The consultant will use medical cost analytics to provide strategic insights into emerging trends and develop business cases for medical cost programs. They will also coordinate savings projections and create executive-ready presentations to communicate analytical findings to business partners.
The Client Benefit Analyst provides account support for dental groups, ensuring the resolution of benefit interpretations, claims, and billing inquiries. They also analyze customer data to make recommendations and represent the company at client meetings and wellness events.
The coder is responsible for reviewing and interpreting medical records to assign accurate ICD-10 CM and CPT codes for diagnoses and procedures. They also abstract data elements for statistical reporting and ensure efficient management of medical information and cash flow.
This role supervises and coordinates daily claims processing activities and manages staff performance across multiple units. The supervisor is responsible for monitoring inventories, ensuring compliance with regulations, and implementing process improvements to enhance accuracy and efficiency.
Review medical records concurrently, prospectively, and retrospectively to improve the quality and completeness of clinical documentation and support accurate coding, reimbursement, and outcomes reporting. Collaborate with physicians, nurses, caregivers, and coding professionals to clarify documentation and educate care teams on compliant documentation, coding, reimbursement, and performance improvement.
The Coding Auditor Educator performs internal coding audits to ensure accuracy and compliance with regulatory requirements for medical billing and documentation. They also develop and deliver educational programs to staff and physicians to address identified deficiencies and improve clinical documentation quality.
Manage a caseload of members by assessing their health needs, developing individualized care plans, coordinating services, and monitoring progress toward health goals. Advocate for members while promoting quality, cost-effective care, preventing improper benefit utilization, and ensuring compliant documentation.
The analyst will conduct detailed financial, operational, and clinical performance reporting to support organizational initiatives. They will also mentor junior analysts and present executive-level summaries of analytical projects to leadership.
The intern will support the internal audit lifecycle, including engagement planning, fieldwork testing, and the preparation of audit reports. They will collaborate with business process owners to evaluate risk management, internal controls, and governance processes across the organization.
The intern will support the Evaluation Analytics team by conducting research, performing statistical analyses, and evaluating healthcare programs to generate actionable insights. They will also collaborate with cross-functional teams to prepare reports and recommendations that improve healthcare quality and business performance.
The Care Manager implements utilization management strategies by reviewing health care services and applying criteria to ensure appropriate resource utilization. They also monitor health care delivery, educate providers and members, and analyze data to improve performance and member satisfaction.
The intern will support enterprise risk management, governance, and strategic planning initiatives by conducting research, preparing reports, and assisting with risk assessments. They will collaborate with business leaders to strengthen the organization's risk framework and contribute to meaningful projects across various healthcare operations.
The Data Protection Engineer is responsible for implementing, maintaining, and providing operational support for the organization's data protection infrastructure and applications. They will troubleshoot security incidents, develop automation scripts, and collaborate on the design of data protection solutions across cloud and on-premises environments.
The intern will support data operations, reimbursement processes, and business analysis activities within the Professional Provider Reimbursement Operations team. Responsibilities include conducting data research, documenting processes, and assisting with reporting initiatives to support operational efficiencies.
The intern will collaborate with a multidisciplinary team to develop innovative solutions using clinical and healthcare data. They will participate in research initiatives involving predictive modeling, AI applications, and medical imaging to support healthcare transformation.
Manage complex member cases by assessing health needs, developing individualized care plans, coordinating services, and monitoring outcomes. Advocate for members while promoting quality and cost-effective care, ensuring compliant documentation, and mentoring lower-level case managers.
Conduct financial and business research and analysis, including forecasts, financial reports, trends, and variance explanations, and advise management on findings and recommendations. Lead financial analysis projects, develop and maintain spreadsheets and databases, prepare reports and presentations, and coordinate project progress and deadlines with stakeholders.
