Lead the Pricing team to craft winning PBM offers for new and existing clients.
Partner with Sales, Strategy, and Clinical teams to develop next-generation pricing and forecasting models.
Translate complex actuarial and market analytics into clear narratives for executives and clients.
SmithRx is a venture-backed health-tech company disrupting the pharmacy benefit management (PBM) sector with a next-generation drug acquisition platform. With hundreds of thousands of members since 2016, it has a mission-driven, collaborative culture guided by integrity, courage, and togetherness.
Process and maintain Medicare Advantage member enrollment and disenrollment requests with accuracy and timeliness.
Investigate and resolve enrollment system rejections, billing discrepancies, and CMS compliance issues.
Reconcile membership reports, monitor SLAs/KPIs, and mentor junior team members to support operational quality.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies through an objective review process. It uses AI to identify top-fitting applicants and shares them directly with employers, while final hiring decisions are made by humans.
Lead healthcare fraud lead and case development, turning analytic leads from VA's Palantir platform into decision-ready War Room referral packages.
Build referral packages with documentation supporting administrative actions and weekly decision packages for executive-level audiences.
Collaborate with OIC staff, VA OIG, and VHA stakeholders while supporting knowledge transfer and process improvement.
Arlo Solutions is an information technology consulting services company that specializes in delivering technology solutions. The company focuses on quality, value-added solutions that reduce costs, improve business processes, and support federal clients.
Lead external customer audits and utilization management oversight activities as a subject matter expert.
Analyze complex UM data, investigate findings, and prepare evidence-based responses for regulators and accreditation organizations.
Collaborate with operational, technical, and client-facing teams to drive compliance and process improvements.
This company is a healthcare organization specializing in utilization management and regulatory compliance. It operates with a remote team across the United States, fostering a collaborative and improvement-driven culture.
Provide human services policy expertise for BerryDunn projects, leading policy workstreams for a Guam engagement.
Interpret federal laws and regulations to assess client impacts and recommend practical implementation steps.
Develop policy manuals, briefs, and decision documents that translate complex requirements into actionable guidance.
BerryDunn is a professional services firm that provides tax, advisory, and consulting services to businesses, nonprofits, and government agencies. It is a client-centered, people-first firm with a focus on learning, development, and well-being.
Interpret federal and state regulations to ensure compliance and drive process improvements.
Analyze data in Excel to identify trends, savings, and process improvements.
SIHO Insurance Services provides health insurance administration and related services, focusing on payment integrity and regulatory compliance. The company operates in a managed care environment and emphasizes collaboration, professionalism, and adaptability among its employees.
Architect end-to-end TPA solutions across eligibility, claims, billing, and benefit administration.
Own PBM solution design, manage vendor partnerships, and negotiate data standards and SLAs.
Track financial performance, pricing, rebates, and operational health to drive client wins.
Personify Health created the first and only personalized health platform bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. They serve employers, health plans, and health systems with data-driven solutions that reduce costs and improve health outcomes.
Conduct clinical audits for suspected fraud, waste, and abuse with high autonomy.
Document findings in formal reports, graphs, and audit logs, aligning with unit goals.
Develop and present FWA-related education to Oscar teams, ensuring compliance with regulations.
Oscar is a health insurance company built on a full stack technology platform, focused on serving members like a doctor in the family. Founded in 2012, it is a forward-thinking company that values diversity and innovation, with a culture of fostering belonging and support.
Lead federal proposal pricing efforts from solicitation review through final submission.
Develop compliant, competitive, and well-supported cost and price solutions.
Coordinate with cross-functional teams and mentor pricing staff.
MicroTech is a Service-Disabled Veteran-Owned Small Business providing information technology and communications solutions. The company focuses on customer-centric innovation, offers strong benefits and a culture devoted to professional development.
Supports and strengthens the Compliance program by providing advisory support to business stakeholders.
Conducts compliance investigations and assists with auditing and monitoring activities.
Advances policy governance and development, translating regulations into practical guidance.
Rula is a mental health company dedicated to providing evidence-based, compassionate care to treat the whole person. They are a remote-first organization with a culture that values diversity, equity, and inclusion, hiring in most U.S. states.
Manage day-to-day health plan relationships, program commitments, and client communications.
Coordinate onboarding and delivery with internal teams, monitor service levels, and resolve issues.
