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Asbestos Claims Specialist - East Orange, NJ Insurance Claims Specialist Adjuster Examiner Analyst Attorney Environmental Toxic Tort Asbestos Pollution Health Hazard _ . REMOTE WORK FROM HOME AVAILABLE Manage all aspects of defense litigation for toxic tort, asbestos and pollution claims. Shall draft and oppose motions, mediation statements, and deposition summaries, in addition to preparing for and attending depositions, mediation, arbitrations, and trials. Comprehensive compensation plan with competitive bonus and full medical, dental, vision, life and liability insurance included. Full company matched 401(k), and opportunities to advance within the organization. For complete details contact Greg Foss at: (609) 584-9000 ext 270 Or submit resume online at: Or email to: Please reference #41792NJ465 when responding. Diedre Moire Corporation Education Requirements: Bachelor Degree Minimum Experience Requirements: 5-10 years Job City Location: East Orange Job State Location: NJ Job Country Location: USA Salary Range: $110,000 to $160,000 Diedre Moire Corporation, Inc. diedremoire.com WE ARE AN EQUAL OPPORTUNITY EMPLOYER and our employment decisions are made without regard to race, color, religion, age, sex, national origin, handicap, disability or marital status. We reasonably accommodate individuals with handicaps, disabilities and bona fide religious beliefs. Jobs Career Position Hiring. CONSIDERED EXPERIENCE INCLUDES: Insurance Claims Specialist Adjuster Examiner Analyst Attorney Environmental Toxic Tort Asbestos Pollution Health Hazard #DiedreMoire #JobSearch #JobHunt #JobOpening #Hiring #Job #Jobs #Careers #Employment #jobposting #InsuranceJobs DISCLAIMER: We will make every effort to consider applications for all available positions and shall use one or more of the contact methods and addresses indicated in resume or online application. Indicated location may be proximate or may be desirable point of embarkation for paid or unpaid relocation to another venue. Job descriptions may fit single or multiple presently available or anticipated positions and are NOT an offer of employment or contract implied or otherwise. Described compensation is not definite nor precise and may be estimated and approximate and is negotiable depending on market conditions and candidate availability and other factors and is solely at the discretion of employers. Linguistics used herein may use First Person Singular and First Person Plural grammatical person construction for and with the meaning of Third Person Singular and Third Person Plural references. We reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. Response to a specific posting or advertisement may result in consideration for other opportunities and not necessarily the incentive or basis of the response. Nothing herein is or may be considered a promise, guarantee, offer, pledge, agreement, contract, or oath. If you submit an application or resume which contains your email address, we will use that email address to communicate with you about this and other positions. We use an email quality control service to maintain security and a remove and dead address filter. To cancel receiving email communications, simply send an email from your address with the word remove"" in the subject line to Or, visit the website at . If you have further concern regarding email received from us, call (609) 584-5499

Environmental Claims Examiner - Union City, NJ Insurance Claims Specialist Adjuster Examiner Analyst Attorney Environmental Toxic Tort Asbestos Pollution Health Hazard _ . REMOTE WORK FROM HOME AVAILABLE Seeking an environmental claims examiner with insurance defense attorney experience to manage claims in General Liability (GL), environmental, toxic tort and asbestos or construction defect. Responsibilities: • Investigate, negotiate and settle complex, long-tail claims. • Negotiate cost sharing agreements • Analyzing and evaluating liability 8+ years experience with 4 year degree required. Join a company committed to being the best in class in the industry offering competitive salary, full compensation package, retirement plans and more. For complete details contact Greg Foss at: (609) 584-9000 ext 270 Or submit resume online at: Or email to: Please reference #41792NJ489 when responding. Diedre Moire Corporation Education Requirements: Bachelor Degree Minimum Experience Requirements: 5-10 years Job City Location: Union City Job State Location: NJ Job Country Location: USA Salary Range: $110,000 to $160,000 Diedre Moire Corporation, Inc. diedremoire.com WE ARE AN EQUAL OPPORTUNITY EMPLOYER and our employment decisions are made without regard to race, color, religion, age, sex, national origin, handicap, disability or marital status. We reasonably accommodate individuals with handicaps, disabilities and bona fide religious beliefs. Jobs Career Position Hiring. CONSIDERED EXPERIENCE INCLUDES: Insurance Claims Specialist Adjuster Examiner Analyst Attorney Environmental Toxic Tort Asbestos Pollution Health Hazard #DiedreMoire #JobSearch #JobHunt #JobOpening #Hiring #Job #Jobs #Careers #Employment #jobposting #InsuranceJobs DISCLAIMER: We will make every effort to consider applications for all available positions and shall use one or more of the contact methods and addresses indicated in resume or online application. Indicated location may be proximate or may be desirable point of embarkation for paid or unpaid relocation to another venue. Job descriptions may fit single or multiple presently available or anticipated positions and are NOT an offer of employment or contract implied or otherwise. Described compensation is not definite nor precise and may be estimated and approximate and is negotiable depending on market conditions and candidate availability and other factors and is solely at the discretion of employers. Linguistics used herein may use First Person Singular and First Person Plural grammatical person construction for and with the meaning of Third Person Singular and Third Person Plural references. We reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. Response to a specific posting or advertisement may result in consideration for other opportunities and not necessarily the incentive or basis of the response. Nothing herein is or may be considered a promise, guarantee, offer, pledge, agreement, contract, or oath. If you submit an application or resume which contains your email address, we will use that email address to communicate with you about this and other positions. We use an email quality control service to maintain security and a remove and dead address filter. To cancel receiving email communications, simply send an email from your address with the word remove"" in the subject line to Or, visit the website at . If you have further concern regarding email received from us, call (609) 584-5499

ROLE SUMMARY The Senior Reporting Data Analyst brings 13+ years of experience in enterprise data warehousing and reporting, with deep expertise in the Property & Casualty (P&C) insurance domain, especially Workers’ Compensation. Acts as a Subject Matter Expert (SME) on enterprise data warehouse (EDW) content and insurance source systems, ensuring accurate data interpretation, strong data lineage, and reliable, business-aligned reporting outputs. ROLE RESPONSIBILITIES • Act as a Data & Domain SME across P&C insurance subject areas including policy, claims, billing, and financials. • Demonstrate deep expertise in Commercial Lines: Workers’ Compensation, General Liability, Commercial Auto, Property, Umbrella/Excess. • Collaborate with business stakeholders to gather, analyze, and validate reporting and data extract requirements. • Translate complex insurance business processes into data models, KPIs, metrics, and dimensional structures. • Leverage strong knowledge of Guidewire (PolicyCenter, ClaimCenter, BillingCenter), Genius, and SAP for accurate data interpretation and lineage. • Explain and map policy lifecycle events (submission, quote, bind, issue, endorsements, renewal, cancellation, reinstatement) into warehouse models. • Analyze claims lifecycle data including reserves, payments, recoveries, and claim financials. • Perform data lineage, source-to-target mapping, and transformation analysis across ETL and EDW layers. • Develop and validate complex SQL queries, views, and reporting datasets. • Ensure data reconciliation and consistency between transactional systems and enterprise warehouse. • Review and certify reports for accuracy, completeness, and regulatory compliance. • Investigate and resolve data discrepancies across source systems, ETL pipelines, and reporting layers. • Document data definitions, mappings, lineage, and business rules. • Support UAT, defect resolution, and reporting enhancements. • Educate stakeholders on data interpretation, reporting usage, and governance standards. TECHNICAL QUALIFICATIONS • 13+ years of experience as a hands-on Reporting/Data Analyst in enterprise environments. • 10+ years working with Enterprise Data Warehousing (EDW/DWH) solutions. • 7+ years of experience in Property & Casualty Insurance (Commercial Lines). • Strong domain expertise in Workers’ Compensation and claims analytics. • 5+ years of experience with BI/reporting tools: MicroStrategy, Power BI. • Hands-on experience with Guidewire (PolicyCenter, ClaimCenter, BillingCenter), Genius, SAP. • Advanced SQL skills with extensive experience querying large-scale data warehouses. • Strong understanding of: • Data lineage and traceability • Source-to-target mappings • Dimensional modeling (facts, dimensions, aggregates) • Enterprise reporting architecture • Proven ability to reconcile data between source systems and warehouse environments. GENERAL QUALIFICATIONS • Strong initiative with ability to self-manage in complex, ambiguous environments. • Excellent communication and stakeholder management skills. • Proven ability to work with senior business leaders and cross-functional teams. • Ability to clearly explain complex data concepts to technical and non-technical audiences. • Recognized as a trusted SME in Insurance Data & Data Warehousing. EDUCATION REQUIREMENTS • Bachelor’s degree in Computer Science, MIS, or related field (or equivalent experience).

