Provides business analysis support for development, implementation, and maintenance of Technical Operations products.
Understands Government Programs regulations and ensures compliance with CMS and state guidance.
Uses data analysis and reporting tools like Excel and QlikView to support process improvements.
Navitus is a pharmacy benefit manager (PBM) focused on reducing drug costs to make medications more affordable. The company values diversity, creativity, and growth, fostering a collaborative culture for team members.
Lead business requirement conversations with customers and internal teams.
Develop business and functional requirements for Claims, Enrollment, Provider, Authorization, and Payment systems.
Collaborate with business users, management, IT, and offshore staff using Agile methodology.
UST HealthProof is a company focused on reshaping the future of health insurance by reducing administrative costs and building better healthcare experiences. It is run by leaders with strong health plan and technology backgrounds, fostering a start-up mindset and supportive environment where individual growth is nurtured.
Identifying and coordinating portfolio/product requirements, epics, user stories, and acceptance criteria with product owners and scrum masters.
Evaluating business risk and criticality through system of records and workbooks, and recommending risk mitigation strategies.
Facilitating pre-testing intake assessments and collaborating with stakeholders to support software and hardware application goals.
Planned Systems International (PSI) is a Government Contractor providing IT solutions and independent verification and validation services to federal clients. The company focuses on supporting Veterans Affairs initiatives and offers a competitive compensation package with benefits including paid leave, insurance, and a 401(k) retirement plan.
Partner with stakeholders to translate strategic priorities into well-defined solution requirements and process designs.
Elicit, document, and validate business requirements, maintaining traceability from concept through deployment.
Support product roadmaps, backlog prioritization, and agile delivery to ensure solutions solve real client pain points.
Cotiviti reshapes the economics of healthcare through data-driven solutions. They are a large company offering competitive benefits and a client-first culture, supporting team members with flexible remote work.
Partner with clients and cross-functional teams to gather, document, and refine business and data requirements.
Perform data analysis, source-to-target mapping, and data validation using SQL to ensure data quality and accuracy.
Contribute to Agile ceremonies and help improve team processes, documentation, and backlog management.
Cohere Health provides a clinical intelligence platform and agentic AI-powered solutions that connect health plans and providers to optimize care speed, cost, and quality. The company has been named to the 2025 Inc. 5000 list and ranked as a Top 5 LinkedIn Startup for 2023 & 2024, backed by leading investors like Deerfield Management and Define Ventures.
Lead analysis and delivery of coding, billing, and policy solutions from requirements to implementation.
Translate complex medical coding concepts into clear documentation and actionable deliverables.
Act as a key liaison between operations, technical teams, and client stakeholders to ensure alignment.
Partner company focused on healthcare operations, medical coding, and policy. They offer a fully remote environment with comprehensive benefits and professional development opportunities.
Coordinates data collection from multiple sources to audit and monitor compliance with regulations.
Investigates and resolves compliance matters and monitors corrective action plans.
Develops training materials and publications to educate organization stakeholders.
UnityPoint Health is a healthcare system serving Iowa, Illinois, and Wisconsin. It is recognized as a Top 150 Place to Work in Healthcare, with a culture focused on belonging and support for its team members.
Translate business needs from stakeholders into actionable technical requirements and system documentation.
Maintain ATO artifacts including System Security Plans, POA&M tracking, and scan evidence for VA umbrella ATO.
Bridge communication between Government stakeholders, program management, and development team.
9th Way Insignia is a service-disabled, veteran-owned small business delivering transformative technology to government clients, specializing in cybersecurity, cloud modernization, and software development. The company is a small business with a culture focused on mission-driven innovation and supporting veterans.
Lead advanced data analysis and trend analysis to proactively assess compliance risks and enhance monitoring mechanisms.
Develop comprehensive compliance dashboards and automated reporting systems for real-time insights into compliance performance.
Drive predictive modeling initiatives and cross-departmental collaboration to optimize compliance operations and resource allocation.
Aledade is a public benefit corporation that empowers independent primary care practices to thrive in value-based care. As the largest network of independent primary care in the country, Aledade offers a collaborative, inclusive, and remote-first culture.
Manage data intake and processing to ensure accurate client population health insights.
Analyze complex datasets using spreadsheets to drive data-driven decisions.
Collaborate with cross-functional teams and present findings to support patient enrollment and KPIs.
Jaan Health is an AI-based care management company serving healthcare providers with its Phamily platform. As an early-stage company, it fosters a collaborative, mission-driven culture built on growth and ownership.
