbursement methodologies. This role involves partnering with operations and quality teams to translate complex policies into practical learning solutions while evaluating employee performance.
The Service Representative will research and resolve inquiries from providers, County Waiver Agencies, and the Department of Health Services. They are also responsible for conducting training sessions and maintaining strong stakeholder relationships.
The Director of Pharmacy Strategy is responsible for the design, development, and execution of pharmacy programs to support Medicaid members and state clients. They lead market analysis, financial forecasting, and cross-functional collaboration to drive business growth and optimize pharmacy performance.
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 role involves answering inbound customer calls, resolving inquiries, and accurately documenting account history. You will also perform data entry and collaborate with team members to ensure service level agreements are met.
The Senior Professional Trainer designs, develops, and delivers advanced training programs for management and professional development. They also conduct needs assessments, evaluate training effectiveness, and provide leadership guidance to less experienced personnel.
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 Batch Developer is responsible for coding, testing, debugging, and documenting programs to meet client objectives. They also assist in resolving production support issues and conduct quality assurance activities like peer reviews.
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 Senior Subrogation Case Worker is responsible for processing probate and estate functions for Medicaid beneficiaries, including asset investigation and claims review. They must manage case workflows, negotiate settlements, and maintain professional communication with attorneys, court staff, and family members.
The Associate Manager leads a team of Process Writers to develop, maintain, and improve operational documentation such as SOPs and process maps. They are responsible for quality oversight, project management, stakeholder coordination, and coaching team members to ensure documentation standards are met.
The Process Writer Associate Manager leads a team in developing and maintaining operational documentation such as SOPs, DLPs, and process maps. This role ensures documentation quality, manages project timelines, and acts as a key liaison between the writing team and executive leadership.
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 Provider Enrollment Specialist supports Medicaid provider enrollment, maintenance, and renewal activities for the WV Medicaid program. Responsibilities include reviewing and processing applications according to federal and state guidelines.
The representative will answer inbound calls to assist members with healthcare benefits, eligibility, and services while maintaining accurate documentation in the CRM system. They will also conduct outbound calls as needed and collaborate with team members to resolve member inquiries effectively.
Design, build, test, and support complex applications and batch solutions within a C, Unix/Linux, and Oracle environment. Partner with technical leads and business stakeholders to deliver scalable, reliable healthcare claims solutions while ensuring long-term stability and performance.
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.
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 analyst will monitor and evaluate voice and non-voice interactions to ensure compliance with regulatory standards and quality policies. They will also collaborate with teams to provide data-driven insights and support process improvement initiatives.
The Senior Quality Assurance Analyst establishes and maintains project-specific quality assurance strategies, plans, and metrics to ensure process and product compliance. They also lead quality programs, conduct audits, and provide mentorship to less experienced team members.
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 Enrollment Representative is responsible for reviewing and inputting enrollment data using multiple systems while ensuring compliance with contract requirements and regulations. The role requires maintaining high productivity, punctuality, and focus in a remote, metric-driven environment.
Provide exceptional customer service to Medicaid providers and members by assisting with coverage, claims, and benefit-related inquiries. Accurately interpret Medicaid policies, research disputed claims, and ensure timely follow-up to achieve prompt resolution.
The Provider Field Representative is responsible for reviewing and inputting enrollment data across multiple systems while maintaining compliance with contract requirements. The role also involves answering inbound calls and traveling throughout the state of Delaware to manage face-to-face interactions.
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 Batch 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, resolve production support problems, and research industry technical trends.
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.
Process over 500 Medicaid prior authorization requests per week while ensuring accuracy and compliance with policies. Collaborate with clinical teams and state employees to facilitate timely authorization and communicate effectively with providers.
The Systems Manager is responsible for the operational health, performance, and modernization of the Medicaid Management Information System (MMIS) and related enterprise services. This role leads technical delivery, enforces ITSM maturity, and acts as the primary liaison between technical teams and client stakeholders.
The Client Delivery Leader manages all aspects of service delivery for customer accounts while acting as a trusted advisor to the Account General Manager. They are responsible for coordinating cross-functional teams, ensuring SLA compliance, and driving operational metrics to improve public health outcomes.
Perform complex processing, quality reviews, audits, and reporting activities to support outsourced healthcare services. Identify operational issues, recommend workflow improvements, and provide leadership and guidance to team members.