Head of Intelligence New York City (On-Site) | $140,000–$155,000 + Equity | Full Benefits The Company The company is a venture-backed claims intelligence startup building technology that helps insurers and businesses identify and prevent property and casualty insurance fraud. Our platform analyzes data across employers, insurers, contractors, and other sources to uncover fraud networks that cost the U.S. economy billions annually. They are not a mile-wide, inch-deep solution. The company goes a mile deep—finding social media accounts under aliases, uncovering post-claim activity that contradicts injury narratives, and mapping fraud rings that look more like criminal networks than simple one-off schemes. Our clients already see enormous value from what we do; now we need someone to help us do it at scale. The Opportunity We are hiring a Head of Intelligence to own and operationalize our investigative intelligence function. This is a hands-on, execution-first role. You are not coming in to write strategy decks or build an empire of analysts—you are coming in to do the work, build repeatable processes around it, and work directly with our engineering and data science teams to turn manual tradecraft into scalable, programmatic solutions. The strategy is already defined. We know what our clients will pay for. What we need is someone who can execute at a high level and figure out how to do it faster, better, and at volume. What You Will Do • Conduct and lead structured OSINT investigations to locate individuals, uncover hidden social media accounts, and surface post-claim activity that contradicts reported injuries. This is what you will spend most of your time doing, especially early on., • Identify and map fraud networks and identity relationships across claims—connecting claimants, contractors, and accomplices using network analysis techniques similar to those used in counterterrorism and criminal intelligence., • Evaluate and integrate off-the-shelf intelligence tools (commercial OSINT platforms, social media monitoring, identity resolution tools) into they company’s workflows, configuring them for our specific use cases to get 80% of the way there before custom engineering takes over., • Partner directly with our machine learning engineer, CTO, and data science team to convert investigative insights and manual processes into structured data signals that feed our fraud scoring models., • Build repeatable, scalable processes for intelligence collection, validation, and documentation—taking what currently works at a dozen investigations per week and making it work at thousands., • Produce intelligence products that support fraud investigations, litigation defense, and client decision-making., • Manage a small number of offshore analysts performing manual research, with the potential to grow the team over time based on results. What We Are Looking For Required • Demonstrated, hands-on OSINT expertise. You have personally conducted structured open-source investigations—finding people who don’t want to be found, locating accounts under aliases, pulling actionable intelligence from social media, public records, deep web sources, and foreign-language content. This is not a “I managed a team that did OSINT” role. You need to be the person who can sit down and do the work., • Experience with identity networks and link analysis. You think in networks, not individuals. You understand how to map relationships between people, entities, and claims—whether that background comes from counterterrorism, criminal intelligence, fraud investigation, or similar domains., • Comfort working with technical teams. You do not need to be a software engineer, but you need to understand how data pipelines, APIs, and intelligence platforms work well enough to tell an engineering team exactly what needs to be built and why. You should be able to articulate investigative logic in terms that data scientists can operationalize., • Execution orientation. You are in the 3–7 year experience range (military, government, private sector, or a mix) and still deeply engaged in doing investigative work—not someone who has moved entirely into management or strategy., • Willingness to relocate to New York City. This is a fully on-site role in our Manhattan office. There is no remote or hybrid option. Strongly Preferred • Military intelligence, HUMINT, SIGINT, or CI background—especially if you conducted or supported network-based targeting or identity analysis., • Experience at federal agencies (DHS, DoS, CISA, FBI, FEMA, or IC elements) in roles involving threat intelligence, fraud investigation, or counter-disinformation., • Familiarity with commercial OSINT and intelligence platforms (Recorded Future, Maltego, Babel Street, Skopenow, open-source tools, etc.) and a track record of configuring off-the-shelf tools for specific mission sets., • Insurance fraud, litigation support, or financial crime investigation experience., • Exposure to graph databases (Neo4j or similar) or network visualization tools., • Working knowledge of Spanish, Portuguese, or other languages relevant to Central and South American open-source research. What This Role Is Not To be direct: this is not a role where you come in, hire a team of analysts on day one, and manage from a distance. Early on, you are the analyst, the investigator, and the process builder. You will have support from our existing team and engineering resources, but you need to be comfortable being the person in the weeds doing the investigative work while simultaneously thinking about how to scale it. We are also not looking for someone whose primary orientation is strategy and business development. We know the strategy. We need someone who can execute it. Compensation & Benefits • Base salary: $140,000–$155,000, • Equity participation, • 100% employer-paid medical coverage, • Dental and vision coverage, • On-site in Manhattan (currently Midtown, relocating to Chelsea) Reports To CTO and COO

Position: Data Quality Analyst / Claims Service Correspondent Location: New York, NY 10004 (Hybrid) Job Type: Contract Contract: ~8 weeks with potential extension Schedule: Monday – Friday | 9:00 AM – 5:00 PM Guaranteed hours per week: 35.00 Pay: Up to $65/hour Job Summary Pride Health is seeking a skilled Data Quality Analyst / Claims Service Correspondent for a contract opportunity in New York, NY. This role focuses on data validation, claims inquiry resolution, and quality assurance, supporting healthcare operations and ensuring accurate claims processing and data integrity. Responsibilities • Respond to provider claim inquiries and ensure timely resolution, • Review, validate, and maintain accuracy of healthcare data, • Perform claims adjustments for overpayments and underpayments, • Collaborate with internal teams (Provider Relations, Medical Management, Claims), • Maintain accurate documentation and data entry in IMAX systems, • Analyze datasets to identify discrepancies and improve data quality, • Support quality control processes for data reporting and analytics, • Track and manage inquiry resolution workflows, • Assist with audits, reporting, and process improvements, • Communicate effectively with providers and internal stakeholders Requirements • Strong experience in claims processing and healthcare operations, • Knowledge of MetroPlus claims guidelines and benefit structures, • Experience with IMAX and TXEN systems, • Proficiency in Excel and data analysis tools, • Strong analytical, problem-solving, and communication skills, • Ability to manage high-volume inquiries and meet deadlines Preferred Qualifications • Experience with SQL, Python, or R, • Background in data quality, analytics, or reporting, • Strong customer service and issue resolution skills, • Ability to work independently and handle complex workflows Why Work with Pride Health? Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors.

Job Description: • The Sr Research Analyst position will be part of the Impact & Insights team of Education. This role is responsible for the analysis and reporting of online education activities targeting physicians and healthcare professionals with the focus on the Outcomes reporting. The Outcomes reports provide analysis of knowledge, competence, performance and patient impact changes as a result of participation in medical education programs. This role ensures data from CME Outcomes reports are appropriately summarized and strategically-focused within the agreed timeline. This role also requires management of the timelines and delivery to the teams associated with these reports. This position includes collaboration with cross-functional internal teams including sales, content, clinical strategy and analytics and external clinical and patient care experts across multiple therapeutic topics., • The ideal candidate should have strong analytical, organization, communication, writing, and project management skills to develop reports to internal and external clients to support sales and revenue goals. He/she must have a proven ability to meet deadlines, while being proactive and detail-oriented. Responsibilities Include: • Provides highly skilled analysis and writing support to ensure data from CME Outcomes projects are appropriately summarized, strategically-focused, and completed within agreed priorities and timeline to the highest quality and with little to no supervision. Specific tasks include, but are not limited to:, • Collaborate with clinical strategists, scientific directors, data analytics team and external clinical experts to analyze data to identify the focus for each report (e.g. educational needs and knowledge, competence, performance and patient impact changes), • Compile, write, and edit Outcomes reports summarizing quantitative and qualitative analysis results that are aligned with educational objectives and project assessment goals, • Communicate regularly with internal teams regarding project status and individual roles/responsibilities, • Work closely with the Data Analytics team to provide enhancement suggestions and assist with troubleshooting, • Provide feedback on outcomes deliverables to improve and enhance their quality, • Maintain and enhance reporting template(s) and customize as needed using reporting tools such as Tableau, Excel and PowerPoint, • Ensure deliverable, messaging and branding is consistent across business units and its products, • Maintain familiarity with current industry practices and regulatory requirements and guidelines that affect medical education and outcomes research, • Maintain a friendly and productive relationship through clear articulation and an effective communication style with internal and external stakeholders, • Continuously identify opportunities for process improvement Qualifications: • Bachelors Degree or equivalent experience; BA/BS degree in life sciences, public health, clinical sciences with a minimum of 5 years of relevant experience in evaluating programs effectiveness and providing actionable insights, • Experience in health or education-related research or in certified medical education preferred. This may include medical education/communications company, professional medical publisher, academic institution/ hospital/university center, medical society, etc., • Experience with a statistical or data management software (e.g., Tableau, SAS, SPSS, R)Excellent technical writing skills, • Experience with healthcare data, • Excellent computer skills that includes working remotely on shared networks and cloud-based systems, • Moderate to advanced experience in Microsoft Excel and Microsoft PowerPoint, • Superior ability to describe complex data and results to a non-technical audience, • Excellent time management and organizational skills, with the ability to efficiently work on multiple tasks simultaneously in a highly deadline-driven environment, while taking into consideration stakeholders based across multiple time zones, • Ability to work well in a collaborative research environment, as well as the ability to work independently with limited supervision, • Attention to detail with high level of accuracy, • Positive attitude/ very high energy with a willingness to accept varied assignments, • Strong verbal and written communication skills Preferred Skills: • Advanced statistical analyses (e.g., regression), • CME/CPD evaluation, • SQL, • Tableau or PowerBI, • Experience with claims data

Position: Lead Claims Business Analyst - W2 Location: New York, NY 10004 Contract: Approx. 8 weeks (with potential extension) Schedule: Monday–Friday | 9:00 AM – 5:00 PM (Hybrid) Guaranteed hours per week: 35.00 Pay: Up to $60/hour Job Summary Pride Health is seeking an experienced Lead Claims Business Analyst for a contract opportunity in New York, NY. This role will serve as the primary point of contact for the Claims Processing workstream, supporting system implementation, workflow optimization, and process improvement initiatives within a healthcare environment. Responsibilities • Serve as the main point of contact for the Claims Processing workstream, • Gather, analyze, and document business requirements in collaboration with stakeholders and consultants, • Develop current and future state workflows for claims processes and downstream systems, • Identify gaps in processes and documentation; recommend and implement improvements, • Partner with leadership to define product roadmaps and prioritize system enhancements, • Review and validate business requirements, workflows, policies, and procedures, • Collaborate with QA teams to define test cases, scenarios, and acceptance criteria, • Support UAT testing and ensure alignment with business requirements, • Identify and resolve system or process deviations during testing phases, • Assist in development and review of training materials, • Monitor project progress and provide updates to stakeholders, • Act as liaison between business, technical teams, and leadership, • Ensure timely delivery of project milestones and objectives Requirements • Strong experience as a Business Analyst in healthcare or claims environment, • Hands-on experience with claims processing (Medicaid/Medicare/Commercial), • Proven experience with UAT, test case creation, and system implementation, • Strong analytical, problem-solving, and process improvement skills, • Experience with workflow documentation and gap analysis, • Excellent communication and stakeholder management skills Preferred Qualifications • Experience with Behavioral Health claims, • Prior experience working on large-scale system implementations, • Strong understanding of healthcare operations and claims lifecycle, • Ability to work cross-functionally with technical and business teams Why Work with Pride Health? Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors.

