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The role involves solving healthcare problems using AI, building impactful systems, and shipping real code in a challenging environment.

Support and maintain CMS HCC/RxHCC models, produce risk-adjusted revenue accruals, build automated actuarial tools and dashboards, analyze claims and EDS data, and collaborate across teams to inform pricing, forecasting, and risk adjustment strategy.

Manage end-to-end CMS EDS claim and supplemental submission workflows, monitor and resolve encounter data errors, build pipeline tracking and operational dashboards, collaborate with Engineering and Risk Adjustment, and maintain documentation and controls for compliant CMS submissions.

The Director of Analytics leads analytics strategies, data engineering, and statistical modeling to enhance decision-making for healthcare operations, managing a team and ensuring data integrity and quality.

As a Senior Investigator, you will lead and execute audit processes to combat healthcare fraud, ensuring compliance with regulatory standards and improving operational efficiency.

As an Investigator in the SIU, you will implement audit strategies to detect healthcare fraud and ensure compliance, supporting regulatory communications and managing audit workloads.

The Senior Manager of Quality Improvement oversees the Regulatory QI Program, ensures compliance, leads QOC investigations, manages performance monitoring, and supervises a team to foster continuous improvement in healthcare delivery.

Identify, develop, and deploy automated cost-saving audits using complex SQL against claims data. Build and maintain financial and ad-hoc reports, run medical record review and administrative hold concepts, lead cross-functional discussions, train teammates on SQL, triage operational tasks (Salesforce, audit letters, reimbursements), and partner with data/engineering to resolve data issues affecting payment integrity.

The Operations Specialist will support payment integrity processes, manage claim recovery workflows, resolve provider disputes, and collaborate across teams to enhance operational efficiency and regulatory compliance.

We are seeking an Engineering Manager to lead a team of engineers, ensure technical productivity, and foster a collaborative culture while supporting primary care physicians with our healthcare tool.