The analyst performs complex processing and quality tasks to support outsourced healthcare services while ensuring adherence to compliance and regulatory standards. They are responsible for analyzing data, preparing reports, and collaborating with management and clients to resolve issues and improve workflows.
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 advisor participates in establishing information system frameworks and defining components to ensure alignment with business needs. They also work with clients to eliminate architectural gaps and ensure solutions meet performance and project constraints.
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 Batch Developer will code, test, and implement complex technical programs while participating in requirements gathering and design documentation. They will also provide on-call support, troubleshoot production issues, and perform root cause analysis to ensure system stability.
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 Senior Quality Assurance Analyst establishes and maintains project-specific quality assurance strategies, plans, and metrics to ensure process and product compliance. They also lead quality programs, conduct audits, and provide mentorship to less experienced team members.
The DRG Quality Advisor Nurse performs ongoing quality assurance audits, complex clinical review validations, and DRG clinical/coding audits of medical records. They also assist management with onboarding, training, and mentoring new reviewers while serving as a subject matter expert for business initiatives.
Supervise a multidisciplinary team of coders and auditors to ensure accurate medical record coding and DRG validation. Develop quality assurance processes, monitor performance metrics, and provide coaching to maintain regulatory integrity and revenue accuracy.
The Process Writer is responsible for documenting CX functional processes through flowcharts, process maps, and the creation of Standard Operating Procedures (SOPs) and Desk Level Procedures (DLPs). The role involves collaborating with Lean Six Sigma Black Belts to identify inefficiencies and maintain standardized documentation across the organization.
Lead the design, implementation, and governance of enterprise-wide ServiceNow solutions with a focus on platform scalability and architectural integrity. Manage third-party integrations and optimize CMDB health and data relationship modeling.
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.
Perform design, development, and testing for batch services within a Unix/Linux environment. Resolve complex technical product integration issues and create comprehensive technical documentation.
Lead and mentor a technical team to deliver high-quality C/Unix batch development solutions while overseeing the end-to-end software development lifecycle. Collaborate with cross-functional teams to design technical architecture and ensure alignment with business objectives for healthcare clients.
Perform complex quality assurance tasks and processing for provider enrollment services to ensure efficient transaction handling. Analyze reports, implement process improvements, and maintain documentation for standard operating procedures.
Perform complex processing, quality reviews, and audits to support outsourced healthcare services. Provide leadership and guidance to team members while implementing workflow improvements and maintaining standard operating procedures.
Perform design, development, and testing for batch services within a Unix environment. Resolve complex technical product integration issues and influence technical decisions across the project lifecycle.
Lead medium-sized project management teams to create innovative healthcare technologies and solutions for clients. Manage project deliverables, budgets, and schedules while interfacing with stakeholders to communicate metrics and mitigate risks.
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.
Lead large technical project teams to deliver healthcare and human services outcomes through planning, tracking, and oversight. Manage project budgets, schedules, and risks while coordinating with clients and leadership to ensure quality deliverables.
Perform design, development, and testing for batch services within a Unix/Linux environment. Resolve complex technical product integration issues and create comprehensive technical documentation.
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.
Responsible for monitoring and evaluating voice and non-voice interactions to ensure accuracy, compliance, and a positive member experience. This includes conducting daily audits, leading calibration sessions, and recommending process enhancements based on data insights.
Serve as a Quality Assurance subject matter expert providing hands-on support for evaluations, audits, and compliance across call center and back-office channels. Analyze quality metrics to identify root causes and partner with cross-functional leaders to drive process improvements and mitigate risk.
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.
Perform design, development, and testing for batch services within a Unix and SQL environment. Resolve complex technical product integration issues and create comprehensive technical documentation.
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.
Perform design, development, and testing for batch services and product integration. Responsible for coding, debugging, and documenting programs while conducting quality assurance through peer reviews.
Leads production control and database administration operations for the NJMMIS environment to ensure stability and performance of batch processing and database platforms. Oversees service delivery, claims configuration, and operational performance while managing technical teams and client relationships.
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 production control and database administration for the NJMMIS environment to ensure stability and performance of batch processing and database platforms. Oversee service delivery, claims configuration, and operational performance while managing technical teams and client relationships.
Design, develop, and maintain scalable and secure database systems to support critical healthcare operations. Lead client engagements to define design strategies and optimize database performance through monitoring and automation.
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.
