Job Summary: The Provider Contracting Analyst II supports the development, validation, and optimization of provider reimbursement strategies through advanced data analysis, financial modeling, and AI-enabled analytic tools. This role is responsible for evaluating provider payment methodologies,
Job Summary: Vice President, Actuarial - Product is responsible for driving company strategy and managing actuarial expertise in coordination with other leaders on all aspects of CareSource’s rate levels to ensure actuarial soundness, and to use
Job Summary: The Senior Director, Clinical Data Governance & Integration is responsible for developing, executing and coordinating enterprise clinical data governance and integration activities. This role ensures standardized business requirements, oversees governance cadence, and drives cross-functional
Job Summary: The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects. Essential Functions: Represent claims on cross-functional project work teams Submit, monitor and prioritize IT tickets for
Job Summary: The Operations Regulatory Specialist II provides analytical support and leadership for key internal Operations projects and partners with the Operations departments to ensure all regulatory and compliance deliverables are met. This position will work
Job Summary: The Board-Certified Behavior Analyst serves as the clinical lead in developing and implementing evidenced based clinical policies and practices for members with Autism and their families Essential Functions: Oversee coverage determinations for ABA utilization
Job Summary: The Health Plan Data Analyst III is responsible for extracting, analyzing, reporting, tracking and monitoring provider data across business functions, systems and interfaces. Additional responsibilities include analyzing data operations to support building new solutions
Job Summary: The Claims AI Business Analyst IV is responsible for driving end-to-end process transformation initiatives across Claims Operations by leveraging automation and artificial intelligence (AI) to improve efficiency, reduce costs, and enhance quality. This role
Job Summary: The Quality Consumer Experience (Cx) Project Manager is responsible for managing variably complex high-priority, cross-functional projects within the Consumer Experience organization, executing within the project management framework. Essential Functions: Ensure project milestone deliverables are
Job Summary: The Vendor Medical Coding Analyst is responsible for guiding the overall efficiency and accuracy of the vendor payment process through analyzing medical records and supplemental data to ensure diagnostic and procedural codes accurately reflect