The Associate Actuary will lead the development of actuarial studies, analyses, and presentation materials to inform management decision-making. They are also responsible for mentoring less experienced staff and applying statistical techniques to functions like premium development, claim trend analysis, and predictive modeling.
The analyst will participate in the Actuarial Executive Development Program and apply statistical techniques to functions like pricing, claim trend analysis, and predictive modeling. They are responsible for developing efficient data queries, creating analytical studies, and providing recommendations to management.
Analyze financial and contractual results, budgets, trends, and performance metrics to support business decisions, including identifying root causes and recommending revenue or cost improvements. Maintain financial processes and reporting, support budgeting, close and audit activities, and provide expertise on reimbursement, regulatory requirements, and financial performance.
The Program Manager leads a strategically related portfolio of programs and initiatives by connecting enterprise strategy, governance, and cross-functional delivery. They are responsible for translating strategy into measurable business outcomes while facilitating executive decision-making and managing systemic risks.
The Project Manager leads complex initiatives from definition through transition by coordinating cross-functional teams and ensuring disciplined execution. They are responsible for maintaining project plans, managing risks and dependencies, and providing transparent reporting to stakeholders.
The specialist performs HCC coding for government programs like Medicare Advantage and ACA to ensure accurate risk adjustment. They also support remote patient monitoring projects and assist with regulatory audits by analyzing physician documentation.
The incumbent analyzes risk factors and financial data to price quotes and structure group insurance contracts while ensuring profitability. They also provide oversight and technical guidance to lower-level underwriters and manage a book of business for new and renewing accounts.
Lead the regional government relations function, develop advocacy and policy strategies, and manage relationships with government officials, trade associations, coalitions, and other stakeholders. Monitor and analyze legislation and regulations, advise internal leaders on their impact, coordinate lobbying and advocacy efforts, and produce communications supporting the organization’s policy positions.
The incumbent will support enterprise business areas by configuring, testing, and deploying HR and payroll system solutions. They are responsible for gathering business requirements, managing system upgrades, and ensuring process improvements through stakeholder collaboration.
The incumbent manages physician preference items and develops specialty-specific panels to drive product and process decisions across the network. They act as a liaison between vendors and clinical staff to ensure contract compliance, standardization, and the achievement of supply chain savings goals.
The incumbent manages a panel of members by assessing health needs, developing personalized care plans, and facilitating clinical or lifestyle interventions. They collaborate with a multi-disciplinary team to improve health outcomes through telephonic, digital, or virtual engagement.
The intern will support IT audit, cybersecurity, and risk management activities by evaluating technology controls and compliance processes. They will also assist in performing research, documenting audit results, and collaborating with stakeholders to improve organizational processes.
The intern will support the Business PMO team by contributing to automation and artificial intelligence initiatives, including project coordination and data analytics. Responsibilities also include conducting research, developing reports, and assisting in the conversion of legacy code to modern analytics languages.
The intern will support sales operations, client service activities, and strategic business initiatives within the healthcare industry. Responsibilities include conducting research, analyzing business information, and collaborating with various departments to support sales objectives.
The intern will analyze large-scale healthcare datasets to generate actionable insights supporting population health and value-based care strategies. They will collaborate with clinical and business stakeholders to conduct research, performance measurement, and strategic project implementation.
The candidate will design and develop scalable software applications using C# and Azure while participating in all agile scrum ceremonies. They are responsible for writing high-quality code, performing code reviews, and mentoring junior software engineers.
The Platform Engineer designs, implements, and supports enterprise cloud platforms, databases, and application services. They provide strategic consultation to business customers and lead improvement programs to ensure scalable and secure technical solutions.
The Associate Business Systems Analyst supports the application product life cycle by gathering requirements, creating business cases, and translating business needs into detailed technical specifications. They also participate in Agile scrum teams to ensure quality delivery, perform testing, and resolve project risks and defects.
The Sales Executive is responsible for selling dental insurance products to medium and large groups while meeting profitability goals. They must also manage relationships with brokers and consultants while coordinating with internal teams to resolve sales challenges.
