This role manages day-to-day security platform operations, including patching, upgrades, and policy configuration to detect and mitigate enterprise risks. The analyst also recommends and executes proactive security tool updates to strengthen the organization's security posture based on the evolving threat landscape.
The role involves participating in a 12-month analytics consulting program to produce datasets, reports, and strategic insights for health care business problems. Responsibilities include building dashboards, interpreting data trends, and presenting findings to senior leadership.
The representative will develop and maintain cooperative relationships with healthcare providers to support network performance and facilitate ease of business. They are responsible for issue resolution, provider education, and evaluating performance against operational and financial requirements.
The Sr Proposal Writer leads the development of complex, national Request for Proposals (RFPs) by collaborating with internal stakeholders to create persuasive, high-quality content. This role involves managing multiple projects simultaneously, ensuring compliance with client requirements, and mentoring junior staff to streamline the proposal process.
The Proposal Writer is responsible for leading complex Request for Proposal (RFP) activities and ensuring high-quality, compliant responses are delivered under strict deadlines. They also coordinate with internal subject matter experts and sales teams to maintain proposal content and support the overall sales cycle.
The Technical Eligibility Analyst is responsible for managing eligibility processes in a fast-paced, production-driven environment. They must ensure high attention to detail while communicating effectively with members, providers, and internal management.
The auditor is responsible for reviewing clinical, billing, and coding documentation to validate claims and ensure compliance with policies and legislation. They coordinate with various internal departments to conduct research and document findings related to special investigations and care affordability.
The Reimbursement Analyst develops reports using internal and external databases and creates pricing models for network negotiations and fee schedule updates. They are also responsible for implementing pricing information into the PREMIER Pricer system and validating report results.
This role involves providing advanced clinical leadership across medical management programs and integrating utilization review with population health strategies. The incumbent will align medical policy expertise with clinical strategy to influence quality, affordability, and provider performance.
The role involves answering customer calls, researching cases for third-party involvement, and documenting information in recovery systems. Additionally, the advocate will review claims related to accidents and manage correspondence and voicemail messages.
This role is responsible for creating reports, insights, and analytics to support divisional strategic initiatives and business needs. The consultant will interface between business and data teams to build actionable tools and interpret complex trends within datasets.
The role involves supporting strategic and analytical projects while assisting in the development of business plans for retail markets. You will interface with various business teams to align project outcomes with the overall company strategy.
This role supports the strategy, design, and optimization of Medicare Advantage provider Value-Based Care programs and alternative payment models. Responsibilities include integrating analytical findings to inform program strategy, developing contracting templates, and creating executive-level recommendations.
The Technical Eligibility Analyst manages technical tasks such as loading Triple E files and performing manual eligibility updates within the department. Additionally, the role involves providing quality service by accurately modifying eligibility data and responding to inquiries from members, clients, and colleagues.
This role manages data sets, analytical tools, and reporting functions to deliver strategic provider network insights. It also leads a team of analysts while fostering stakeholder relationships and implementing innovative data methodologies.
This role develops and maintains reimbursement and financial models to support contracting, pricing strategies, and network initiatives. The analyst will conduct financial impact analyses, produce reports, and provide actionable insights to support business decision-making.
The associate is responsible for selling healthcare products through inbound and outbound channels while conducting consultative needs assessments. They must manage sales opportunities, maintain territory programs, and ensure all activities comply with CMS and HCSC standards.
This position supports the provider recruitment and contracting process to ensure strategic coverage for an assigned territory. Responsibilities include negotiating small to mid-size contracts for physicians and maintaining ongoing relationships with providers.
This role supports pharmacists and pharmacy programs through member outreach, care coordination, and the resolution of pharmacy-related issues. The representative collaborates with internal departments, providers, and pharmacies to facilitate access to care and ensure high-quality member support.
The Senior Training Specialist partners with operational leaders to design, develop, and deliver learning solutions that improve employee performance and speed to proficiency. This role involves consulting with stakeholders to identify performance gaps and measuring the effectiveness of training programs.
This role involves designing technical solutions and specifications by integrating business requirements with information systems. The specialist will lead high-profile healthcare initiatives while supporting production operations and system stability.
This position is responsible for conducting care management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing, and providing data for regulatory reports while representing the company to members.
This role serves as the marketing lead for driving direct-to-consumer growth for Medicare Advantage through DRTV and digital channels. The advisor is responsible for developing and executing strategies to meet application and call volume goals while optimizing channel performance.
This role is responsible for driving Medicare product sales growth by managing relationships with brokers, agencies, and community partners. The associate will execute sales strategies, conduct training, and monitor performance metrics to ensure compliance with CMS guidelines.
The consultant is responsible for the design, implementation, and management of database assets in cloud environments using enterprise automation and monitoring tools. They will establish best practices for PaaS database automation and work with subject matter experts to provision infrastructure as code.
The Eligibility Analyst is responsible for managing eligibility and benefits data while ensuring high attention to detail in a fast-paced environment. They must effectively communicate with team members, clients, and providers to resolve issues and meet production deadlines.
The Customer Advocate Specialist is responsible for analyzing, resolving, and coordinating the processing of telephone and written inquiries. They also provide unit-specific coaching and handle escalated customer issues for lower-level advocates.
