The Analytics Analyst III will partner with multiple customers to provide more complex resolutions to analytics/data problems (i.e. linear models, pattern analysis, directional modeling, etc.) that require a more detailed and deeper study of situational factors, gathering information from several sources, and providing reporting analysis deliverables (i.e. tables, visual

The Analytics Analyst III will partner with multiple customers to provide more complex resolutions to analytics/data problems (i.e. linear models, pattern analysis, directional modeling, etc.) that require a more detailed and deeper study of situational factors, gathering information from several sources, and providing reporting analysis deliverables (i.e. tables, visual

Responsible for the general operational oversight of multiple disciplines/units to ensure enterprise and divisional performance goals are achieved. Job Responsibilities Direct staff to ensure overall client satisfaction and appropriate level of service delivery. Develop and monitor goals for staff and provide ongoing feedback and coaching. Manage staff, including individu

Under general supervision, responsible for producing reports from various sources to provide the department /division with actionable information or business intelligence. This is an intermediate level position performing basic assignments, and may require guidance. Responsibilities Evaluate, write, and present utilization and cost containment reports. Determine or agree

The Data Analyst leads the technology process for the end to end Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data flow and works within key regulator guidelines for acceptable data submission. Using SQL and SAS programs lead the gathering of data for submissions Risk Adjustment. As the senior analyst of data, will be responsible fo

The Identity and Access Management (IAM) Engineer will collaborate cross functionally with Security Architects, Senior Infrastructure Analysts, and Senior Application Developers to provide a stable WAM environment by applying new and best practices in Identity and Access Management and Customer IAM technologies to support business applications. This position will be respo

This position is responsible for the ability to understand and abide by Federal Centers for Medicare and Medicaid Services guidance. Fast paced environment with frequent priority changes. Organization and follow up abilities will be critical. Policy and reconciles daily systemic eligibility discrepancies. Responsibilities Reconciliation of all daily, weekly and monthly Me

Responsible for conducting file audits for all areas of clinical operations. These audits review daily business practice compliance to regulatory compliance relative to NCQA, URAC and CMS. Responsibilities Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS

This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportu

The Tax Analyst I is accountable for assisting with the compliance of federal, state and local tax laws and is accountable for the filing of assigned federal and state income, premium, franchise and other tax returns. This position will contribute to the company's payroll tax compliance as well as Federal & State tax laws. This position will also ensure compliance with th

The Cyber Security Analyst II supports a 24/7/365 Security Operations Center (SOC) and provides 2nd Tier analysis and response to security events. Actively prepares for, and hunts for, malicious internal and external threats as a part of our cyber incident response program in the Security Operations Center (SOC). CSA II will analyze malware, emerging threats and emerging

Responsible for managing multiple aspects of the Enterprise medical costs structure including both on system and off system medical costs and directly lead efforts across the Enterprise to provide and present meaningful medical cost trend analysis to drive opportunities and decision making. Collaborate with multiple Commercial and Government Program business partners, inc

Provide excellent service to customers through the resolution of basic customer inquiries received by phone or though written correspondence. Responsibilities Receive customer inquiries via phone, fax, mail, e mail, etc. If necessary, probe for additional helpful information (i.e. member ID, claim number, name, etc.) in order to effectively handle inquiry. Review computer

This position is accountable for the conservation of existing accounts and selling additional product lines where appropriate and profitable for the SHBP, Public, and Jumbo markets. This position as it functions in the Labor market will be accountable for servicing of existing accounts as well as selling new business. Manages contract renewals and ensures services are pro

This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators Responsibilities Performs review of service requests for completeness of information, collection and transfer of non clinical data, and acquisition of structured clinical data from physicians/pa