The role involves collaborating with cross-functional teams to translate business needs into detailed technical requirements and project specifications. You will also leverage AI tools to analyze data, identify process improvements, and ensure high-quality delivery of solutions.
The incumbent will design and develop scalable software applications while participating in all aspects of the agile software development lifecycle. Responsibilities include writing high-quality code, performing code reviews, and mentoring junior team members to ensure project success.
The Senior Investigator conducts investigations into potential fraud, waste, and abuse by providers, members, and employees while managing anti-fraud programs and regulatory reporting. They also serve as a subject matter expert, mentor team members, and coordinate with law enforcement and regulatory agencies to recover misappropriated funds.
The software engineer will design and build complex, scalable applications while adhering to agile methodologies and coding standards. They are responsible for technical execution, code reviews, and collaborating with business stakeholders to translate requirements into effective reporting solutions.
The incumbent conducts comprehensive clinical assessments for geriatric and palliative patients in home, virtual, and telephonic settings. They are responsible for managing chronic conditions, facilitating advance care planning, and coordinating care within an interdisciplinary team.
The Case Manager is responsible for assessing member needs, developing individualized care plans, and coordinating services to ensure quality, cost-effective health outcomes. They act as an advocate and liaison, monitoring member progress and collaborating with healthcare providers to prevent improper utilization of benefits.
The Case Manager is responsible for assessing member needs, developing individualized care plans, and coordinating services to ensure quality and cost-effective health outcomes. They act as an advocate and liaison, monitoring member progress and collaborating with healthcare providers to resolve utilization issues.
The role involves performing financial research, preparing forecasts, and analyzing financial reports to provide actionable insights to management. Additionally, the analyst will lead special projects, maintain databases, and coordinate with various departments to resolve financial issues.
The coder is responsible for reviewing medical records to interpret and apply 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 to support cash flow.
Coordinates and facilitates the enrollment and recredentialing of professional providers with various payers to ensure reimbursement. Maintains provider databases and resolves enrollment issues through collaboration with internal staff and external insurers.
The Payroll Administration Specialist is responsible for executing accurate multi-state payroll processing and maintaining HR information systems. They also provide Tier Two support for payroll inquiries and ensure compliance with federal, state, and local regulations.
The role involves implementing utilization management strategies, reviewing health care service appropriateness, and identifying opportunities for case management interventions. The care manager will also educate providers and members while analyzing data to improve health outcomes and service quality.
The Senior Payroll Administration Specialist manages enterprise-wide payroll processing, ensuring accurate disbursement and regulatory compliance across multi-state operations. The role also involves maintaining HRIS integrity, developing process improvements, and serving as a subject matter expert for payroll-related inquiries and audits.
The incumbent performs clinical review and data abstraction of patient records to support quality initiatives and clinical process improvement. They are responsible for accurate data entry into aggregate databases and communicating with medical staff to ensure data integrity.
Gather and translate customer needs into detailed requirements, business cases, and project deliverables for Pega Customer Decision Hub capabilities. Coordinate with cross-functional teams on testing, defect resolution, compliance, project communication, and quality delivery.
Design, develop, and review scalable software applications, contributing across the full product lifecycle from technical design and story planning through implementation and execution. Monitor production systems, troubleshoot and resolve issues, communicate progress and blockers, and mentor associate engineers as needed.
The Senior Decision Support Analyst will develop and maintain data-driven reporting solutions while translating complex clinical and business metrics into high-impact presentations. This role involves managing the full lifecycle of reporting projects, from requirements gathering and data modeling to implementation and stakeholder consultation.
The Pharmacy Coordinator Senior provides guidance to front-line staff and ensures the efficient delivery of pharmacy call center services. They are responsible for reviewing prior authorization requests, evaluating medical necessity, and ensuring adherence to state and federal drug benefit regulations.
This role provides technical leadership for application developers to build and maintain scalable software while driving the execution of products across the development lifecycle. The incumbent collaborates with stakeholders to model data, define operational frameworks, and deliver innovative decision support solutions.
This role involves collecting, analyzing, and reporting on key performance indicators using Python and Tableau to support operational excellence and decision-making. The analyst will design dashboards, automate reporting processes, and present complex data findings to leadership.
The role involves designing and creating engineering specifications while building scalable software applications within an agile team. Responsibilities include writing high-quality code, performing code reviews, and participating in all scrum ceremonies to ensure project success.
The intern will support business decision-making by collecting, organizing, and validating data to develop reports and dashboards. They will collaborate with business partners to investigate data trends and communicate actionable insights for operational improvement.
The incumbent manages post-award financial activities for grants, contracts, and clinical trials, including award set-up, transaction processing, and financial reporting. They are responsible for ensuring compliance with institutional policies and sponsor guidelines while maintaining accurate financial statements and performing root cause analysis.
The representative is responsible for performing enrollment and billing activities, including verifying status and updating databases within a call center environment. They must communicate with internal and external contacts to resolve discrepancies and ensure service level metrics are met.
The Case Manager is responsible for assessing member needs, developing individualized care plans, and coordinating services to ensure quality, cost-effective health outcomes. They act as an advocate and liaison for members while monitoring progress and ensuring compliance with regulatory and company standards.
Supports the technical aspects of the Mainframe Cobol application lifecycle by gathering requirements and translating business needs into detailed specifications. Collaborates with cross-functional teams to execute test cases, manage defects, and ensure quality delivery of technical solutions.
The intern will support the day-to-day operation, monitoring, and maintenance of enterprise network infrastructure alongside experienced engineers. Responsibilities include troubleshooting connectivity issues, assisting with infrastructure changes, and maintaining network documentation and inventories.
The incumbent manages end-to-end delivery of Risk Adjustment programs, including capability analysis, process engineering, and incentive model design. They lead project teams and coordinate with executive leadership to ensure strategic objectives and business outcomes are achieved.
The associate software engineer will design, develop, and maintain scalable software applications within an agile team environment. Responsibilities include writing high-quality code, performing code reviews, and participating in all scrum ceremonies to ensure project success.
Performs clinical review and data abstraction of patient records to support quality initiatives and clinical process improvement. Communicates with physicians and staff to clarify clinical findings and provides education as needed.