Overview: Our client, a US Fortune 50 organization and a leading provider of Healthcare and Health Insurance services, seeks an accomplished Medical Claims/ Appeals Specialist Position: Medical Claims/ Appeals Specialist Location: New York, NY Duration: 3-6 months+ temp-to-hire!!! Pay rate: $24/hr on W2 Note: • REMOTE role with possibility, • The schedule for the training period will be a set schedule: 8:00am to 4:30pm EST time., • Training will be 5-6 weeks. After training, the candidates may choose to flex start time of 6:00 AM EST to 10:00 AM EST., • Candidates can work from 50 miles (or 1 hour) from any NGS or PulsePoint locations (EXCEPT the state of CA). These are not HYBRID requirements while working temp. However, if/when they convert temp-hire, they must be willing to work onsite depending on what the HYBRID requirements for FTE associates are at the time of conversion (usually 1-3 days per week). JOB DESCRIPTION: This is an entry level position in the Appeals Department that reviews, analyzes and processes non-complex pre-service and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (Part A & B) related to clinical and non-clinical services, quality of service, and quality of care issues to include executive and regulatory grievances. • The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments., • Requires a High school diploma or GED; up to 2 years’ experience working in grievances and appeals, claims, or customer service or any combination of education and/or experience which would provide an equivalent background., • Familiarity with medical coding and medical terminology, demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, all of the company's internal business processes, and internal local technology strongly preferred., • Preferred Skills: Medical Terminology, Letter Writing, Claims Experience, Appeals Experience Primary duties may include, but are not limited to: • Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language., • Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review., • The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements., • As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination., • Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information. Recruiter Contact Info Gurjant Singh Phone: 925-297-5994 Email: I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you. Company Overview: Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally: as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with a service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients’ businesses forward. Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Applicants with criminal histories are considered in a manner that is consistent with local, state and federal laws.

Based in San Francisco, ___ is a rapidly growing healthcare technology and clinical services company with a mission to ensure individuals receive the safest and most effective treatments for their unique and evolving healthcare needs. Frequently, medications cause more harm than good. Incorrect drugs and doses costs the US healthcare system over $528 billion in waste, avoidable harm, and hospitalizations each year. Arine is redefining what excellent healthcare looks like by solving these issues through our software platform (SaaS). We combine cutting edge data science, machine learning, AI, and deep clinical expertise to introduce a patient-centric view to medication management, and develop and deliver personalized care plans on a massive scale for patients and their care teams. Arine is committed to improving the lives and health of complex patients that have an outsized impact on healthcare costs and have traditionally been difficult to identify and address. These patients face numerous challenges including complicated prescribing issues across multiple medications and providers, medication challenges with many chronic diseases, and patient issues with access to care. Backed by leading healthcare investors and collaborating with top healthcare organizations and providers, we deliver recommendations and facilitate clinical interventions that lead to significant, measurable health improvements for patients and cost savings for customers. Why is Arine a Great Place to Work?: Outstanding Team and Culture - Our shared mission unites and motivates us to do our best work. We have a relentless passion and commitment to the innovation required to be the market leader in medication intelligence. Making a Proven Difference in Healthcare - We are saving patient lives, and enabling individuals to experience improved health outcomes, including significant reductions in hospitalizations and cost of care. Market Opportunity - Arine is backed by leading healthcare investors and was founded to tackle one of the largest healthcare problems today. Non-optimized medications therapies which cost the US 275,000 lives and $528 billion annually. Dramatic Growth - Arine is managing more than 18 million lives across prominent health plans after only 4 years in the market, and was ranked 236 on the 2024 Inc. 5000 list and was named the 5th fastest-growing company in the AI category. The Role: The Data Engineering Lead is a pivotal hybrid role within the Data Engineering team, combining hands-on development with leadership responsibilities. This individual will lead a squad of Data Engineers to deliver high-quality, high-velocity customer data pipelines while maintaining existing ones. The Data Engineering Lead owns end-to-end delivery including project management, data quality, and timelines and is accountable for both team output and their own individual contributions. This role requires consistently high standards in both coding and execution. What You'll be Doing: • Collaborate with the Implementation and Data Analyst team to review and own DE requirement write-ups, ensuring they fully address data needs discussed in implementation calls., • Communicate timelines for deliverables to unblock Data Engineers for ETL pipeline development., • Proactively flag risks to timelines or quality to stakeholders and project managers., • Lead backlog grooming for implementation-related tickets., • Ensure team cross-coverage: both the DE Lead and assigned Data Engineer should understand the full ETL flow, with at least two additional engineers familiar at a high level., • Conduct thorough peer reviews and DE UATs after initial UAT completion., • Design and maintain data transformation pipelines using dbt, including utilizing core concepts like macros, incremental models and dbt tests, • Work with QA and CSA teams to resolve post-UAT issues and update the DE UAT checklist., • Provide technical guidance and mentorship to junior engineers, and promote best practices and coding standards., • Identify and escalate inefficiencies within and across teams., • Support project management and provide leadership to peers as needed., • Author and support high-quality technical documentation, assisting junior engineers in doing the same., • Collaborate with the DE Manager to report on DE contractor performance issues. Who You Are and What You Bring: • 6+ years of experience working with Data, • Experience leading a team of up to 3 Engineers, • Experience creating an automated ETL process using Python and DBT SQL, • Hands on experience with modern data technologies and comfortable leveraging AI coding assistants to accelerate development, improve code quality, and enhance productivity., • Experience with data processing, validation, cleaning, and debugging data sets, • Experience with building production grade ETL pipelines using dbt (including macros, incremental and Python models and testing), • A demonstrable and deep understanding of healthcare /healthcare claims data, • Experience with processing large data sets (over 10 GB), • Excellent verbal and written communication skills Remote Work Requirements: • An established private work area that ensures information privacy, • A stable high-speed internet connection for remote work, • This role is remote, but you will be required to come to on-site meetings multiple times per year. This may be in the interview process, onboarding, and team meetings Perks: Joining Arine offers you a dynamic role and the opportunity to contribute to the company's growth and shape its future. You'll have unparalleled learning and growth prospects, collaborating closely with experienced Clinicians, Engineers, Software Architects, and Digital Health Entrepreneurs. The posted range represents the expected salary for this position and does not include any other potential components of the compensation package (including bonus and equity), benefits, and perks. Ultimately, the final pay decision will consider factors such as your experience, job level, location, and other relevant job-related criteria. The salary range for this position is: $150,000-170,000/year. Job Requirements: • Ability to pass a background check, • Must live in and be eligible to work in the United States Information Security Roles and Responsibilities: All staff at Arine are expected to be part of its Information Security Management Program and undergo periodic training on Information Security Awareness and HIPAA guidelines. Each user is responsible to maintain a secure working environment and follow all policies and procedures. Upon hire, each person is assigned and must complete trainings before access is granted for their specific role within Arine. Arine is an equal opportunity employer. We are committed to creating a diverse and inclusive workplace where all employees are treated with fairness and respect. We do not discriminate on the basis of race, ethnicity, color, religion, gender, sexual orientation, age, disability, or any other legally protected status. Our hiring decisions and employment practices are based solely on qualifications, merit, and business needs. We encourage individuals from all backgrounds to apply and join us in our mission. Check our website at . This is a unique opportunity to join a growing start-up revolutionizing the healthcare industry! Job Offers: Arine uses the arine.io domain and email addresses for all official communications. If you received communication from any other domain, please consider it spam. Note to Recruitment Agencies: We appreciate your interest in finding talent for Arine, but please be advised that we do not accept unsolicited resumes from recruitment agencies. All resumes submitted to Arine without a prior written agreement in place will be considered property of Arine, and no fee will be paid in the event of a hire. Thank you for your understanding.

Job Description: • The Sr Research Analyst position will be part of the Impact & Insights team of Education. This role is responsible for the analysis and reporting of online education activities targeting physicians and healthcare professionals with the focus on the Outcomes reporting. The Outcomes reports provide analysis of knowledge, competence, performance and patient impact changes as a result of participation in medical education programs. This role ensures data from CME Outcomes reports are appropriately summarized and strategically-focused within the agreed timeline. This role also requires management of the timelines and delivery to the teams associated with these reports. This position includes collaboration with cross-functional internal teams including sales, content, clinical strategy and analytics and external clinical and patient care experts across multiple therapeutic topics., • The ideal candidate should have strong analytical, organization, communication, writing, and project management skills to develop reports to internal and external clients to support sales and revenue goals. He/she must have a proven ability to meet deadlines, while being proactive and detail-oriented. Responsibilities Include: • Provides highly skilled analysis and writing support to ensure data from CME Outcomes projects are appropriately summarized, strategically-focused, and completed within agreed priorities and timeline to the highest quality and with little to no supervision. Specific tasks include, but are not limited to:, • Collaborate with clinical strategists, scientific directors, data analytics team and external clinical experts to analyze data to identify the focus for each report (e.g. educational needs and knowledge, competence, performance and patient impact changes), • Compile, write, and edit Outcomes reports summarizing quantitative and qualitative analysis results that are aligned with educational objectives and project assessment goals, • Communicate regularly with internal teams regarding project status and individual roles/responsibilities, • Work closely with the Data Analytics team to provide enhancement suggestions and assist with troubleshooting, • Provide feedback on outcomes deliverables to improve and enhance their quality, • Maintain and enhance reporting template(s) and customize as needed using reporting tools such as Tableau, Excel and PowerPoint, • Ensure deliverable, messaging and branding is consistent across business units and its products, • Maintain familiarity with current industry practices and regulatory requirements and guidelines that affect medical education and outcomes research, • Maintain a friendly and productive relationship through clear articulation and an effective communication style with internal and external stakeholders, • Continuously identify opportunities for process improvement Qualifications: • Bachelors Degree or equivalent experience; BA/BS degree in life sciences, public health, clinical sciences with a minimum of 5 years of relevant experience in evaluating programs effectiveness and providing actionable insights, • Experience in health or education-related research or in certified medical education preferred. This may include medical education/communications company, professional medical publisher, academic institution/ hospital/university center, medical society, etc., • Experience with a statistical or data management software (e.g., Tableau, SAS, SPSS, R)Excellent technical writing skills, • Experience with healthcare data, • Excellent computer skills that includes working remotely on shared networks and cloud-based systems, • Moderate to advanced experience in Microsoft Excel and Microsoft PowerPoint, • Superior ability to describe complex data and results to a non-technical audience, • Excellent time management and organizational skills, with the ability to efficiently work on multiple tasks simultaneously in a highly deadline-driven environment, while taking into consideration stakeholders based across multiple time zones, • Ability to work well in a collaborative research environment, as well as the ability to work independently with limited supervision, • Attention to detail with high level of accuracy, • Positive attitude/ very high energy with a willingness to accept varied assignments, • Strong verbal and written communication skills Preferred Skills: • Advanced statistical analyses (e.g., regression), • CME/CPD evaluation, • SQL, • Tableau or PowerBI, • Experience with claims data