Lead business reviews with performance insights and maintain alignment between client expectations and deliverables.
This role is with a healthcare services company that partners with health plans to deliver clinical assessments and close care gaps. The company uses AI to review applications and is committed to fairness and transparency in hiring.
Lead advanced compliance activities for healthcare administrative products including HSAs, FSAs, HRAs, and COBRA.
Apply expert regulatory judgment to risk assessments, compliance monitoring, investigations, and corrective actions.
Collaborate with stakeholders to integrate compliance requirements into strategic initiatives and leverage AI-powered tools.
HealthEquity empowers healthcare consumers by providing administrative solutions like HSAs, HRAs, FSAs, and COBRA. The company is a large, mission-driven organization that values inclusion and connects health and wealth for American families.
Manage day-to-day client relationships, business reviews, escalations, and executive engagement for pharmacy accounts.
Lead implementations, monitor service delivery, and resolve issues across retail, mail, specialty, rebate, and clinical programs.
Analyze data, develop reports, and coordinate vendors to ensure contractual commitments are met.
Blue Cross Blue Shield Association is a national association of 33 independent, community-based Blue Cross Blue Shield companies. We are purpose-driven with a culture built on connection, work-life flexibility, well-being, and community commitment.
Manage formularies, coverage determinations, and benefit design for PBM services.
Resolve clinical inquiries from members, clients, providers, and pharmacies.
Support P&T Committees with drug monographs, summaries, and medication policies.
OHSU is Oregon's only public academic health center with hospitals, clinics, and research schools. It is Portland's largest employer and a national research hub, welcoming diverse backgrounds.
Analyze high-value and complex claims, ensuring alignment with carrier guidelines and regulatory requirements.
Oversee delegated claims operations and third-party administrators, monitoring compliance and quality.
Provide subject matter expertise and process improvements to strengthen claims governance and outcomes.
They are an insurance organization focused on claims governance, compliance, and operational performance. They are a growing company that prioritizes accountability, service quality, and effective risk management.
Investigate known or suspected fraud, waste, and abuse with high autonomy.
Develop documentation and reports to substantiate findings and support recoupments.
Analyze prior cases to improve preventive identification and meet savings targets.
Oscar is a health insurance company built around a full-stack technology platform and focused on serving members. The company fosters an inclusive culture where employees can be their authentic selves, with a mission to change health care.
Investigate potential payment inaccuracies using Medicare Advantage claims and reimbursement knowledge to interpret data and explain payment outcomes.
Review claims populations identified through SQL analysis, distinguishing supported discrepancies from exceptions and correctly adjudicated claims.
Document validated findings clearly and support downstream recovery, Compliance/Legal review, and recurring audits.
Clover Health provides healthcare plans for seniors, using data and technology to improve care and lower costs. The company is a remote-first, mission-driven organization focused on diversity and inclusion.
Provide clinical expertise and strategic recommendations to clients and internal teams on drug spend, formulary compliance, and clinical programs.
Act as a clinical liaison between Plan Operations and other departments, communicating formulary changes and program updates.
Analyze drug benefit designs, prepare clinical marketing materials, and support go-live activities for new client groups.
SmithRx is a venture-backed health-tech company disrupting the PBM sector with a next-generation drug acquisition platform. It has hundreds of thousands of members and a mission-driven, collaborative culture guided by integrity, courage, and togetherness.
Convert raw medical claims (837 EDI, UB-04, CMS-1500) into canonical models applying healthcare coding standards.
Perform data quality audits and write SQL/Spark SQL queries to validate pipeline output and detect overpayment patterns.
Act as SME on claims coding, adjudication rules, and payer policy, mentoring analysts and collaborating with cross-functional teams.
Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients across the US. Deployed by over 85 health plans and representing more than 270 million lives, the company combines an AI-powered platform with industry expertise to maximize financial outcomes and reduce healthcare costs.
Own development of cost volumes, pricing models, and rate structures for competitive federal proposals.
Ensure FAR, DFARS, CAS, and TINA compliance while supporting audits and fact-finding sessions.
Manage teaming partner pricing intake, subcontractor negotiations, and prime pricing data calls.
Valiant Solutions is a security-focused IT solutions provider serving public clients nationwide. It is a fast-growing privately held company known for its employee-centric culture and recognition as a Best Place to Work in the D.C. area.