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HealthEdge
HealthEdge
18 open remote positions
HealthEdge provides a digital foundation for healthcare payers with integrated solutions including claims administration, business intelligence, and integration capabilities. The company is committed to an inclusive workplace and building diverse teams.
Salary Distribution
12 of 18 jobs
Benefits Overview
2 of 18 jobs
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Open Positions
Install and upgrade HealthEdge applications across private cloud, AWS, and customer-hosted instances. Use agile deployment methodologies and automation tools to manage SaaS-hosted environments. Troubleshoot issues collaboratively and communicate with senior management on high-visibility assignments.
Linux
SQL
AWS
Kubernetes
Shell Scripting
Coordinate and manage Major Incident process activities, including Sev1 and Sev2 incidents. Communicate with internal and customer stakeholders on status, resolution, and success criteria. Partner with Problem Management on RCA process and create Technical Action Plans.
Incident Management
Communication
Troubleshooting
AWS
Adjudicate healthcare claims based on client-specified guidelines and determine appropriate payment for services. Meet productivity, financial accuracy, and procedural standards while mentoring junior team members. Collaborate on special projects including process documentation, training, quality audits, and surge activity.
ICD-10
CPT
HCPCS
Perform prospective, concurrent, and retrospective reviews of healthcare services to ensure medical necessity and appropriate level of care. Contact medical and support personnel to recommend alternative treatment plans and coordinate care across the healthcare continuum. Research and resolve issues related to benefits, eligibility, and appeals while delivering targeted education to providers.
Registered Nurse
Utilization Management
Case Management
MCG
Provide advanced technical support and incident management for complex production issues within the GuidingCare platform. Perform root cause analysis, write complex SQL/T-SQL queries, and manage backend data corrections to maintain system stability. Collaborate with Engineering, Product, and Infrastructure teams while acting as a direct technical contact for enterprise customers.
SQL Server
T-SQL
C#
.NET
REST APIs
Develop automation in existing tools and frameworks and extend them as necessary. Execute both white- and black-box testing, creating test plans and cases for complex data scenarios. Identify testing gaps, suggest improvements, and contribute to DevOps and CI/CD pipelines.
Java
Cucumber
Cypress
JavaScript
Git
Provide first-line product and technical support, diagnosing customer issues and resolving tickets within SLA guidelines. Troubleshoot technical problems through systematic analysis and collaborate cross-functionally to implement effective solutions. Maintain flexible availability for customer needs across time zones, including occasional early morning or evening shifts.
Java
SQL
Relational Databases
Support ETL pipelines processing large healthcare datasets, ensuring reliability and performance. Perform production support by analyzing issues, code fixes, and delivering immediate solutions. Collaborate with customers and cross-functional teams to diagnose and resolve software-related issues.
Python
C#
SQL
ETL
NoSQL
Drive new business and expand existing accounts in Risk Adjustment and Quality healthcare SaaS/BPaaS solutions. Manage key client relationships and anticipate customer needs to exceed service expectations. Collaborate cross-functionally with Marketing, Product, and Customer Success to ensure seamless onboarding.
Risk Adjustment
Healthcare SaaS
Client Relationship Management
Sales Strategy
Pipeline Management
Lead end-to-end data conversion of healthcare payer data between platforms, acting as subject matter expert for Claims, Enrollment, Provider, and Authorizations. Design and execute phased conversion plans, including mock, parallel, and full-volume runs, while managing client expectations. Mentor junior team members and contribute to reusable conversion assets and knowledge repositories.
SQL
Python
ETL
Data Mapping
Lead global IT service desk operations ensuring 24/7/365 follow-the-sun support for 7,500 employees across five countries. Drive AI transformation initiatives, implementing intelligent self-service, automation, and AI copilots to enhance efficiency. Manage budgets, vendors, and strategic partnerships while fostering a culture of customer service excellence.
ITIL
AI/ML
ITSM
Leadership
Handle inbound and outbound phone calls to assist customers with inquiries. Document all interactions in ticketing systems and track requests. Research customer claims and provide accurate data within required timeframes.
Customer Service
MS Office
Spanish
Communication
Own our Atlassian architecture and governance, setting direction for multi-instance Cloud environment. Own our HIPAA/BAA compliance posture and licensing strategy in partnership with procurement. Partner with senior stakeholders to redesign how teams work, using AI to drive smarter platform design.
Atlassian
Python
Platform Strategy
Process and maintain accurate Medicare enrollment and disenrollment requests, ensuring compliance with CMS regulations. Reconcile membership reports and resolve enrollment system rejections, building case files for CMS approval. Mentor junior team members and collaborate on special projects, including process documentation and quality reviews.
Eligibility Verification
Data Analysis
Microsoft Office
Lead and develop a team of WFM Scheduling Analysts supporting both Contact Center and Back Office operations. Own schedule publication, real-time and intraday management, and back office inventory and workload management. Serve as the primary escalation point for scheduling issues, staffing exceptions, and real-time monitoring gaps.
Workforce Management
Scheduling
Lead end-to-end forecasting and capacity planning across operational functions. Develop and maintain forecasting models using historical trends and business drivers. Partner with Finance, HR, and Operations to align workforce plans with budgets.
Excel
SQL
Workforce Planning
Analytical Skills
Forecasting
Design and build AI agents and automation to solve real problems across engineering, product, and delivery. Partner with stakeholders to identify high-leverage opportunities and deliver end-to-end solutions. Stay current with LLM and agentic frameworks to drive innovation in healthcare technology.
Python
LLM APIs
LangChain
PyTorch
CI/CD
Set enterprise priorities for operational reporting and dashboards that deliver trusted, decision-ready information. Lead business intelligence and analytics efforts that surface actionable insights for Operations, Product, and executive stakeholders. Identify and drive business process automation opportunities, including applying AI to improve speed, accuracy, or cost.
Business Intelligence
Analytics
Process Automation
Data Strategy
Cross-functional Leadership