Lead and scale the Business Operations Support Enablement team to drive customer and organizational improvement initiatives within BPaaS Claims operations. Manage complex cross-functional programs to deliver measurable gains in cost, quality, and efficiency across multiple client accounts.
HealthEdge
30 Remote Job Openings at HealthEdge
Lead the strategy, roadmap, and execution of retrospective risk adjustment product portfolios while mentoring a high-performance team of product managers. Collaborate with technical and clinical teams to build AI-driven predictive models and ensure compliance with CMS regulatory standards.
Manage operations for multiple clients and processes to ensure adherence to SLAs, KPIs, and quality standards. Drive operational efficiency, manage P&L for engagements, and lead team performance and capacity planning.
Design and deliver end-to-end BI dashboards in Tableau and Amazon QuickSight to provide actionable insights for executive and operational stakeholders. Collaborate with data engineers to refine AWS-based data sources and ensure high-quality data visualization and performance.
Responsible for scheduling and conducting training sessions for new and experienced call center agents to maintain productivity and quality. This includes developing educational materials, monitoring calls for upskilling opportunities, and collaborating with managers for on-the-job coaching.
Lead business requirement conversations and develop functional requirements for core healthcare administration systems including claims, enrollment, and payments. Collaborate with stakeholders and technical teams to translate business needs into technical specifications using Agile methodologies.
Serve as a strategic advisor to senior leadership to align people strategies with business outcomes and drive organizational transformation. Lead efforts in organizational design, workforce planning, and the development of a high-performance culture.
The Manager of Revenue Accounting owns the accounting for revenue and billing functions, specifically focusing on SaaS and on-prem software licenses under ASC 606. They are responsible for managing a team of four, reporting monthly results to FP&A, and serving as the primary contact for external auditors.
Lead the design and operation of scalable AWS data infrastructure and pipelines to power the Care Solutions platform. Manage a team of data engineers while partnering with cross-functional teams to ensure data reliability and governance.
Lead a team of regulatory professionals to monitor and operationalize federal and state requirements for the HealthEdge Source platform. Partner with Product and Engineering teams to ensure regulatory changes are integrated into product roadmaps and client deliverables.
Oversee a global team of configuration analysts to ensure the successful delivery of fully configured HealthRules systems. Act as a Subject Matter Expert to advise clients on business problems and ensure project milestones are met on time.
The analyst will serve as a functional lead to analyze business requirements and configure the HealthRules Payor system. They are responsible for unit testing, managing offshore configuration tasks, and ensuring timely project delivery.
Lead end-to-end data conversion of healthcare payer data between platforms, serving as a subject matter expert for claims, enrollment, and provider domains. Design and execute phased conversion plans, develop ETL processes using Python and SQL, and manage communication with clients and stakeholders.
Design and maintain data pipelines to consolidate operational data and identify repeat failure patterns using AI and automation. Drive the Problem Management lifecycle to translate technical insights into permanent engineering resolutions and strategic prioritizations.
Lead a team to ensure operational excellence through rigorous performance integrity, quality governance, and continuous process improvement. Manage SLA and KPI targets while driving a culture of accountability and maintaining strong stakeholder relationships.
Lead and mentor the Service Delivery team in Tier 1 and Tier 2 consulting initiatives while providing subject matter expertise on healthcare payment policies and plan operations. Act as a primary escalation point for complex client issues and collaborate with internal teams to drive product improvements and user adoption.
The Director will unify onshore and offshore operational resources into a cohesive team by establishing a common language of performance and accountability. They are responsible for bridging communication gaps, ensuring operational readiness, and scaling international teams to support growth.
The Senior Release Engineer owns the end-to-end release execution lifecycle for the HealthRules Payer product line, managing branch preparation and final delivery. They serve as the technical authority for the Change Control Board and coordinate release activities across global teams.
Design and implement comprehensive enterprise-scale security architectures encompassing network, application, and identity management. Lead strategic security visions and integrate advanced security controls and automation across the technology stack.
Lead the end-to-end strategy, financial performance, and operational execution of payment integrity solutions across the HealthEdge ecosystem. Drive innovation through AI and analytics while managing executive-level client relationships and cross-functional partnerships.
Develop and implement new product features and bug fixes as a back-end server engineer within an agile team. Design Java application components and ensure quality through thorough unit, system, and integration testing.
Provide first-line technical support by diagnosing customer issues and resolving tickets within SLA guidelines. Collaborate cross-functionally to identify root causes and contribute to knowledge base documentation.
Drive test planning and execution for healthcare payer systems, focusing on claims processing, enrollment, and EDI transaction flows. Manage the defect lifecycle and coordinate with cross-functional teams and offshore QA analysts to ensure quality.
Design, implement, and optimize enterprise network infrastructure across on-premises and multi-cloud environments. Manage network security, automation workflows, and provide 24/7 incident response support for a healthcare SaaS platform.
Develop and enhance software products using the Microsoft platform, focusing on WebAPI, JSON, and database development. Collaborate with cross-functional teams to design complex features and ensure code quality through unit testing and debugging.
Lead the sales strategy to acquire new logo prospects and grow relationships within the assigned healthcare payer territory. Manage the full enterprise sales lifecycle, including lead identification, proposal development, and contract negotiations for BPaaS and EPaaS solutions.
Design and maintain CI/CD pipelines and AWS cloud infrastructure to support Java-based healthcare microservices. Automate infrastructure provisioning and ensure system reliability, security, and HIPAA compliance across environments.
Lead the configuration and optimization of Workday Benefits and Advanced Compensation modules to support global HR operations. Manage annual cycles such as Open Enrollment and provide Tier 2/3 technical support to global HR teams.
Lead operations strategy and service design for Core Administration BPaaS programs, focusing on future-state operating models and modernization. Support sales pursuits by translating BPaaS capabilities into business outcomes for health plan executives.
Design, develop, and deploy scalable enterprise-grade Java applications while leading solution architecture and technical planning. Mentor junior engineers, conduct code reviews, and implement automated testing and deployment pipelines.