Actively hiring "Provider Network Operations Analyst (HRP Migration)" at New York NY (Hybrid) for position at a hospital. pay rate is $65-$70/Hr. Please find below the Job Description: • Job Title : Provider Network Operations Analyst (HRP Migration), • Duration : 3-6+ (Extendable), • Location : New York NY (Hybrid), • Pay Rate : $65-$70/Hr. Job Summary We are seeking a detail-oriented Provider Network Operations Analyst to support the migration to HealthRules Payer (HRP), a core claims processing system. This role will work closely with cross-functional teams to ensure smooth implementation, accurate provider data management, and effective issue resolution throughout the migration lifecycle. Key Responsibilities • Support migration to HealthRules Payer (HRP) for Provider Network Operations (PNO), • Participate in project meetings across all phases: planning, testing, and post-go-live, • Maintain and track PNO project issues, providing updates to leadership, • Assist in resolving provider-related issues during HRP implementation, • Update and maintain process documentation, policies, and procedures, • Prepare executive summaries and communications on project updates, • Represent leadership in operational and project meetings as needed, • Ensure provider data accuracy across systems (e.g., CACTUS, PowerStepp, HRP, Salesforce), • Monitor and escalate provider complaints related to system migration, • Perform data analysis, reporting, and tracking for migration and operational issues, • Act as liaison across Credentialing, Provider Maintenance, and Customer Service teams, • Support additional PNO projects and operational initiatives as required Qualifications • Bachelor’s degree or equivalent experience, • 3–5 years of experience in a health plan environment (Medicaid preferred), • Strong understanding of provider network operations and healthcare data structures, • Experience with system migrations or claims platforms preferred, • Excellent analytical, communication, and organizational skills, • Ability to manage multiple priorities in a fast-paced environment Benefits: Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, , legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Job Title: Senior Data Analyst. Conduct exploratory data analysis to uncover hidden patterns, correlations, and insights within medical claims data that inform hypothesis generation and strategic initiatives. You’re a thoughtful, detail-oriented analyst who gets excited about using data to solve c

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: • Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,, • Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Position Summary We are seeking a highly analytical and detailoriented Analyst to join our team. This role plays a key part in validating and coding audit deliverables, developing performance monitoring reporting, quantifying financial impact, and driving efficiency through automation and advanced analytics. The ideal candidate brings experience with internal controls, audit testing, and risk assessment, along with a proven ability to deliver highquality results in a fastpaced, collaborative environment. Position Responsibilities: • Research and analyze pharmacy claims to ensure accuracy and contractual compliance across benefit setup, pricing, and guarantees, • Perform audit risk assessments, annual logic reviews and ongoing monitoring activities, • Analyze, reconcile and validate large datasets across multiple internal systems; develop and maintain SQL/Python queries for audit reporting and performance monitoring, • Create audit deliverable reporting, quantify financial impact of potential and confirmed audit findings, and build dashboards to identify trends and risks, • Identify and implement automation and process improvements across audit, reporting, and reconciliation workflows, • Maintain and enhance code, reporting tools, and dashboards to improve reliability, efficiency, and scalability, • Define and document technical requirements, data specifications, and methodologies to support transparency and repeatability, • Collaborate with internal and technology teams to improve data quality, workflows, and controls, • Provide ad-hoc analysis to support evolving business and audit needs, • Bachelor's degree in a quantitative or business-related field (e.g., Actuarial Science, Statistics, Economics, Finance, Data Analytics, or Business Administration), • 2+ years of of experience in data analytics, audit, or a related role, • Experience in healthcare, PBM, or pharmacy claims; knowledge of pharmacy benefits, pricing, guarantees, and pharmacy claims analysis preferred, • Proficiency with SQL (Snowflake preferred), Excel, Tableau, • Familiarity with Python and project management/version control tools (e.g., Jira, Confluence, GitHub), • Strong attention to detail with an intellectual and professional curiosity along with a passion for continuous improvement, • Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables, • Effective communicator with both technical and non-technical stakeholders Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at___.

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: • Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,, • Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Position Summary: The Underwriting Data Analyst position is a fast-paced, detail-orientedrolefor someoneready fora professional career working with data, especially concerned with data cleanliness, standardization,andunification.Analysts support claims processingand templated code requestsforbothnew and currentbusiness. Whyyou'lllove working here: • You will make a tangible impact on society.Your workwill directly improve healthcare experiences for millionsas we code new analyses and data views., • We are a late-stage startup with stability. We have startup energy with a focus on delivery, but healthy processes with a strong financial outlook that provides a sense of security., • Collect, clean, process, and analyze potential and current clients' pharmaceutical data - using SQL, R, Python, and MS Excel asappropriate -to support the Underwriting and Sales teams in the acquisition of new business and retention of current clients, • Thoroughly understand internal and external data fields,identifypatterns of data irregularities, and improve data quality and intake, • Reach out to and question relevant partiesregardingany data ambiguity and request anyadditionaldata elements that may berequiredor beneficial for analysis, • Assistin the writing and maintenance of the Underwriting infrastructure code in SQL, R, and Python, • Participate in process enhancement for data analytics and reporting, • Provide ad-hoc analytics support the Underwriting team in the successful completion of all bid opportunities, • Provide analytics support to the Pricing, Clinical Account Management, and Implementation teams tofacilitateclient transitions as needed, • Proficient in SQL; Knowledgeable in Python and R, • 1+ years of proven experience in data analysis(academic or professional), • Exceptional written and verbal communication skills, • Extremely flexible, highly organized, and able to shift priorities easily, • Knowledge of pharmaceutical claims, • Knowledge of and passion for improving the healthcare industry Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at___.

Job Title: Billing Analyst Location: Remote – Must reside in California Employment Type: Full-Time Reports To: Revenue Cycle Manager or Designee Hourly Pay Range: $22.00 – $24.00 per hour About Pacific Health Group Pacific Health Group is at the forefront of revolutionizing health and wellness. We are setting new benchmarks in healthcare services, leading with groundbreaking approaches and innovative solutions to empower our members, uplift families, and impact communities. Pacific Health Group's vibrant culture fuels passionate problem-solvers who thrive on collaboration to deliver unparalleled care. Joining us means being part of a progressive movement championing personal and professional growth through industry expertise, advanced tech, and an appreciative community. Position Summary The Billing Specialist plays a key role in ensuring accurate documentation, timely billing, and regulatory compliance across member and patient services. This role supports our long-term care coordination programs and works cross-functionally with case managers, patient coordinators, and finance staff to ensure accurate reimbursement, efficient claims management, and billing compliance with Medicaid and consolidated health plans. Key Responsibilities • Collaborate with case managers, social workers, patient coordinators, and other staff to ensure complete documentation of patient care plans, services provided, and changes in condition or level of care., • Assign accurate medical codes (e.g., ICD-10, other relevant codes) for diagnoses, treatments, and services in long-term care settings., • Prepare and submit claims to Medicaid and other payers, ensuring proper documentation and compliance with guidelines., • Create invoices and claims for member/patient interactions and outreach activities., • Ensure compliance with consolidated billing requirements, confirming all services are billed by Pacific Health Group as the designated entity., • Review, analyze, and appeal denied claims as needed; gather additional documentation or clarification from internal teams to support resubmission., • Monitor and manage accounts receivable; follow up with payers and health plans to resolve delays or discrepancies and ensure timely reimbursement., • Reconcile payer reimbursements with submitted claims to maintain accurate billing records., • Stay current with changes in billing regulations, long-term care reimbursement policies, and coding guidelines to ensure ongoing compliance., • Provide training or guidance to internal teams on documentation and billing procedures to support accurate and compliant submissions., • 1–2 years of experience in medical billing, preferably in long-term care, managed care, or Medicaid environments, • Working knowledge of ICD-10 and consolidated billing processes, • Familiarity with denial management, appeals, and accounts receivable follow-up, • Strong attention to detail and documentation accuracy, • Ability to work independently and manage multiple tasks and deadlines, • Excellent communication skills for working cross-functionally with internal staff and external payers, • Proficiency in medical billing software and standard office tools, • 160 Hours of Paid Time Off (PTO), • 12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment, • 4 Paid Volunteer Hours per Month to support causes you care about, • Bereavement Leave, including Fur Baby Bereavement, • 90% Employer-paid Employee-Only Medical Benefits, • Dental and Vision Insurance, • FSA | Dependent Care Account, • 401(k) with Company Match, • Monthly Stipend, • Short-Term & Long-Term Disability | AD&D, • Employee Assistance Program (EAP), • Employee Discounts via Great Work Perks and Perks at Work, • Quarterly In-Person Events, • Fully remote work within California Pre-Employment Requirements Employment is contingent upon the successful completion of a background check.

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: • Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,, • Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Location: Hybrid (Local to NYC or Denver areas) or Remote-US Position Summary: The Business Analyst provides support gathering and documenting business and reporting requirements that align with state and federal guidelines. This individual will analyze complex problems and issues using available information from both internal and external sources. Other responsibilities will include - creating specifications documents for business processes, reports, data extracts, and analyses based on business needs. Identify and interpret trends in datasets to find possible outliers or patterns that can be used to drive process improvements. Collaborates with internal and external cross-functional teams (compliance, product, sales, marketing, underwriting, implementation, client services, clinical operations) to design, refine, automate, and maintain operational capabilities. Position Responsibilities: • Monitors for changes in existing business processes and updates documentation accordingly - Finds new opportunities for process developments and improvements, • Intake, analyze and manage requests from stakeholders, • Proactively reviews business processes and data to develop subject matter expertise of processes supported by our team, • Drives root-cause-analysis and resolution of data and processes issues/errors by partnering with key stakeholders, • Supports analytical, problem-solving functions by defining and documenting specifications pertinent to all departmental processes, • Analyzes business workflow and system needs for conversions and migrations to ensure that government submissions, recovery, and cost savings regulations are met, • Prepares end user documentation and training materials as needed, • Support government data submission processes by analyzing complex data issues using data from internal and external sources, • Improve government data submission processes by reviewing and synthesizing state and federal recourses, consolidating into comprehensive business requirements documents, • Support creation of intake request to enhance existing processes by gathering requirements and level setting with stakeholders on required processes, • Develop and set up performance metrics for stakeholder distribution, • 3+ years of healthcare experience, • 3+ years of business process analysis, preferably in healthcare, • 3+ years of experience with Government Exchange programs, • Demonstratable knowledge of SQL, Excel, and flow-charting tools, • Experience with implementation/project management, • Experience working with cross-functional teams, • Extremely flexible, highly organized, excellent communication and able to shift priorities easily, • Attention to detail & commitment to delivering high-quality work product, • Comfort or experience in a fast-paced, growing environment, • Intellectual and professional curiosity, • Familiarity with the agile framework/Certified Scrum Product Owner preferred, • Bachelor's degree in Business Administration, Data Analytics, Computer Science or 3+ years of relevant experience This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job. Remote, US Salary Range$90,000—$105,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at___.