The role involves reviewing and interpreting medical records to assign accurate ICD-10 CM and CPT codes for diagnoses and procedures. Additionally, the coder abstracts data for statistical reporting and maintains efficient management of medical information to support hospital cash flow.
The Outreach Representative serves as a liaison between members and the health plan, conducting telephonic support to assess needs and provide appointment assistance. They also educate members on their rights and responsibilities while coordinating access to preventive health services and disease management programs.
The role involves providing high-quality customer service in a contact center by resolving inquiries from members and providers. Additionally, the representative is responsible for processing and adjusting claims while maintaining accurate records and adhering to HIPAA regulations.
The analyst will manage process improvement initiatives, conduct medical record audits, and ensure compliance with CMS and NCQA standards. They will also serve as an educator for providers regarding documentation, coding accuracy, and quality improvement programs.
Interns will support underwriting operations through data-driven analysis, financial modeling, and risk assessment within the healthcare industry. They will also participate in projects, conduct research, and assist with reporting to support business objectives.
The dietitian will perform individualized patient nutritional assessments and develop, implement, and monitor comprehensive nutrition care plans. Additionally, they will provide educational programs for patients and staff while maintaining accurate documentation according to professional standards.
The supervisor oversees daily audit operations, statistical sampling, and performance reporting within the Performance Measurement and Reporting department. They are also responsible for staff development, mentoring, and leading system projects to ensure operational compliance and quality.
The analyst develops and manages process improvement initiatives related to medical record documentation, coding accuracy, and quality care standards. They conduct audits, analyze data, and educate providers on regulatory requirements to ensure compliance and improve performance metrics.
This role involves reviewing medical records to interpret and apply accurate ICD and CPT codes for diagnoses and procedures. The coder also abstracts data elements for statistical reporting and ensures efficient management of medical information to support hospital cash flow.
The VP of Ancillary Provider Strategy & Management will lead the development and maintenance of ancillary provider networks while implementing innovative reimbursement and care delivery models. This role involves overseeing contract negotiations, managing multi-market provider relationships, and collaborating with internal stakeholders to ensure service competitiveness.
The analyst is responsible for configuring, testing, and supporting Epic ClinDoc applications while performing workflow analysis to meet end-user needs. They also manage small to medium projects and provide ongoing system maintenance and problem resolution.
The Quality Lead will define data-testing strategies and oversee end-to-end quality activities across healthcare transformation programs. They will guide technical teams, manage data-quality risks, and communicate business impacts to stakeholders.
The Imaging Systems Administrator ensures the optimal performance, integrity, and compliance of medical imaging systems and related interfaces. They manage vendor relations, support clinical workflows, and participate in the full system development lifecycle for imaging technologies.
The analyst is responsible for configuring, rolling out, and supporting Epic Beaker applications while performing business systems analysis. They will also document workflows, resolve system issues, and provide guidance to end-users to enhance system functionality.
The Senior Case Manager provides comprehensive case management services to members by assessing needs, developing individualized care plans, and coordinating services to ensure quality and cost-effective outcomes. They also act as an advocate and liaison for members while providing mentorship and clinical expertise to lower-level staff.
This role assists in the design, development, and implementation of Information Security and Risk Management (ISRM) infrastructure systems. Responsibilities include monitoring security systems, conducting root cause analysis, and ensuring compliance with organizational standards and policies.
The analyst is responsible for configuring, testing, and supporting Epic OpTime modules to meet perioperative clinical needs. They will collaborate with staff to analyze workflows, resolve system issues, and implement new functionalities.
The coder is responsible for reviewing medical records to interpret and apply accurate ICD codes for diagnoses and procedures. They also abstract data elements to satisfy statistical requests and ensure efficient management of medical information.