Act as a bridge between clients and technical staff to define, document, and validate business requirements for IT projects. Coordinate the business analyst team and analyze business processes to improve client technology goals.
Develop, test, and debug complex technical programs for healthcare administration products. Provide on-call production support, perform root cause analysis, and collaborate with clients to validate program requirements.
Execute risk-based audits of business processes and operational activities to evaluate control effectiveness and governance. Develop practical recommendations to mitigate risks and monitor the implementation of corrective actions.
Serve as a QA subject matter expert providing hands-on support, evaluations, and audits across call center and back-office channels. Drive quality improvements through root cause analysis, peer coaching, and collaboration with cross-functional stakeholders.
Monitor and evaluate voice and non-voice interactions to ensure accuracy, compliance, and a high-quality member and provider experience. Conduct daily audits and collaborate with stakeholders to recommend process enhancements based on data-driven insights.
Lead the enterprise adoption of IAM process and technology enhancements while documenting requirements for system changes. Coordinate security best practices, support IAM operations such as access reviews and audits, and ensure compliance with industry standards.
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.
Lead large project management teams to deliver healthcare technology solutions by creating actionable plans, schedules, and budgets. Manage client expectations and project metrics while escalating risks and implementing mitigation strategies.
The Senior IAM Analyst facilitates the adoption of process and technology improvements in the Identity and Access Management space. Responsibilities include documenting requirements for software changes, supporting access reviews, and ensuring security compliance with industry standards.
Drive the delivery of care management solutions and cross-functional initiatives to support internal and external customers. Manage product delivery from strategic planning to tactical implementation while serving as a product evangelist.
The role involves planning and designing business processes to improve healthcare activities and documenting client requirements through data and process models. Additionally, the analyst is responsible for creating test scenarios, performing UAT, and validating that functional requirements are met.
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.
Define program goals and long-term strategies while overseeing the end-to-end delivery of complex healthcare technology programs. Facilitate communication between engineering, operations, and leadership to ensure alignment and operational excellence.
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.
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.
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.
Design, develop, and deploy advanced AI and Generative AI solutions to improve healthcare outcomes and operational efficiency. This includes end-to-end model deployment, data engineering with large healthcare datasets, and ensuring compliance with HIPAA standards.
Design, develop, and deploy advanced AI and Generative AI solutions to improve healthcare outcomes and operational efficiency. This includes building ML models, integrating them into existing technology stacks, and ensuring compliance with healthcare regulatory standards.
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 design, implementation, and governance of identity and access management solutions primarily across AWS and Azure platforms. Ensure secure and compliant access to healthcare data by enforcing least privilege and auditing configurations against frameworks like NIST and HITRUST.
Provide comprehensive support and troubleshooting for FraudCapture client users to ensure retention and system efficiency. Develop training materials and act as the primary point of contact for technical issues and requirement gathering.
The role involves leading data governance committees and ensuring the security and quality of healthcare data, specifically PHI and PII. Responsibilities include managing database architecture, data repositories, and collaborating with stakeholders to implement data services.
The role involves leading data governance committees and ensuring the security and quality of healthcare data, specifically PHI and PII. Responsibilities include designing database architecture, maintaining data management plans, and collaborating with stakeholders to solve complex data-related issues.
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.
Handle customer inquiries regarding insurance and healthcare while ensuring service level agreements are met. Investigate claim characteristics, resolve provider appeals, and recommend workflow modifications for efficiency.
Perform clinical reviews of medical records, itemized bills, and UB-04 forms to ensure billing accuracy and compliance. Conduct level-of-care and utilization reviews to determine the appropriateness of services while mentoring new reviewers.
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.
Design, develop, and maintain scalable data pipelines and models using Databricks, Spark, and Python to power organizational analytics. Collaborate cross-functionally to optimize data workflows and ensure governed access to data for reporting.
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.
Design, develop, and deploy advanced AI and Generative AI solutions to improve healthcare outcomes and operational efficiency. This includes building ML models, integrating them into existing technology stacks, and ensuring compliance with healthcare regulatory standards.
The CX Solution Consultant acts as a strategic advisor designing end-to-end customer experience solutions to drive business outcomes. They bridge the gap between client needs and technology capabilities by leading discovery sessions and developing value-based narratives.
Handle a high volume of inbound provider calls to resolve billing, policy, and Medicaid-related inquiries while meeting performance standards. Accurately document all interactions in the designated system to ensure data integrity and proper follow-up.
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.