Thank you for considering Progyny! The Claims Analyst is responsible for researching, analyzing, and resolving complex claim-related inquiries from internal teams and external partners, including providers and ancillary laboratories. This role manages claim adjustments, reprocessing requests, denial investigations, and claim status inquiries to ensure accurate and timely resolution. This position supports efficient claims operations by ensuring accuracy in data review, identifying root causes of claim issues, and collaborating cross-functionally to resolve escalated concerns. The ideal candidate demonstrates strong attention to detail, the ability to manage multiple priorities, and a proactive, customer-focused approach in a fast-paced environment. What you'll do... * Maintain expertise in processing requirements, benefit structures, and reimbursement guidelines across assigned health plans. * Manage and resolve accounts receivable (AR) for assigned providers and ancillary labs by reviewing and addressing items on open AR reports. * Lead regular calls with providers and partners to address claim inquiries, including claim status, denial reasons, reprocessing requests, and authorization issues. * Review and follow up on unadjudicated claims, proactively contacting providers to obtain missing information or resolve processing barriers. * Monitor and respond to inquiries through the dedicated claims email inbox, ensuring timely investigation and resolution. * Maintain accurate provider and reimbursement of information in internal systems, ensuring data integrity and compliance with plan requirements. * Act as a liaison between Provider Services, Member Services, and internal teams for escalated claim issues and complex provider inquiries. * Review and validate our claims processor's weekly reports to ensure claims are adjudicated according to guidelines and plan requirements. * Collaborate with Provider Account Managers, Provider Relations, Progyny Care Advocates and the Contracting Team to resolve escalated claims issues and enhance the provider experience. * Provide ongoing case management for assigned providers and ancillary labs, tracking and resolving outstanding claim issues. * Identify recurring claim processing issues and partner with internal teams to recommend process improvements, preventing future delays or denials. About you... * 3-5+ years of experience in healthcare claims, provider billing, or revenue cycle operations, including researching claim status, resolving denials, and managing adjustments or reprocessing. * Experience in a healthcare environment required; fertility industry experience strongly preferred. * Knowledge of insurance carriers, reimbursement processes, medical billing practices, and CPT/HCPCS/ICD-10 codes. * Proficient in Microsoft Excel, Outlook, and case management or CRM platforms (Salesforce preferred). * Ability to manage multiple priorities, navigate varying insurance products and benefit structures, and work in a fast-paced, data-driven environment. * Excellent communication and interpersonal skills, including managing complex provider conversations professionally. * Strong organizational, analytical, and problem-solving skills, with a focus on accuracy and quality. * Adaptable, proactive, and able to work independently while collaborating cross-functionally and escalating issues appropriately. Please note: This is not a digital nomad or remote international position; candidates must be based in the United States. Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future. About Progyny: Progyny (Nasdaq: PGNY) is a global leader in women's health and family building solutions, trusted by the nation's leading employers, health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians. Our benefits solution empowers patients with concierge support, coaching, education, and digital tools;provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs. Our mission is toempower healthier, supported journeys through transformative fertility, family building and women's health benefits. Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit ___. Our perks: * Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents' Employee Affiliation Group * Menopause and midlife care * Health, dental, vision and life insurance options for employees and family * Free in-person, virtual and text-based mental health and wellness support * Paid time off, including vacation, sick leave, personal days and summer flex time * Company equity * Bonus program * 401(k) plan with company match * Access to on-demand legal and financial advice * Learning and development programs to help you grow professionally and a mentorship program * Company social eventsto include annual volunteer day and donation matching * Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office In compliance with New York City's Wage Transparency Law, the hourly salary [wage] range for NYC-based applicants is: $28.85/hour - $31.25/hour. There are a variety of factors that go into determining a salary range, including but not limited to external market benchmark data, geographic location, and years of experience sought/required. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity. Progyny is proud to be anEqual Opportunity and Affirmative Action employer.We respect and seek to empower each individual and support the diverse cultures, perspectives,skillsand experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, marital status, pregnancy or related condition, status as a protected veteran, criminal history consistent with legal requirements or any other basis protected by law. If you are an individual with a disability and need assistance or an accommodation during the recruiting process, please send an e-mail to ___. #LI-BR1

Sr Biostatistician-Sr Data Scientist/Analyst OMOP (US and UK Only) Syneos Health is a leading fully-integrated life sciences services organization built to accelerate customer success. We partner with innovators at every point across the drug development and commercialization continuum, helping them navigate complexity, anticipate change and accelerate progress. Our Clinical Solutions team members act with a drug development mindset, applying their years of experience and deep expertise to truly understand customer needs and represent those in the solutions we shape. Whether you join us in a Functional Service Provider partnership or a Full-Service environment, you'll collaborate with passionate problem solvers, innovating as a team to help our customers achieve their goals. We are agile and driven to deliver - for one another, our customers, and, most importantly, for those in need. Discover what your 25,000 future colleagues already know: Why Syneos Health • We are passionate about developing our people, through career development and progression; supportive and engaged line management; technical and therapeutic area training; peer recognition and total rewards program., • We are committed to building an inclusive culture - where you can authentically be yourself. Central to this is our purpose - Driven to Deliver - which captures the passion of our colleagues to show up each day and shape solutions that have the ability to dramatically impact someone's life., • We are continuously building the company we all want to work for and our customers want to work with. Why? Because we know that when we bring together smart colleagues from across the world, we can shape the future of healthcare, driving impact for customers and defining the pace of patient progress. Job Responsibilities *Must be located in the United States or UK with no sponsorship needs to be considered for this position. Key Responsibilities OHDSI / DARWIN Analytics & Implementation • Collaborate with researchers to understand project requirements and translate them into OHDSI/DARWINcompatible solutions., • Build, validate, and execute OMOP CDM cohorts and analyses using:, • ATLAS (cohort definition, characterization, exploration), • ATHENA (vocabulary browsing, concept sets), • ACHILLES (data characterization and quality insights), • R packages in the OHDSI/DARWIN ecosystem (for cohort execution, characterization, estimation, and related workflows)., • Perform analyses using ATLAS and/or Prometheus or via programmatic workflows in R (and Python where appropriate), depending on study needs and platform patterns., • Apply and document observational study designs and epidemiologic concepts for RWE (e.g., descriptive epidemiology, cohort designs, self-controlled designs, comparative approaches as applicable)., • Implement and interpret appropriate statistical methods, including confounding control strategies, time-to-event approaches, sensitivity analyses, and fit-for-purpose evaluations., • Develop reusable and maintainable analytic code, prioritizing reproducibility and auditability (clear methods, parameterization, and structured outputs)., • Incorporate AI-assisted workflows (nice to have and can be taught) to improve efficiency in:, • Code generation/refactoring, • Validation and QA checks, • Documentation and study write-ups, • Masters degree in Statistics or related field., • Demonstrated experience with OMOP CDM and OHDSI tooling, including ATLAS (or Prometheus), ATHENA, and ACHILLES., • Proficiency in common OHDSI community languages: SQL and R. Python is good too but most open-source tooling is in R, • Strong understanding of observational study design and epidemiologic concepts, with emphasis on RWE., • Experience working with healthcare data such as EHR and insurance claims, including healthcare data standards and fit-for-purpose evaluation., • Solid understanding of clinical terminologies such as SNOMED, ICD-9/10, CPT, HCPCS, READ (and related standard vocabularies used in OMOP)., • Experience with data quality assessment and data validation techniques., • Proven ability to work in a fast-paced environment, delivering high-quality outputs with strong documentation and collaboration., • Strong problem-solving ability and comfort working in cross-functional teams., • Excellent communication skills, with the ability to convey technical concepts to technical and non-technical stakeholders., • Strong experience developing and maintaining documentation for RWE studies and insight generation., • Demonstrated willingness and ability to incorporate AI tools into workflows for efficiency and quality., • Experience supporting federated/network study execution patterns (where applicable). At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position may include a company car or car allowance, Health benefits to include Medical, Dental and Vision, Company match 401k, eligibility to participate in Employee Stock Purchase Plan, Eligibility to earn commissions/bonus based on company and individual performance, and flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos complies with all applicable federal, state, and municipal paid sick time requirements. Salary Range: The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate's qualifications, skills, competencies, and proficiency for the role. Get to know Syneos Health Over the past 5 years, we have worked with 94% of all Novel FDA Approved Drugs, 95% of EMA Authorized Products and over 200 Studies across 73,000 Sites and 675,000+ Trial patients. No matter what your role is, you'll take the initiative and challenge the status quo with us in a highly competitive and ever-changing environment. Learn more about Syneos Health. Additional Information Tasks, duties, and responsibilities as listed in this job description are not exhaustive. The Company, at its sole discretion and with no prior notice, may assign other tasks, duties, and job responsibilities. Equivalent experience, skills, and/or education will also be considered so qualifications of incumbents may differ from those listed in the Job Description. The Company, at its sole discretion, will determine what constitutes as equivalent to the qualifications described above. Further, nothing contained herein should be construed to create an employment contract. Occasionally, required skills/experiences for jobs are expressed in brief terms. Any language contained herein is intended to fully comply with all obligations imposed by the legislation of each country in which it operates, including the implementation of the EU Equality Directive, in relation to the recruitment and employment of its employees. The Company is committed to compliance with the Americans with Disabilities Act, including the provision of reasonable accommodations, when appropriate, to assist employees or applicants to perform the essential functions of the job.