This position provides assistance to providers and Indian Health Services by analyzing and resolving inquiries related to claims, pricing, and benefits. The role also involves acting as a liaison between providers and IHS while contributing to project testing and process improvements.
The Senior Reliability Analyst optimizes reliability and stability objectives for production applications within the ARES team. They collaborate with management and technical staff to develop cost-effective solutions and ensure reliability challenges are systematically addressed.
This role supports population health, quality improvement, and value-based care initiatives through collaboration with providers and internal partners. Responsibilities include care gap identification, provider education, and the implementation of clinical strategies to enhance health outcomes.
The Senior Contract Specialist is responsible for drafting account-specific documents, reviewing non-standard language, and submitting regulatory filings. They also act as a liaison between stakeholders and manage the development of desk-level procedures and workflows.
Process complex medical claims that require further investigation, including coordination of benefits. Resolve pended claims under supervision.
This role supports quality imperatives and value-based care models by collaborating with medical practices to improve HEDIS measures. The consultant is responsible for clinical readiness assessments, provider training, and evaluating the effectiveness of quality improvement programs.
This role is responsible for supporting enhancements and new capabilities for critical business applications within the claims portfolio. The analyst will build system requirements, facilitate design and code reviews, and coordinate testing and release activities.
The Claims Recovery Examiner is responsible for researching refund checks, out-of-balance entries, and non-negotiated checks. This role involves performing actions such as offsetting, voiding, or reissuing provider checks based on complex pricing and coordination of benefits.
This role is responsible for aligning project designs with the application architecture roadmap and supporting technical design activities. The architect will act as a subject matter expert for product integrations and define interactions between application packages, databases, and middleware.
This position is responsible for developing and managing network strategies, drafting reimbursement contracts, and negotiating agreements for commercial and government networks. The role also involves overseeing staff, managing operational budgets, and ensuring network adequacy while maintaining provider relationships.
This role involves implementing, maintaining, and analyzing actuarial models for pricing, underwriting, and forecasting. The analyst will also develop presentations to communicate findings and support business decision-making.
The Customer Service Representative will resolve customer issues quickly and accurately while navigating multiple systems and screens. They are responsible for providing service excellence in a fast-paced, structured environment while maintaining high quality metrics.
The Claim Correction Analyst is responsible for managing claim corrections, including voids, history adjustments, stop payments, and refunds. They also coordinate with the legal department and fund accounting to resolve payment and check-related issues.
This position supports the development of divisional strategies and identifies tools to track strategic opportunities. It involves providing end-to-end report development and facilitating communication between business and technical teams to achieve organizational goals.
The Claims Corrections Analyst is responsible for processing system claims corrections, including voids, history adjustments, stop payments, and refunds. This role requires maintaining high accuracy and efficiency within a fast-paced, customer-service-driven environment.
The Medical Director is responsible for managing medical policies and programs while performing clinical reviews. They also interact with provider communities to ensure quality care standards.
This position is responsible for processing complex claims that require further investigation and coordination of benefits. The role also involves resolving pended claims under supervision.
The Senior Sales Manager is responsible for leading Individual Medicare sales across Tennessee and Arkansas by managing a team of Broker Sales Representatives. This role focuses on executing market growth strategies, strengthening broker partnerships, and ensuring alignment with enterprise sales priorities.
This role is responsible for aligning project designs with the application architecture roadmap and supporting functional and technical design activities. The architect will define interactions between application packages, databases, and middleware systems while acting as a subject matter expert for integration.
The role involves managing the implementation, maintenance, and analysis of actuarial models for pricing, underwriting, and reserving functions. It also requires developing complex models, training staff, and leading projects that involve both internal and external stakeholders.
The COBRA Analyst oversees all aspects of the COBRA client and member experience, including benefit elections, payments, and reporting. This role manages inbound and outbound communications via phone, email, and fax for COBRA, FMLA, and leave programs.
The Infrastructure Engineer will improve the Virtual Desktop experience through automation, design, and the creation of repeatable deployment patterns. They will collaborate with engineering and operations teams to manage desktop virtualization roadmaps and transition knowledge to support staff.
This position is responsible for managing medical policies and programs while performing medical reviews. The role involves interacting with provider communities to ensure effective healthcare delivery.
This position is responsible for managing medical policies and programs while performing medical reviews. The role involves interacting with provider communities to ensure effective clinical oversight.
The Senior Claims Analyst is responsible for the accurate adjudication and processing of medical, dental, and vision claims while serving as a liaison for internal departments. They also analyze claim information to make benefit determinations in accordance with policy provisions and state or federal laws.
The Executive Director is responsible for retaining and growing hospital and health system accounts by developing strategic business plans and product roadmaps. They will lead a team of client managers and serve as an executive sponsor to ensure client satisfaction, profitability, and effective resolution of complex issues.
The Senior Claims Analyst is responsible for the accurate adjudication and processing of medical, dental, and disability claims in accordance with plan documents and legal regulations. They also serve as a liaison for internal departments and provide guidance to team members regarding claim processing procedures.
Respond to high-volume telephonic and electronic inquiries regarding benefits, eligibility, and claim status. Accurately document all actions and navigate multiple system applications to resolve customer issues.
Supervise and manage a remote team of inbound and outbound customer service representatives to ensure exceptional service delivery. Responsible for meeting client service expectations, achieving service objectives, and fostering staff development.