The Oncology Data Specialist performs data abstraction by capturing patient history, diagnosis, staging, and treatment information for the cancer registry. They are responsible for maintaining the database, ensuring data accuracy, and complying with regulatory reporting requirements.
The analyst is responsible for configuring, testing, and supporting Epic Orders applications while performing workflow analysis and system design. They also provide guidance to end-users, resolve system issues, and manage small to medium projects.
The analyst coordinates and maintains the delegated credentialing program to ensure compliance with NCQA and regulatory standards. They are responsible for conducting pre-delegation assessments, monitoring delegate performance, and facilitating corrective action plans.
The role involves reviewing and interpreting medical records to apply accurate ICD codes for diagnoses and procedures. Additionally, the coder abstracts data for statistical reporting and acts as a subject matter expert to support the coding team.
The Product Manager will define and execute the strategic vision and roadmap for Provider Data Products to ensure data accuracy and regulatory compliance. They will act as a bridge between business strategy and technical execution, overseeing the end-to-end delivery of products in partnership with engineering teams.
The HRIS Consultant serves as the functional architect for the Workday ecosystem, leading enterprise implementations and defining scalable design standards. They provide technical mentorship to HRIS analysts and partner with cross-functional stakeholders to align HR technology with business strategy.
The Senior Enterprise Solution Architect will lead the design and implementation of scalable, robust solutions that align with enterprise architectural standards and strategic business goals. This role involves providing technical leadership, facilitating complex business process development, and ensuring that functional and non-functional requirements are met throughout the solution lifecycle.
The incumbent delivers high-quality, patient-centered care through in-home, virtual, and telephonic clinical assessments for patients with chronic or life-limiting conditions. Responsibilities include diagnostic interpretation, symptom management, advance care planning, and maintaining accurate clinical documentation for risk adjustment.
The Account Manager is responsible for managing a book of business, renewing existing accounts, and selling new products to current clients. They act as a strategic consultant, representing the organization at meetings and coordinating with internal teams to provide policyholder solutions.
The Strategy Partner leads and supports key strategic initiatives across the enterprise, playing a central role in development, execution, and project management. They are responsible for identifying complex issues, performing data analysis, and ensuring alignment across various business units.
The Senior Product Manager owns the end-to-end financial front door for members, defining the product strategy and vision for cost transparency and coverage experiences. They are responsible for managing the product backlog, setting roadmaps, and coaching junior team members in a player-coach model.
Lead the Network’s cost accounting operations, including staff management, consistent cost definitions and allocation methods, and the production of accurate patient-care cost information. Use analytics and decision-support tools to inform clinical and financial decisions, support reimbursement discussions and capital planning, and collaborate with leaders and departments to explain and maintain credible cost data.
The accountant performs professional-level financial tasks including the maintenance, reconciliation, and analysis of financial records. They also provide guidance to lower-level staff and ensure all transactions comply with GAAP and company policies.
The specialist is responsible for requesting and obtaining medical records from healthcare providers to ensure accurate documentation and risk-adjusted revenue. They must coordinate retrieval methods, maintain secure repositories, and adhere strictly to HIPAA regulations.
The Senior Sales Executive is responsible for prospecting and securing new group business for core and supplemental health products within an assigned territory. They will manage the entire sales cycle, including high-stakes meetings, pipeline management, and maintaining relationships with brokers and consultants.
The Claims Adjuster reviews and adjusts Blue Card claims while ensuring accuracy and adherence to corporate procedures. They also identify potential fraudulent cases and resolve customer issues through process improvements.
The Director of Enterprise Transformation Strategy identifies, develops, and directs a portfolio of projects to improve performance metrics and drive strategic value. They are responsible for project execution, financial outcomes, and influencing senior leadership within a matrixed organization.
The Senior Security Engineer will lead the integration of security controls into the software development lifecycle, focusing on shift-left strategies and AI-assisted development. They will also manage vulnerability risk reduction, automate security toolchains, and provide expert guidance to engineering teams.
