Proactively provides resources, information, advice, and expertise with coworkers and stakeholders.
Completes work assignments by applying up-to-date expertise within the Commercial Pharmacy Benefit.
Supports actuarial documentation by preparing and reviewing the actuarial portion of financial reports.
Jobgether uses an AI-powered matching process to ensure applications are reviewed quickly and fairly. They identify the top-fitting candidates and share this list with the hiring company who manages the final decision.
Developing advanced analyses of health plan and employer data.
Translating data into actionable strategies that support value-based care.
Building repeatable, intuitive reports and dashboards.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment in practicing medicine for providers. Driven by empathy and AI, Guidehealth leverages Healthguides™ and a Managed Service Organization to build stronger connections with patients and providers.
Be responsible for the monitoring and management of the end to end data flow of data submissions to vendors and government agencies to mitigate data leakage and submission errors.
Own the claim and supplemental submission workflow for CMS EDS submissions.
Develop data pipeline tracking reports and analyze, research, and resolve encounter data errors.
Clover Health is reinventing health insurance by combining data with human empathy to keep members healthier. They've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most. They are passionate and mission-driven individuals with diverse areas of expertise. From Clover’s inception, Diversity & Inclusion have always been key to their success.
Conduct complex analytic studies using statistical techniques on healthcare data.
Present findings through charts, tables, and graphs for easy interpretation.
Create and maintain efficient statistical and analytic code using tools such as Python, SAS, Stata, R.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. They identify the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Translate Twin Health’s AI-driven outcomes into a rigorous, defensible value proposition.
Architect actuarial models that prove ROI to health plan leaders.
Turn raw data into market-moving insights to scale Twin’s impact.
Twin Health empowers people to improve and prevent chronic metabolic diseases with a new standard of care. They apply AI Digital Twin technology exclusively toward metabolic health to build a dynamic model of each person’s metabolism. They have a passionate, talented team, and are scaling rapidly across the U.S. and globally.
Review payer financial reconciliations for accuracy and adherence to agreed-upon methodologies.
Support for the development and deployment of audit procedures applied to payer data sets.
Partner across teams and with payers to resolve data discrepancies.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. They are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Prepare and coordinate analyses of monthly and quarterly loss data.
Perform complex analysis of data with minimal oversight.
Develop and analyze new methodologies for Commercial insurance loss reserving.
CSAA Insurance Group (CSAA IG), a AAA insurer, is one of the top personal lines property and casualty insurance groups in the U.S. Headquartered in Walnut Creek, California, they have more than 3,800 employees located primarily in Arizona, California, Colorado, Nevada, New Jersey, and Oklahoma. They are proud of their values-based culture and are frequently recognized as a leader in employee professional development, corporate responsibility, diversity and wellness.
Design rigorous experiments and statistical tests to accurately measure the impact of solutions.
Develop innovative methodologies for causal inference and impact measurement.
Lead statistical analysis projects from hypothesis development through final recommendations.
DrFirst empowers providers and patients to achieve better health through intelligent medication management. They improve healthcare workflows and help patients start and stay on therapy with end-to-end solutions. This is a successful Healthcare IT company experiencing significant growth and they want to talk to you!
The primary job function is supporting the work of the Senior Actuaries.
May be responsible for ratemaking, and loss reserves for specific products in specific states.
Works with senior management and the State Administrator with the goal of meeting profit and growth objectives for that line of business.
Mercury Insurance has been helping people reduce risk and overcome unexpected events for more than 60 years. They embrace the strengths and values of each team member believing in diverse perspectives where everyone is included, to serve customers from all walks of life.
Conduct in-depth analysis of claim payments, identifying trends and patterns for cost avoidance through internal and external collaboration.
Ensure medical claims comply with guidelines, contracts, and standards while detecting billing inefficiencies and recommending corrective actions.
Provide data-driven recommendations to management on payment-affecting issues, supporting necessary system and policy updates and provider education.
BCBSRI is dedicated to serving Rhode Islanders by providing access to high-quality, affordable, and equitable care. They actively support associate well-being and work/life balance, fostering a culture of belonging where diverse perspectives are valued and employees are equipped for success.
Build Maven’s ability to drive sales through payer channels through strategic and analytic support to identify potential clients for all Maven programs and build a business case for them.
Lead end‑to‑end outcome evaluations for payer clients, designing robust methodologies and performing hands‑on analyses of medical and pharmacy claims, eligibility files and Maven platform data.
Own technical and clinical relationships with payer stakeholders, serving as their primary point of contact for study design, data sharing, results interpretation and ongoing analytic support.
Maven is the world's largest virtual clinic for women and families on a mission to make healthcare work for all. More than 2,000 employers and health plans trust Maven's end-to-end platform to improve clinical outcomes, reduce healthcare costs, and provide equity in benefits programs.
Own and maintain the company’s rating manual, including documentation, assumptions, updates, and ongoing enhancements.
Perform pricing analysis for new and renewing business, ensuring consistency with actuarial standards and internal guidelines.
Conduct ad-hoc actuarial and financial analyses to support business questions and strategic initiatives.
Optimyl Benefits provides accessible, high-quality, and easy-to-use healthcare plans for small employers. They partner closely with the broker community to help employers offer competitive benefits without unnecessary complexity and are committed to creating a diverse and inclusive work environment.
Developing and calibrating personal lines products.
Assisting with rate filings and DOI correspondence.
Analyzing key performance indicators and drivers of profitability.
Openly is rebuilding insurance from the ground up, re-envisioning and enhancing every aspect of the customer experience. They are a rapidly growing team of exceptional, curious, empathetic people with a wide range of skill sets, spanning technology, data science, product and more.
Support management of internal MGA programs, optimizing multiple areas.
Use data analyses to identify opportunities impact instant price and written premium.
Make recommendations on pricing through profitability analyses and market trends.
Zensurance is redefining commercial insurance for Canadian businesses by making getting the right coverage simple, fast, and accessible through a digital-first experience. They are a leading InsurTech that values ownership, collaboration, and innovation and has been recognized by Deloitte’s Technology Fast 50.
Partner with Sales on strategic opportunities involving quality measurement and Star Ratings solutions.
Lead product demonstrations showcasing HEDIS performance analytics, care gap identification, and quality improvement capabilities.
Articulate how Cotiviti's solutions address NCQA HEDIS certification requirements.
Cotiviti is a healthcare analytics company. They focus on improving healthcare outcomes and reducing costs through data-driven solutions, serving health plans and providers. Cotiviti values diversity and inclusivity, and they are an equal opportunity employer.
Lead support for business initiatives through data analysis and user acceptance testing
Identify and analyze user requirements to improve processes
Perform detailed analysis on projects and recommend business solutions
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. They identify the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Support implementation teams with deployment of Experian's ClaimSource revenue cycle management system.
Analyze internal processes and recommend improvements to enhance efficiency, automation, and effectiveness.
Build strong relationships with clients and implementation/service teams; participate in regular client calls.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. We operate across a range of markets and have a team of 23,300 people across 32 countries, investing in people and new advanced technologies to unlock the power of data and to innovate.
Develop, maintain & enhance non-life pricing models using GLMs/ machine learning techniques and actuarial methods.
Build dashboards in Power BI to communicate pricing insights and performance metrics.
Prepare price monitoring report to track price trends and identify potential areas of adjustment.
WNS (Holdings) Limited is a Business Process Management (BPM) company that combines industry knowledge with technology and analytics expertise to co-create innovative solutions. They have over 44,000 employees and serve over 400 clients across 10 industries, delivering BPM services in finance, accounting, procurement, customer interaction, and human resources.