Analyze complex healthcare claims and eligibility data to identify trends, anomalies, and opportunities for improvement.
Develop and maintain dashboards using Tableau, Power BI, or QlikView to provide clear insights for business decisions.
Collaborate with cross-functional teams to translate business questions into analytical solutions and present findings to non-technical audiences.
This company specializes in healthcare data analytics, turning complex claims and eligibility data into actionable insights. The size and culture of the organization are not disclosed in the posting.
Own the data methodology and carry derived data points through development, QA, and production into metrics and categories.
Validate numbers using reconciliation SQL, version-over-version comparisons, and impact analysis before logic changes ship.
Turn feature requests from product and customer teams into delivered analytics by scoping, writing logic, and validating results.
Clarify partners with 60+ health systems to provide healthcare analytics and outcomes by mapping patient journeys and care economics. The company works with 300 million patient journeys and fosters a collaborative, impact-driven culture with a focus on mission and margin alignment.
Design and maintain complex financial models to track cost-saving initiatives and provide insights.
Perform advanced data analysis to assess prior authorization trends, claims trends, and cost drivers.
Lead post-implementation assessments to measure the impact of cost-saving initiatives and ensure sustainability.
Cohere Health's clinical intelligence platform and agentic AI-powered solutions optimize the speed, cost, and quality of care. The company is a growing organization with a supportive, growth-oriented environment and has been recognized as a top startup.
Own and maintain client-facing reporting that measures cost savings, outcomes, and performance of prior authorization programs across specialty areas.
Build, maintain, and QC actuarial models and methodology behind that reporting, keeping them ready to scale to new clients and lines of business.
Analyze and interpret authorization and claims data to identify trends, key drivers, and opportunities to improve customer value, quantifying the dollar and utilization effect of each.
Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. Backed by leading investors and named to the Inc. 5000 list, the company fosters a supportive, growth-oriented culture with diverse and inclusive teams.
Own outcomes measurement and savings analysis to quantify the impact of RightMove's care model on total cost of care and patient outcomes.
Analyze medical claims, referral patterns, and provider performance to identify savings opportunities and guide patients to high-value care.
Communicate findings through executive-ready reports and presentations to support commercial teams and customer stakeholders.
RightMove is redefining musculoskeletal (MSK) care by shifting from fragmented, volume-driven care to a coordinated, expert-led model powered by AI and data. Backed by leading investors and built in partnership with the Hospital for Special Surgery, the company is a rapidly expanding startup with a high-performing team that values impact, direct communication, and collaboration.
Cultivate deep understanding of clinical content and UM products to drive program effectiveness.
Lead clinical analytics projects with multi-disciplinary partners to build analytical solutions.
Independently conduct in-depth analyses using statistical modeling and data mining on healthcare data.
Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. The company works with over 660,000 providers and handles over 12 million prior authorization requests annually.
Review and analyze Medicare claims sampled by the Department of Justice to determine correct coding and payment based on coverage and utilization.
Conduct in-depth claims analysis to detect fraudulent or abusive billing practices using ICD-10, CPT-4, and CMS guidelines.
Complete summary reports and communicate findings internally while maintaining confidentiality and compliance with DOJ and CMS regulations.
Empower AI provides AI-powered solutions for federal government agencies, helping them transform their workforce and operations. Headquartered in Reston, Va., the company has three decades of experience in Health, Defense, and Civilian missions and is recognized as a 2024 Military Friendly Employer.
Perform data management activities to generate analytic-ready datasets using SQL and/or SAS.
Perform descriptive and basic statistical analysis using large patient and claims databases.
Contribute to the development of concept proposals, scope of work, and analysis plans.
Avalere Health is a healthcare advisory firm focused on ensuring every patient is identified, treated, supported, and cared for. The company has a global team with major hubs in London, Washington DC, and New York, and fosters an inclusive culture with six Employee Network Groups.
Develop and maintain operational, clinical, quality, compliance, and executive dashboards supporting the LTSS program.
Transform complex healthcare, operational, and financial data into actionable insights for program oversight and improvement.
Partner with cross-functional teams to monitor performance indicators, support compliance, and drive data-informed decisions.
The hiring partner is a healthcare organization supporting a large-scale Long-Term Services and Supports (LTSS) program. The role offers substantial autonomy and cross-functional collaboration in a fully remote environment.
Utilize Press Ganey and client data assets to consult with healthcare stakeholders on experience improvement and growth.
Partner with health plans and medical groups to conduct data analysis, interpretation, and process design to solve business problems.
Manage client relationships, prepare deliverables including data analyses, training, and presentations, and coordinate project activities.
Press Ganey is a leading experience measurement, data analytics, and insights provider for complex industries, helping organizations improve the human experiences at the heart of their business. The company has world-class talent, a collaborative work ethic, and a passion for the work, earning trusted advisor status among the world's most recognized brands.
Perform advanced analysis and interpretation of Medicaid data, developing methodologies to support program oversight.
Analyze large datasets to identify patterns, anomalies, and high-risk areas for fraud, waste, and abuse.
Create data visualizations and dashboards that communicate complex findings to technical and non-technical audiences.
This partner company provides advanced data analytics solutions for public-sector healthcare programs, focusing on Medicaid integrity. They foster a collaborative, mission-driven culture with a multidisciplinary team of analysts and technical experts.