The Account Executive is responsible for driving sales revenue and growing market share by acquiring new clients within the national print and mail manufacturing footprint. They will manage the full sales cycle, including prospecting, needs assessments, contract negotiations, and ongoing client retention.
The Senior Investigator conducts investigations into potential fraud, waste, and abuse involving providers, members, and employees while managing anti-fraud programs. They also provide subject matter expertise, mentor team members, and coordinate with law enforcement and regulatory agencies to ensure compliance and financial recovery.
The Registered Nurse is responsible for assessing, planning, and implementing nursing care for patients in a home infusion setting. This includes administering infusion therapy, coordinating with interdisciplinary teams, and ensuring accurate documentation and patient education.
The auditor will ensure claims are processed according to internal procedures and plan documents while monitoring audit workflows for timely turnaround. They will also provide coaching to the claims team, conduct specialized audits, and assist with system upgrade testing.
The Product Manager will define and deliver data products leveraging conversational AI and omnichannel interaction data to improve member experience and operational efficiency. They are responsible for managing the product backlog, setting strategic roadmaps, and ensuring data governance and regulatory compliance.
The incumbent analyzes clinical data to identify trends and cost drivers while preparing reporting metrics for healthcare clients. They collaborate with internal teams to develop clinical management strategies and support the RFP/RFI process.
The lead is responsible for managing the Finance technology product roadmap and portfolio, ensuring alignment with strategic business objectives. They act as the primary liaison between Finance stakeholders and technology teams to oversee the end-to-end demand lifecycle and project delivery.
The senior auditor leads complex clinical, documentation, and billing compliance reviews while providing guidance to the audit team. They are responsible for implementing orientation programs, conducting investigations, and managing corrective action plans to ensure adherence to federal and state regulations.
The Senior Case Manager is responsible for providing comprehensive case management services to members with complex health needs to ensure quality and cost-effective care. They will develop and implement individualized care plans while collaborating with physicians and healthcare providers to monitor member progress.
The Community Health Worker acts as a liaison between members and healthcare providers to improve health outcomes and close care gaps. They conduct face-to-face outreach, provide health literacy education, and assist members in navigating the healthcare system and accessing community resources.
This leadership role oversees underwriting operations, managing team performance and strategic initiatives to support customer acquisition and retention. The incumbent collaborates with sales leadership to develop book management strategies and ensures adherence to internal and governmental regulations.
The supervisor manages the Medicare Fee-for-Service appeals unit, delegating assignments and ensuring compliance with CMS thresholds and internal standards. They provide direct oversight to staff, handle high-profile provider issues, and monitor departmental performance against budget and quality goals.
The incumbent will support, maintain, and optimize cloud technologies through engineering and automation builds. They will collaborate with cross-functional teams to design, test, and implement technical solutions that meet organizational goals.
The investigator is responsible for developing anti-fraud programs and conducting investigations into alleged fraud, waste, and abuse by providers and members. They must also prepare cases for legal referral, testify in court, and coordinate the recovery of misappropriated funds.
The Senior Oracle Cloud EPM Analyst will administer, maintain, and enhance Oracle Cloud EPM applications, with a primary focus on Planning and EPBCS. They will also partner with Finance, Accounting, and IT teams to translate business requirements into scalable technical solutions and provide production support.
The consultant manages a block of stop loss business, overseeing new business and renewal pricing, risk analysis, and financial performance. They collaborate with sales, clinical, and underwriting teams to develop creative solutions and provide leadership and training to staff.
The Principal Information Security Architect leads the design and advancement of enterprise data security architectures to protect sensitive information across its lifecycle. They collaborate with cross-functional teams to establish secure solutions for modern data platforms, analytics environments, and cloud infrastructure.
