Caresource

A/B Testing AWS Azure Business Intelligence Cloud +15 skills

Job Summary: The Data Scientist I is responsible for supporting the design and validation of predictive models, machine learning models, and artificial intelligence that inform and improve business processes across the…

New RemoteNorth AmericaSenior

7 days ago

Senior Financial Data Analyst - Reconciliation & Controls

Analytics Data Warehousing Databricks Financial Reporting Root Cause Analysis +2 skills

About the role: This position is ideal for an experienced financial analyst or auditor who combines strong financial reconciliation and controls experience with technical skills in SQL and Excel. Job Summary: Financial…

New RemoteNorth AmericaSenior

7 days ago

Director, Operations Regulatory and Accuracy Assurance Oversight(Preferred Experience In Operational Transformation)

Agentic AI Automation Corrective Action Root Cause Analysis Stakeholder Management

Job Summary: The Director, Operations Regulatory and Accuracy Assurance Oversight is responsible for representing and leading regulatory, compliance, and accuracy assurance activities on behalf of the Operations…

7 days ago

Digital Product Designer III

Accessibility Analytics Design Thinking Figma Information Architecture +6 skills

Job Summary: The Digital Product Designer III is responsible for leading user research and experience design activities across member- and provider-facing digital products and experiences. This role operates with a…

last week

Pharmacy Technician II

Job Summary: The Pharmacy Technician II is responsible for data entry and review of submitted authorization requests, providing assistance to providers or pharmacies calling for assistance, and ensuring resolution for…

Manager, Cost Reporting

Databricks ETL Financial Reporting Power BI Process Improvement +6 skills

Job Summary: The Manager, Finance - Cost Reporting is responsible for managing the cost reporting processes within the finance department. This role involves ensuring accuracy and completeness of financial data,…

New RemoteNorth AmericaContract

last week

Director, Utilization Management Operations(Preferred Experience in Prior Authorization Strategies)

Job Summary: The Director, Utilization Management Operations assists the UM Department with all open projects and progress towards company and department initiatives including program descriptions, evaluations,…

Customer Care Specialist I (Healthcare/Medicare Experience, must live in Ohio)

Job Summary: The Customer Care Specialist I assists members/beneficiaries or providers with routine service inquiries. Essential Functions: Resolve member/beneficiaries or provider routine service inquiries; examples…

Manager, Clinical Appeals

Job Summary: The Manager, Clinical Appeals is responsible for the oversight of all clinical appeals activities ensuring consistency of services and achievement of compliance targets. Essential Functions: Assist in…

Business Analyst IV

Agile AI Analytics Automation Azure +7 skills

Job Summary: The Business Analyst IV serves as a business analysis leader responsible for shaping business strategy, guiding enterprise initiatives, and driving alignment between organizational objectives and…

2 weeks ago

Operations Business Analyst IV - Claims adjudication and/or Facets claims adjudication (preferred)

Job Summary: The Operations Business Analyst IV oversees the business analysis initiatives to drive operational excellence and efficiency of existing processes and systems, leads cross functional process improvements,…

Integrated Care Clinical Manager - RN - Lynn, MA

RemoteNorth AmericaContract

Job Summary: The Integrated Care Clinical Manager - Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with…

Director, Actuarial Science (Medicaid Rate Advocacy, Month End Close, Forecasting)

AI Business Development SAS SQL

Job Summary: The Director, Actuarial Science is responsible for guiding the strategic direction, driving innovation and producing key insights for the organization that drive company performance. Essential Functions:…

2 weeks ago

Product Manager - Data Migration

Acceptance Criteria Agile AI Analytics Cloud +3 skills

Job Summary: The Product Manager owns the strategy, vision, operating model, and roadmap for assigned products, capabilities, or enterprise transformation initiatives. This role translates business, customer,…

2 weeks ago

Director, Claims Process Optimization ( Facets Required)

Analytics Automation Data Analytics Performance Management Root Cause Analysis

Job Summary: The Director, Claims Process Optimization leads the design, implementation, and ongoing oversight of automation and artificial intelligence capabilities across CareSource claims operations. This position…

RemoteNorth AmericaContractSenior

3 weeks ago

Senior Director, Actuarial Science(Preferred Experience In Federal Health Policy Analysis & Advocacy)

Business Development SAS SQL

Job Summary: The Senior Director, Actuarial Science is responsible for setting the strategic direction, driving innovation and producing key insights for the organization that drive company performance. Essential…

3 weeks ago

Manager, Utilization Management - Must have a MA RN License

Job Summary: The Manager, Utilization Management is responsible for the oversight of all utilization management activities ensuring consistency of services and achievement of utilization targets. Essential Functions:…

Systems Analyst III

Acceptance Criteria Agile Azure Azure DevOps CI/CD +7 skills

Job Summary: The Systems Analyst III is responsible for leading research and analysis to identify systems impacted by requirements, possible interfaces, cross team dependencies and affected lines of business. Preferred…

4 weeks ago

Applied AI Scientist IV - Healthcare, LLM/SLM, RAG experience