Summary of Job Perform provider and member outreach to reconcile member records and validate data entry to support continuous quality improvement in Healthcare Effectiveness Data and Information Set (HEDIS) rates and STAR measures for the enterprise. Facilitate provider and member outreach supporting the MTM, OMW, and Medication Adherence quality measures to ensure member receipt of important clinical services to improve member health outcomes. Daily telephonic outreach to secure appointments with pharmacists and/or vendors to close gaps in care. Support efficient medical record retrieval for HEDIS medical record review and HEDIS supplemental data collection activities. Track calls for all lines of business related to the MTM, OMW, and Medication Adherence quality measures, reporting weekly completion statistics. Produce and process department mailings to members and physicians. Monitor internal mailboxes for department faxes and calls. Collaborate with internal departments in order to administer the MTM, OMW, and Medication Adherence quality measures. Responsibilities • Work closely with Clinical Pharmacist(s), Registered Nurses and Data Analyst(s) to prioritize members for outreach who fall in HEDIS measures including but not limited to Medication Adherence and OMW (Osteoporosis Management in Women who had a fracture) and the STAR measure MTM (Medication Therapy Management) Program., • Perform daily telephonic outreach to secure appointments with pharmacists and/or vendors to close gaps in care supporting Enterprise goals., • Perform daily provider and member outreach supporting the MTM, OMW, and Medication Adherence quality measures to ensure member receipt of important clinical services to improve member health outcomes., • Prepare and execute member and provider mailings., • Collaborate with providers and internal departments to ensure the receipt and correct processing of all supplemental data related to HEDIS claims and records and assist in correcting discrepancies., • Maintain high data integrity while adhering to HIPAA standards and protecting patient information., • Perform provider outreach to verify and document member's appropriate medical diagnoses and subsequent treatments both by telephone and in writing., • Coordinate call tracking and provide statistics to stakeholders., • Intake and organize data from other departments while ensuring proper compliance with all CMS regulations, policies and procedures., • High School Diploma (Required), • College Degree (Preferred), • Pharmacy Technician License (Preferred), • Minimum of 1 year direct customer service experience in a healthcare setting (Required), • Excellent telephonic and customer service skills (Required), • Experience analyzing data and building action plans based upon data outcomes (Required), • Personal motivation to achieve set goals (Required), • Flexibility and ability to adjust workflow to achieve company goals (Required), • Experience with or knowledge of Electronic Medical Records (Preferred), • Knowledge of or experience with HEDIS, STAR ratings, and/or quality improvement (Preferred), • Experience in a managed care health services environment (Preferred), • Experience in data collection, data entry and analysis (Preferred), • Knowledge of Excel and other analytical tools (Preferred) Additional Information, • Requisition ID: 1000002961, • Hiring Range: $39,960-$70,200

Summary of Position • Support contract performance management of a large health system., • Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on contractual and industry guidelines., • Identify and analyze single issues and trends to determine root causes., • Provide recommendations for solutions to minimize errors and delays in systems and/or processes., • Monitor system output to ensure proper functioning. Roles and Responsibilities • Evaluate disputed claims for system configuration, claims processing, and/or contractual issues to facilitate claims review., • Maintain and organize detailed information on claims dispute files to ensure appropriate and comprehensive data is returned to the provider timely., • Track issues and monitor trends to support their resolution., • Identify potential/actual claims problems (single or recurring/trending) and document root cause analysis; present findings to management., • Improve quality, enhance workflow, and provide efficiencies within departments, identify opportunities for improvements; develop and present recommendations for changes., • Conduct regular meetings with the assigned provider groups for status of AR files and recycles, • Support departmental goals for cycle time by organizing and tracking claims for review., • Monitor and provide timely responses for the designated provider group emails and AR files., • Bachelor's Degree; additional experience/specialized training may be considered in lieu of educational requirements., • 2 - 3 years' prior related work experience in professional/facility claims or benefits/billing environment., • Strong knowledge of claim processing policies and procedures., • Knowledge of medical terminology, ICD/CPT coding, per diem and DRG reimbursement and EDP testing procedures., • Proficiency with MS Office applications (word processing, database/spreadsheet, presentation)., • Ability to accurately interpret information from contractual and technical perspectives., • Must be conscientious and detail oriented; ability to recognize unusual patterns and troubleshoot for operational improvement and efficiencies., • Strong analytical and problem-solving skills., • Ability to effectively work on multiple projects/tasks with competing priority levels and deadlines., • Ability to effectively absorb and communicate information., • Strong Interpersonal and teamwork skills. Additional Information, • Requisition ID: 1000003050, • Hiring Range: $48,600-$83,160

REMOTE Summary of Position • Responsible for managing the manual check workflow, ensuring appropriate documentation, quality review, and reconciliation of recovery payments., • Coordinate key departmental meetings, maintaining agendas, task outlines and task follow-up., • Manage escalated financial recovery issues, and ensure administrative processes operate efficiently and in compliance with regulatory and organizational standards., • Responsible for supporting the operational integrity of financial recovery processes while ensuring administrative coordination, compliance, and effective departmental communication. Principal Accountabilities • Provide administrative oversight of the manual check process, ensuring submissions meet documentation and approval requirements prior to processing. Conduct quality reviews of manual check requests to confirm accuracy, completeness, and compliance with internal financial recovery procedures., • Research and investigate recovery checks received without supporting documentation to determine appropriate claim attribution and disposition. Work independently to analyze data to identify trends and quality improvement opportunities. Track issues and monitor trends to support their resolution. Identify potential process gaps and document root cause analysis; present findings to management, and work with CTS for resolution., • Support governance and operational initiatives such as Mass Recycle Governance and Negative Balance Improvement efforts by coordinating materials, reporting updates, and monitoring progress against action plans., • Maintain organized records and documentation related to recovery activities, vendor payments, and operational initiatives., • Collaborate with Claims, Finance, Compliance, and Operations teams to ensure alignment on recovery processes and administrative workflows. Serve as key contact to internal and external stakeholders to ensure deadlines are met; provide recommendations for problem resolution; direct/escalate inquiries and issues if needed; ensure proper implementation of needed actions; follow up with appropriate actions to ensure resolution., • Perform active research to prepare and present new ideas to improve current processes which impact the business., • Provide support on all administrative matters, recording meeting minutes and following up on important internal and external meetings; perform reporting and other tasks as needed., • Coordinate and track escalated issues related to financial recoveries, working with internal teams and external partners to ensure timely resolution Process and approve vendor invoices related to recovery operations, ensuring proper documentation, coding, and alignment with contractual agreements, • Identify opportunities to improve administrative efficiency and support continuous process improvement within the department., • Perform other duties as assigned or required. Qualifications Education, Training, Licenses, Certifications • Bachelor's degree, preferably in healthcare administration, finance, operations, business administration, or a related field required; Additional years of experience/specialized training may be considered in lieu of educational requirements Relevant Work Experience, Knowledge, Skills, and Abilities • 2 - 3+ years of relevant, professional work experience including positions handling confidential information required Experience as a project analyst in a related field; strong understanding of project management required • Familiarity with CMS regulations and healthcare payer operational standards required, • Proficiency with healthcare claims processing platforms such as FACETS and related operational systems required, • Attention to detail; ability to identify and resolve issues; ability to perform data analysis required, • Experience in the health care industry preferred, • Strong proficiency with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required, • Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences required, • Ability to maintain a calm, professional demeanor, confidentiality, and to effectively complete multiple tasks/projects with competing priority levels and deadlines required Additional Information, • Requisition ID: 1000003109, • Hiring Range: $48,600-$83,160

Thank you for considering Progyny! We are seeking a detail-oriented and analytical Carrier Revenue Analyst to support backend Revenue Cycle Management (RCM) operations, with a strong focus on claims investigation, denial resolution, and revenue recovery. This role is responsible for deep-dive analysis of claims across commercial payors, identifying root causes of payment discrepancies, and driving resolution through internal remediation and external carrier engagement. The ideal candidate brings at least 1+ year of healthcare claims processing or RCM experience, with a strong foundation in claim adjudication workflows, denial management, and reimbursement methodologies. * Perform detailed review of claims lifecycle (submission through adjudication) to identify denials, underpayments, recoupments, and processing errors * Conduct root cause analysis across claim issues, including eligibility, COB, coding, billing, and payer policy misalignment * Validate claims against contracted reimbursement terms, medical policies, and billing guidelines * Investigate and categorize denials * Partner with internal teams and external payors to drive reprocessing, appeals, and corrections * Identify trends and systemic issues impacting reimbursement and recommend scalable remediation strategies * Reconcile payments using 835/EOB data to ensure accurate posting and identify discrepancies * Monitor and track unapplied cash, posting errors, and claim status gaps * Act as a liaison between internal teams and external carriers * Escalate and track issues with payors, ensuring timely follow-up and resolution * Support client and leadership requests with clear, data-driven summaries of claim performance * Ensure adherence to HIPAA, billing compliance, and internal policies * Contribute to process standardization and automation efforts to improve efficiency and reduce manual errors * Participate in QA initiatives and continuous improvement of claims workflows * Support rebill workflows by validating corrected claims and ensuring proper submission logic * Analyze claims and financial data using Excel (required) and SQL (preferred) to uncover trends and performance gaps * Develop and maintain reports and dashboards to track: Denial rates, First-pass resolution, Net collection rate, and Aging AR and recovery progress * Provide actionable insights to leadership on revenue leakage and operational inefficiencies About You... * Bachelor's degree or equivalent experience * 1+ year of healthcare RCM or claims processing experience * Claims lifecycle (837, 835, 277/276, EOB interpretation) * Experience working with commercial carriers (e.g., Aetna, Anthem, UHC, etc.) * CPT/HCPCS coding * Commercial payor workflows and adjudication logic * Experience with denial investigation, appeals, and claims corrections * Advanced proficiency in Microsoft Excel (pivot tables, formulas, data analysis) * Experience in backend RCM functions such as: Denials management, Payment reconciliation, or AR follow-up * Extensive analytical and critical thinking skills with a focus on problem-solving and root cause identification * High attention to detail with the ability to manage large datasets and complex claim scenarios * Effective communication skills, with the ability to translate findings into clear, actionable insights * Ability to thrive in a fast-paced, high-volume environment while maintaining accuracy * Self-starter mindset with ownership over assigned workstreams and outcomes Nice to Have... * Familiarity with SQL or data querying tools * Familiarity with Clearinghouses, Provider Portals, SalesForce, Pharmacy (PBM), Medical claims * Exposure to reporting tools such as Power BI Please note: This is not a digital nomad or remote international position; candidates must be based in the United States. Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future. About Progyny: Progyny (Nasdaq: PGNY) is a global leader in women's health and family building solutions, trusted by the nation's leading employers, health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians. Our benefits solution empowers patients with concierge support, coaching, education, and digital tools;provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs. Our mission is toempower healthier, supported journeys through transformative fertility, family building and women's health benefits. Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit ___. Our perks: * Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents' Employee Affiliation Group * Menopause and midlife care * Health, dental, vision and life insurance options for employees and family * Free in-person, virtual and text-based mental health and wellness support * Paid time off, including vacation, sick leave, personal days and summer flex time * Company equity * Bonus program * 401(k) plan with company match * Access to on-demand legal and financial advice * Learning and development programs to help you grow professionally and a mentorship program * Company social eventsto include annual volunteer day and donation matching * Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office In compliance with New York City's Wage Transparency Law, the annual salary [wage] range for NYC-based applicants is: $65,000 - $80,000. There are a variety of factors that go into determining a salary range, including but not limited to external market benchmark data, geographic location, and years of experience sought/required. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity. Progyny is proud to be anEqual Opportunity and Affirmative Action employer.We respect and seek to empower each individual and support the diverse cultures, perspectives,skillsand experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, marital status, pregnancy or related condition, status as a protected veteran, criminal history consistent with legal requirements or any other basis protected by law. If you are an individual with a disability and need assistance or an accommodation during the recruiting process, please send an e-mail to ___. #LI-BG1