The Lead Enterprise Architect will drive technology strategy and innovation by designing comprehensive architecture roadmaps and leading AI solution strategies. This role involves providing strategic consultation to business customers and mentoring team members to ensure cohesive, scalable, and cost-effective enterprise solutions.
Lead the full project lifecycle from concept to delivery for mid-to-large initiatives, ensuring they are completed on time and within budget. Manage resources, mitigate risks, and maintain strong communication with stakeholders through detailed reporting and documentation.
Lead the full project lifecycle for large to extra-large initiatives, ensuring delivery on time, within budget, and to quality standards. Manage resources, mitigate risks, and maintain strong communication with stakeholders through detailed reporting and documentation.
The role involves designing and developing research databases and analytic solutions to address clinical and financial healthcare challenges. The informaticist serves as a liaison between physicians and research staff to translate data needs into actionable insights.
Manage Information Security and Risk Management services, overseeing personnel, budgets, and the implementation of security technology products. Lead strategic planning, ensure corporate policy compliance, and develop security awareness training programs.
The role involves analyzing industry data and financial conditions to assess risk for small and mid-sized clients. The underwriter collaborates with sales teams to deliver quotes and provide strategic risk management recommendations.
Develops and executes strategic business plans for contract categories and manages high-dollar bids and GPO operational activities. Builds strategic relationships with supplier partners and presents business cases to senior leadership.
Drive the adoption of innovative health products by partnering with sales and marketing to deliver consultative client presentations. Manage a book of business and develop client-specific marketing plans to meet the needs of large key accounts.
Lead the design, implementation, and maintenance of critical mainframe systems including z/OS, DB2, and CICS. The role involves driving platform improvements, troubleshooting critical issues, and mentoring junior engineers in a geographically dispersed environment.
The role focuses on adopting, maintaining, and optimizing cloud technologies and automation builds across the organization. Responsibilities include designing and implementing technical solutions, collaborating with stakeholders, and mentoring junior engineers.
Lead the advancement and integration of the marketing technology stack and AI to scale marketing efforts. Manage vendor relationships, operational strategies, and the delivery of platform roadmaps in collaboration with IT and other stakeholders.
Perform financial and business research, including the preparation of forecasts, trend analysis, and financial reports. Lead special projects by gathering data, documenting findings, and presenting results to management to improve business outcomes.
The Registered Nurse is responsible for assessing patient needs, planning and implementing nursing care, and administering infusion therapy in home settings. They must maintain accurate medical records, coordinate with interdisciplinary teams, and ensure adherence to safety and quality standards.
The Imaging Institute is expanding services and locations, recruiting radiologists for musculoskeletal imaging roles. Positions are available as part-time or full-time, with options for onsite, hybrid, or remote work arrangements.
The role involves reading chest imaging exclusively or a combination of chest and cardiac imaging, with options for body imaging interpretation available. Responsibilities include providing diagnostic services across plain film, various CT modalities (including cardiac CT), and MR imaging (including cardiac MRI).
Physicians will provide a full range of diagnostic neuroradiology services across various AHN facilities, including trauma centers and stroke centers, utilizing state-of-the-art imaging technologies. Involvement in clinical and didactic teaching for residents and medical students, along with active participation in multidisciplinary conferences, is also expected.
The Registered Nurse assesses human responses and plans, implements, and evaluates nursing care for individuals or families, assuring safe delivery of nursing services in alternative care settings like home infusion visits to administer therapy. Responsibilities include active participation in interdisciplinary communication, directing ancillary care, accurate documentation, and timely implementation and evaluation of physician orders.
The Mainframe Systems Programmer will install, upgrade, and manage CICS/MQ environments, ensuring the health and stability of the mainframe system. They will also participate in disaster recovery exercises and troubleshoot issues to determine root causes.
The Medical Director ensures that utilization management responsibilities are performed according to clinical standards by reviewing escalated cases and determining medical necessity. They also participate in multidisciplinary teams for case and disease management, advising on high-risk cases and managing special projects.