Serve as the main point of contact for providers, resolving escalated issues and maintaining positive relationships.
Manage internal projects to improve provider experience, including education on best practices and policies.
Use data analysis and tools like Excel and Salesforce to investigate issues and reduce provider abrasion.
Clover Health provides high-quality, affordable healthcare plans for America's seniors by leveraging data and technology through the Clover Assistant. The company is a mission-driven, remote-first organization with a focus on diversity and inclusion, employing a team of passionate professionals.
Audits claims, customer service inquiries, member and group enrollment activities to validate Plan performance.
Supports internal audit and special investigations as needed.
Analyzes performance guarantee accounts and participates in external client audit requests.
Capital Blue Cross is a health insurance company providing coverage and services. They have been voted one of the 'Best Places to Work in PA' and foster a flexible, supportive culture with emphasis on employee well-being.
Serve as primary coordinator for the Med-Psych Management Program, managing reports, member enrollment, and community resource databases.
Handle high-volume inbound communications and provide administrative support to ensure continuity of care.
Collaborate with internal teams and external partners to streamline workflows and act as a liaison between members and health plans.
Mindoula Health is a healthcare organization focused on behavioral health management, providing support through multidisciplinary teams and health plan partnerships. The company operates as part of a specialty population health management team with a culture that values collaboration and data-driven outcomes.
Provides implementation support and management of MRO applications, including data gathering and configuration.
Serves as primary resource during implementation for internal and external teams on application setup and functionality.
Develops and maintains documentation to transition applications to support team, ensuring proper escalation procedures.
MRO provides Curation technologies and MRO application solutions for healthcare partners. The company offers a remote-first work environment and a comprehensive benefits package, focusing on client relations and employee support.
Responsible for timely and accurate submission of data calls and statistical data to regulatory bodies.
Review and interpret regulatory reporting requirements and analyze their impact.
Reconcile submissions to data sources and resolve variances to ensure accuracy.
Sutton National Group is a rapidly growing national property and casualty insurance carrier group. The company fosters a fast-paced, highly collaborative environment and seeks proactive, experienced problem solvers.
Lead and facilitate requirements gathering with business partners, product owners, technical teams, QA, vendors, and project teams.
Translate business needs into clear story cards, acceptance criteria, process flows, and other project artifacts that support successful delivery.
Analyze current-state processes, identify friction points, and help define future-state workflows that enable automation and AI solutions.
AAA Life leverages technology to put human connection at the heart of what we do, serving Americans with life insurance products that make a true difference for families during their hardest times. USA Today named us 2025 top workplace nationwide, and we are on a mission to double in size as one of the largest providers in the US.
Participate in complex client and system implementations, ensuring compliance with prompt pay laws and analyzing liquidity impacts.
Perform issue management triage, collaborating with stakeholders to identify root causes and resolve payment issues.
Conduct in-depth analysis on payment compliance with federal and state prompt pay laws and contractual requirements.
Prime Therapeutics is a different kind of pharmacy benefit manager (PBM) with a purpose beyond profits, focused on connecting care for those we serve. The company is a large organization that fosters a purpose-driven culture and offers opportunities to make a difference in simplifying healthcare.
Analyze benefit plan documents to build benefit categories and adjudication rules for claims processing.
Review member accumulators and assist in loading benefit logic to member and group records.
Manage daily configuration inventory queues and support cross-functional teams during implementations and renewals.
Gravie creates health benefits that actually benefit small and midsize businesses and their employees. They are well capitalized, have top-tier investors, and a diverse, non-hierarchical, merit-driven culture that values authenticity and high performance.
Provide administrative and programmatic support to VA Research Office, including committee support and research proposal processing.
Coordinate communication between committees and ensure compliance with regulatory guidelines.
Conduct database administration, audits, and project tracking using IRBNet and Excel.
Aptive partners with federal agencies to achieve their missions through improved performance, streamlined operations and enhanced service delivery. Founded in 2012, we have over 300 employees nationwide and specialize in applying technology, creativity and human-centered services to optimize mission delivery.
Serve as the primary point of contact for providers and Medicare contractors, responding to inquiries via phone, written, and electronic channels.
Maintain knowledge of contract requirements, develop professional relationships, and educate providers on proper protocols and appeal rights.
Perform research, due diligence, and data entry to resolve complex issues, while notifying management of escalated concerns.
Machinify is a leading healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, the company combines an AI-powered platform with best-in-class expertise.