Summary of Position • Responsible for receiving, researching and resolving inquiries and requests from internal EmblemHealth departments and business partners (i.e., account management, provider network management, provider file operations, client retention, access to care, care cafe, membership, COB, Contact Center, G&A, etc.) regarding claim outcomes., • Perform root cause analysis and take appropriate steps to have corrected, working directly with support areas (EmblemHealth & CTS) as needed., • Recommend changes in procedures, desk level procedures (DLPs) and workflow to improve quality and efficiency as needed., • Ensure impacted claims are adjusted., • Oversight and quality review of CTS performance., • Provide response to requestor using "speak human" terminology. Roles and Responsibilities • Serve as claim processing subject matter expert (SME) for resolution of issues related to claims processing and adjudication outcomes for medical, hospital, dental claims for all EmblemHealth lines of business as requested by EmblemHealth business partners or CTS business partners., • Research and resolve claim issues as requested and make determination of appropriateness of claim adjudication outcome and/or adjustment request., • Provide oversight and quality review of CTS performance of the claim adjustments required., • Perform root cause analysis and take appropriate actions to ensure root cause is remediated., • In addition to requesting configuration updates, remediation may include recommendation of changes to processing procedures, Facets workflow and desk level procedures (DLPs)., • Collaborate with EmblemHealth and CTS business partners as needed to validate accuracy of benefit configuration, NetworX rate sheets, provider participation status, provider file and membership file, including COB flags impacting the claim(s) adjudication outcome., • Manage high priority/high visibility projects to completion including manual or mass recycles and adjustments., • Ensure issue is closed, providing documentation with appropriate level of detail in "speak human", including claim adjustment detail or explanation for payment correctness to the requestor, • Bachelor's degree, preferably in Business Management., • 3 - 5+ years of relevant, professional work experience, including 3 years of claims processing., • 3+ years of managerial/supervisory experience within a related health care and/or claims environment., • Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits., • 1 - 3+ years' experience managing in a BPASS model., • Additional years of experience may be considered in lieu of educational requirements., • Strong knowledge of claims processing, procedures and systems, State, Federal and Medicare Regulations and Coordination of Benefits applications., • Strong knowledge of member and provider contracts, procedures and systems., • Prior proven EmblemHealth experience., • Strong planning, organizing and prioritizing skills; meticulous attention to detail., • Strong communication skills (verbal, written, presentation, interpersonal) with all types and levels of audiences., • Proficient in MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.)., • Ability to handle multiple priorities and meet deadlines. Additional Information, • Requisition ID: 1000003099, • Hiring Range: $56,160-$99,360

Job details About Us: The people of Memorial Sloan Kettering Cancer Center (MSK) are united by a singular mission: ending cancer for life. Our specialized care teams provide personalized, compassionate, expert care to patients of all ages. Informed by basic research done at our Sloan Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of cancer as a disease and improving the ability to prevent, diagnose, and treat it. MSK is dedicated to training the next generation of scientists and clinicians, who go on to pursueour missionat MSK and around the globe. Exciting Opportunity at MSK : Business Intelligence Analyst II We are seeking a Business Intelligence Analyst with strong technical skills, adept at applying them to real-world problems, and comfortable communicating complex topics to non-technical audiences. You will work to understand MSK's internal dynamics as well as trends in the broader healthcare ecosystem, and you will partner with senior leadership to use your insights to shape MSK's strategy. By helping MSK leadership make better strategic decisions, you will contribute to our legacy of innovation with lasting impact and help us achieve our mission of ending cancer for life. Role Overview: * Serve as a critical thought partner to senior leadership. * Translate ambiguous business problems into structured questions that can be answered analytically. Translate complex analyses back into a straightforward narrative that can be understood by business leaders. * Manage analytical projects from "question to answer", including problem framing, data collection and validation, exploratory analysis, statistical modeling, visualization, synthesis, and presentations. * Find creative approaches to answering questions that do not have a clear methodology or data source. Sample Projects: * How can we use data to identify which of MSK's programs should grow? What are the barriers to growth for different programs, and can we develop a strategy to overcome them? * For financial and resource planning, we need to model MSK's patient activity and resource needs over both the short term (1-2 years) and long term (10-15 years). How should we approach these projections? What different considerations are there in the short and long term? How should we handle uncertainty about the future both in our modeling and in communicating with leadership? * How can we use external claims data to better understand patterns of care for cancer patients beyond just MSK? How can we use this information to direct MSK's strategy of which community providers to build partnerships with? Key Qualifications: * 4-7 years of experience using analytics to impact key business decisions. * Proficiency using R (preferred) or Python to create reproducible data analyses. * Comfort working in relational databases and SQL. * The ability to develop production-grade dashboards using Shiny, Tableau, Power BI etc. Core Skills: * A critical thinker with strong attention to detail and the ability to manage multiple tasks and deadlines. * Excellent written and verbal communication skills. * Willing to act and eager to embrace new challenges. * Curiosity, self-motivation, and a strong desire to use your skills to help MSK's leaders make better decisions. * The ability to choose the right technical approach for a question (from a statistical model to a dashboard and everything in between) and know that the simplest solution is often the best one. Additional Information: * Location: 633 Third Avenue, NY * Reporting to: Principal Business Intelligence Analyst, Strategy & Innovation * Schedule: Onsite once a week Helpful Links: * * Pay Range: $125,400.00 - $200,700.00 FSLA Status: Exempt Closing: At MSK, we believe in fair, competitive pay that reflects your job, experience, and skills. MSK is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sexual orientation, national origin, age, religion, creed, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision. Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: • Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,, • Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Location: Remote (For Non-Local) or Hybrid (Local to NYC area or Denver, CO) Position Summary: As a member of the Enterprise Solutions team, you will play a critical role in contributing to the success of Judi Health's customers leveraging Judi, our Enterprise Health Platform, to service their own pharmacy administrative needs. The Enterprise Solutions team seeks individuals who are passionate to change the landscape of claims processing while providing superior service. This individual will hold responsibility for the setup and ongoing maintenance of accumulator, claims and override data in Judi. Position Responsibilities: • Accountable for configuration, load, and maintenance of data from previous adjudication systems into Judi., • Provide customers with subject matter expertise in Judi's capabilities, ensuring successful migration to the adjudication platform, with parity of all logic and initiatives., • Devise a repeatable process for implementing data in Judi, establishing key milestones, and maintaining up to date project plan., • Build and maintain trusting relationships with customers through superior customer service, meeting or exceeded service level metrics., • Perform QA and claims testing to validate that data loads yield appropriate adjudication results., • Partner with Analytics colleagues to author automated/manual test cases and monitoring processes for configurations and data loads., • Proactively identify execution risks around build status and defects, partnering with internal Product teams and clients to surface mitigation strategies., • Contribute to playbooks/templates that scale configurations for future client onboardings., • Take charge of critical issues or problems to key stakeholders, ensuring swift resolution and communication within service level agreements., • Certain times of year may require meeting participation, travel, service support or other requirements outside of standard business hours, including weekends., • Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance. Minimum Qualifications: • 1+ years of experience in an Analyst role, Software Engineering role or related work experience, • 1+ year of PBM or Health Plan operations experience handling adjudication configurations., • Experience performing complex analyses on large sets of data, • Knowledge of data management, statistics, modeling, • Experience working with structured and unstructured data, • Proficient in SQL, JSON, Java, R, Excel, and other data visualization tools, • Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables., • Exceptional project / time management, prioritization, and organizational skills to ensure customer satisfaction., • Ability to shift between competing priorities and meet organizational goals., • Excellent verbal, written, interpersonal and presentation skills., • Ability to work effectively with virtual teams., • Bachelor's Degree preferred, or equivalent combination of education, training, and experience. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at___.

