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The Grievances & Appeals Representative 3 manages client denials and concerns through comprehensive reviews of clinical documentation, determining if grievances or appeals are warranted. They assist members with quality goals, investigate issues, and perform administrative tasks, utilizing strong data entry skills and experience in the healthcare field. Regular discretion in prioritizing requests is required, along with effective communication skills.

The Coding Educator 2 improves provider documentation in the North East region by creating tailored education plans, reviewing medical records, and conducting educational sessions for providers and office staff. They collaborate with various departments to enhance quality care and document processes, often working independently on complex issues.

As a Senior Application Architect, you will design and develop robust, scalable application architectures, collaborating with teams to align software solutions with business goals. You will review emerging technologies, define performance metrics, and guide on application modernization to improve efficiency while ensuring code quality and performance.

The Provider Engagement Executive builds and nurtures strong relationships with healthcare providers to enhance financial and quality performance within health plans. Responsibilities include advising on clinical management, data sharing, and operational improvements, ensuring effective strategies are developed for provider and member experiences.

As a Power BI Developer, you'll transform raw data into actionable insights and compelling visualizations using Microsoft BI Stack, particularly Power BI. Responsibilities include managing data visualization projects, enhancing data architecture, collaborating with cross-functional teams, and providing ongoing training on Power BI tools.

The Associate Actuary, Pricing is responsible for setting pricing assumptions, submitting bids, and gaining approval of premium rates. This role involves complex data analysis, developing pricing tools, and collaborating on product strategies. It also includes ensuring compliance with regulations and influencing departmental strategies.

The Actuarial Analyst 2 analyzes and forecasts financial and economic data to assist in strategic decision making. Responsibilities include optimizing financial models, evaluating program performance, collaborating on model results, and ensuring data integrity through effective processes and controls.