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Accountant

FL Req ID: R018725 Hybrid
Ensure all accounts are reconciled on a monthly basis and work with other stakeholders within Finance such as the EMR team, STAT team, Actuarial and Accounts Payable to ensure accounts are maintained accurately and so that they balance each month and are ready for audit, accurate reporting and...
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Assessment Nurse

NY Req ID: R018751 Hybrid
Duties and Responsibilities: Conducts home assessments for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills.  As...
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Avature Test - Manager

NY Req ID: R016450 Remote
Partners with Director of Benefits in support of the company’s employee benefit, recognition, and retirement program strategy and administration, including open enrollment Conducts benefits analyses, researches benefits practices, and operationalizes programs to improve employee health, wellness,...
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Budget Analyst

CT Req ID: R018721 Hybrid
Lead annual operating plan and quarterly forecast process.Partner with business leaders to meet the operational budget requirements for area of responsibility.Review and monitor staff work providing training, evaluation and direction.Perform review and analysis of membership, headcount, and...
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Business Analyst

NY Req ID: R018765 Hybrid
Duties & Responsibilities:Review, analyze and create all General Ledger (GL)reports monthly (e.g., Revenue, AFDA; Write offs).Support the AR balance by compiling the details of all DENY/PEND/Unprocessed and Rate Change reports. Support and report AR sub-ledger aging and collections.System...
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CCO Sr Service Agent

NJ Req ID: R018700 Remote
Duties and Responsibilities ·       Provides high quality assistance to the team via phone, chat, video call, email, in person, and/or other communication channels related to servicing our members and/or providers. May include but is not limited to inbound/outbound calls/emails/chats,...
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Claims Implementation Analyst

FL Req ID: R018713 Remote
Duties & ResponsibilitiesAnalyze contract terms, prepare fee schedules and accurately document file changes into the claims processing system Research and identify published updates to payment methodologies, fee schedules and claims editing policies from Medicare, Medicaid, and third-party...
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Claims Supervisor

NY Req ID: R018726 Hybrid
•Responsible for the oversight of claims processing workflow from time of receipt to final adjudication. Review status and inventory reports to ensure acceptable levels are maintained. Alert management to issues affecting timeliness and accuracy of processing and develop plans to...
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Clinical Director

Req ID: R019818 Remote
Duties/Responsibilities:Examines provider claims and service authorizations for completeness, accuracy, and medical necessity and proposes resolutions per internal and regulatory processes.Communicates to relevant teams and providers any claims/ authorization inaccuracies found along with...
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Compliance Administrator

Req ID: R019819 Remote
Assists in implementation of companywide compliance initiatives, policies and procedures such as Conflict of Interest, Vendor Compliance Program, Compliance Training and Compliance Program Effectiveness. Utilize project management skills to assess compliance program risks, facilitate and monitor...
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CW Test

NY Req ID: R016476
Communications: Effective facilitator in client management and/or technical discussions, in developing and delivering presentations, and clearly communicating issues to SMC Leadership. Client Delivery:  Take ownership in delivering high quality, on budget work, with high client...
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Data Analyst

NY Req ID: R020001 Hybrid
Duties and Responsibilities: Supports performance improvement projects to meet deadlines and expected goals/ deliverables. Leads data analysis required to support process improvement efforts. Partners with internal Business Analysts to ensure appropriate data is utilized. Provides ad-hoc analyses...
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Data Analyst - Demos

NY Req ID: R018702 Hybrid
Duties and Responsibilities:Supports performance improvement projects to meet deadlines and expected goals/ deliverables.Leads data analysis required to support process improvement efforts.Partners with internal Business Analysts to ensure appropriate data is utilized.Provides ad-hoc analyses to...
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Data Engineer

Req ID: R019821 Remote
Duties and Responsibilities:Finds trends in datasets and develops workflows and algorithms to make raw data useful to the enterpriseDesigns and implements standardized data management procedures around data staging, data ingestion, data preparation, data provisioning, and data destruction...
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Data Engineer

NY Req ID: R020130 Remote
The Data Engineer will be responsible for finding trends in datasets and developing workflows and algorithms to help make raw data more useful to the enterprise. He or she will also be responsible for createing data acquisition strategy and develops data set processes.Designs and implements...
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Data Entry Clerk

FL Req ID: R018701 Hybrid
Duties & Responsibilities:Check claims and or service form statuses using Healthfirst systems; retrieve and store documents from document imaging system as neededResponsible for handling departmental correspondence/mailScan & document all incoming correspondence into the internal document...
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Data Entry Clerk

FL Req ID: R016443 Hybrid
Duties & Responsibilities: Check claims and or service form statuses using Healthfirst systems; retrieve and store documents from document imaging system as needed Responsible for handling departmental correspondence/mail Scan & document all incoming correspondence into the internal document...
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Data Scientist

MT Req ID: R018728 Remote
Duties/Responsibilities:Build lasting partnerships with stakeholders to deliver solutions that positively impact our members and providersHarness the potential of complex, disparate data sources to create robust solutionsUse statistical modeling and machine learning to predict key outcomes and...
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