Top Tech Jobs & Startup Jobs

The Provider Network Specialist I serves as a liaison between healthcare providers and the health plan, facilitating communication and resolving issues. Responsibilities include conducting training, investigating claims, documenting provider interactions, and educating providers on policies and procedures.

The Advanced Proposal Planning Manager will oversee the pre-proposal processes for RFPs by organizing teams, developing essential documentation, and ensuring quality assurance. They will manage project statuses, facilitate risk mitigation, and support coordination between various functional areas. Additionally, the role involves analyzing project performance and collaborating with subject matter experts for insights.

Manage fraud, waste, and abuse activities while ensuring compliance with state and federal regulations. Monitor billing processes, lead investigations, develop educational materials, and oversee reporting on savings. Collaborate with committees and manage team performance.

As a Senior Actuarial Analyst, you will support financial modeling and analysis of value-based contracts, collaborating with internal and external teams, managing data requirements, and increasing efficiency through process improvements including the design and implementation of evaluation tools for VBC programs.

The Quality Improvement Specialist conducts on-site audits for healthcare providers, documenting compliance with regulatory standards and assisting with data management and report generation. Responsibilities include conducting training sessions, managing audit schedules, and ensuring providers meet accessibility requirements while maintaining HIPAA confidentiality.