Senior Pharmacy Data Analyst AArete is one-of-a-kind when it comes to consulting firm culture. We're a global, innovative management and technology consulting firm with offices in the U.S., India, and Europe. Our name comes from the Greek word for excellence: "Arete." And excellence is exactly what we strive for. We're celebrating our fourth year as one of Forbes' World's Best Management Consulting Firms - and our success starts with our people. From robust career development planning to competitive life and wellness benefits, AArete's "Culture of Care" takes a holistic approach to the employee experience. AAretians (our team members) are leaders at every level. You are encouraged to unlock your full potential by directly contributing to our mission and prioritizing personal development and fulfillment. The Role We are looking for a detail-oriented Pharmacy Data Analyst to analyze large-scale pharmacy and claims datasets, generate insights, and support data-driven decision making across pharmacy operations and healthcare programs. The role involves managing pharmacy claims, prescription validation, and healthcare data across EHR/Pharmacy Information Systems, with a strong focus on Power BI-based reporting and dashboarding to enable data-driven insights. Work You'll Do • Analyze pharmacy claims datasets to identify trends, anomalies, and cost drivers, • Evaluate pharmacy benefit utilization, including unit cost and trend drivers, rebate impact, and 340B programs, • Partner with internal data and analytics teams to develop standardized processes, reusable queries, and data workflows, • Support pharmacy plan, client, and contract configuration activities through analytic review, testing, and validation of claim outcomes, • Validate data quality, completeness, and reasonableness of results, • Handle pharmacovigilance data management, ensuring alignment with regulatory requirements, • Maintain and manage data within EHR (Electronic Health Records) and Pharmacy Information Systems, • Design, develop, and maintain Power BI dashboards and reports to monitor pharmacy operations, claims trends, compliance metrics, and KPIs, • Lead pharmacy analytics workstreams from data intake through insight delivery and stakeholder presentation, • Provide ongoing regulatory and compliance support, including audits and reporting, • Drive project timelines, key deliverables, and issue resolution across cross-functional teams, • Identify discrepancies between configured logic and paid claim results, • Other duties as assigned Requirements • 6+ years of experience in pharmacy data analysis, PBM, payer, or related healthcare roles, • Strong knowledge of pharmacy claims management and payer processes, • Advanced proficiency in Power BI, including dashboard creation, DAX, data modeling, and Power BI Service (workspaces, publishing, refresh schedules), • Understanding of pharmacovigilance data and healthcare regulatory and compliance requirements, • Ability to independently analyze data and explain pharmacy KPIs and findings, • Strong analytical and problem-solving skills with high attention to detail, • Effective communication skills to interact with internal teams and stakeholders, • Familiarity with major drug compendia and reference databases, including NCPDP, Medi-Span, First Databank, CMS ASP and other public-use files, NPPES and other provider reference sources, • Understands claims logic and how to identify final status of claims, • Strong working knowledge of pharmacy claims data and concepts such as formularies, benefit designs, networks, and reimbursement, • Based in Chicago, IL, and flexible to work from our Chicago office as needed Compensation & Benefits • Flexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidays, • Own Your Day flexible work policy, • Competitive majority employer-paid benefits: Medical, Dental, Vision, 401K Match, • Generous paid parental leave options, • Employer-paid Life Insurance, Short Term Disability, Long Term Disability, • Charitable contribution matching program, • New client commission opportunities and referral bonus program AArete will accept applications until the position is filled. The job posting will be removed once the role is no longer available. We put humans at the center of our work We're a global management and technology consulting firm specializing in strategic profitability improvement, digital transformation, and strategy & change for clients. Our cross-industry solutions are powered by a digital-first mindset, market intelligence, and data-driven approach to deliver purposeful change, actionable insights, and guaranteed results. But what sets us apart is our people. We are guided by our deeply embedded guiding principles: Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion. And we've been recognized as a top firm to work for by companies like Forbes, Top Workplaces Chicago Tribune, and Consulting Magazine. We've earned a Great Place to Work Certification and been named a World's Best Management Consulting Firm by Forbes, Vault's Top 50 Firms to Work For, Crain's Chicago Business Fast 50, Inc 5000's Fastest Growing Firms, and Consulting Magazine's Fastest Growing Firms. We are an Equal Employment Opportunity Employer All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. #LI-DNI

Summary of Job Perform provider and member outreach to reconcile member records and validate data entry to support continuous quality improvement in Healthcare Effectiveness Data and Information Set (HEDIS) rates and STAR measures for the enterprise. Facilitate provider and member outreach supporting the MTM, OMW, and Medication Adherence quality measures to ensure member receipt of important clinical services to improve member health outcomes. Daily telephonic outreach to secure appointments with pharmacists and/or vendors to close gaps in care. Support efficient medical record retrieval for HEDIS medical record review and HEDIS supplemental data collection activities. Track calls for all lines of business related to the MTM, OMW, and Medication Adherence quality measures, reporting weekly completion statistics. Produce and process department mailings to members and physicians. Monitor internal mailboxes for department faxes and calls. Collaborate with internal departments in order to administer the MTM, OMW, and Medication Adherence quality measures. Responsibilities • Work closely with Clinical Pharmacist(s), Registered Nurses and Data Analyst(s) to prioritize members for outreach who fall in HEDIS measures including but not limited to Medication Adherence and OMW (Osteoporosis Management in Women who had a fracture) and the STAR measure MTM (Medication Therapy Management) Program., • Perform daily telephonic outreach to secure appointments with pharmacists and/or vendors to close gaps in care supporting Enterprise goals., • Perform daily provider and member outreach supporting the MTM, OMW, and Medication Adherence quality measures to ensure member receipt of important clinical services to improve member health outcomes., • Prepare and execute member and provider mailings., • Collaborate with providers and internal departments to ensure the receipt and correct processing of all supplemental data related to HEDIS claims and records and assist in correcting discrepancies., • Maintain high data integrity while adhering to HIPAA standards and protecting patient information., • Perform provider outreach to verify and document member's appropriate medical diagnoses and subsequent treatments both by telephone and in writing., • Coordinate call tracking and provide statistics to stakeholders., • Intake and organize data from other departments while ensuring proper compliance with all CMS regulations, policies and procedures., • High School Diploma (Required), • College Degree (Preferred), • Pharmacy Technician License (Preferred), • Minimum of 1 year direct customer service experience in a healthcare setting (Required), • Excellent telephonic and customer service skills (Required), • Experience analyzing data and building action plans based upon data outcomes (Required), • Personal motivation to achieve set goals (Required), • Flexibility and ability to adjust workflow to achieve company goals (Required), • Experience with or knowledge of Electronic Medical Records (Preferred), • Knowledge of or experience with HEDIS, STAR ratings, and/or quality improvement (Preferred), • Experience in a managed care health services environment (Preferred), • Experience in data collection, data entry and analysis (Preferred), • Knowledge of Excel and other analytical tools (Preferred) Additional Information, • Requisition ID: 1000002961, • Hiring Range: $39,960-$70,200

About Ogilvy Ogilvy, part of WPP, has been creating impact for brands through iconic, culture-changing, value-driving ideas since the company was founded by David Ogilvy 75 years ago. It builds on that rich legacy through Borderless Creativity - innovating at the intersections of its advertising, public relations, relationship design, consulting, and health capabilities with experts collaborating seamlessly across over 120 offices in nearly 90 countries. Ogilvy currently ___ as the #1 global agency network for creative excellence and effectiveness by WARC, signifying its ability todeliver creative solutions that drive unreasonable impact for clients and communities.Ogilvy is a WPP company (NYSE: WPP). For more information, visit___, and follow us on , About WPP WPP is the trusted growth partner for the world's leading brands. We unitecutting-edge media intelligence and data solutions, world-class creativity, next-generation production, transformative enterprise solutions and expert strategic counselin a single company -powered by exceptional talent and our agentic marketing platform, WPP Open,to help our clients navigate change, capture opportunity and deliver transformational growth. For more information, visit___. OGILVY HEALTH: WE INSPIRE PEOPLE AND BRANDS TO IMPACT THE WORLD Guided by this vision, Ogilvy Health, part of WPP, combines borderless creativity, scientific precision and cultural fluency to build healthcare's most influential movements. We drive measurable impact and category-defining growth for brands ready to shape what's next. Our approach is powered by fearless creativity that dares to be different, sparks emotional connections, and inspires action, ensuring cultural resonance. Scientific precision translates complex data into stories that resonate, while our impact-obsessed mindset focuses on delivering real-world outcomes. For more information on us, visit___, or follow Ogilvy Health on___,,. About the Role We are seeking a Senior Analyst to join our Performance Strategy team within a leading health agency supporting pharmaceutical clients. This role sits at the intersection of data, strategy, and storytelling - transforming complex, multi-source datasets into actionable performance insights that drive measurable business impact. The ideal candidate is technically fluent, strategically minded, and confident translating data into compelling narratives. You will connect the dots across ATUs, integrating web analytics, media performance, research tools, and healthcare claims data to inform optimization and long-term growth strategies. What You'll Do • Lead data extraction, cleansing, and preparation across web analytics, media platforms, survey/research tools, and healthcare claims datasets, • Analyze performance trends across ATUs to identify drivers, risks, and optimization opportunities, • Integrate digital engagement metrics with claims and research data to measure real-world impact, • Develop cohesive, insight-driven stories that influence client and internal strategic decision-making, • Build dashboards, executive-ready presentations, and performance reporting frameworks, • Collaborate closely with media, strategy, and client teams to ensure analytics align with business objectives, • Provide thought leadership on measurement approaches, KPIs, and performance frameworks, • 3-5 years of experience in analytics, performance strategy, or a related role (healthcare/pharma or agency experience preferred), • Strong experience pulling, manipulating, and preparing large datasets for analysis, • Technical fluency in:, • Web analytics platforms (Google Analytics, Adobe Analytics), • Media performance data (paid search, paid social, programmatic, display), • Survey and research tools (Mintel, Kantar, MARS), • Healthcare claims data (IQVIA, Symphony Health), • Proficiency in Excel and SQL; experience with data visualization tools such as Looker, Tableau or Power BI, • Strong analytical and strategic thinking skills with the ability to synthesize across multiple data streams, • Proven ability to translate complex data into clear, compelling insights, • Excellent written and verbal communication skills, • Ability to connect performance metrics to broader business and patient impact, • Comfort working across ATUs and synthesizing insights at both granular and enterprise levels, • Strategic mindset - not just reporting on data, but explaining why it matters and what to do next Ogilvy celebrates its people. Fully. Enthusiastically. Unhesitatingly. We'll empower you with the tools you'll need to succeed. We'll give you the autonomy to seek out new paths and better ways of doing things. We'll support you with colleagues who are experts in their disciplines, drawn from across the Ogilvy network. And we'll provide opportunities for you to do work of which you'll be proud, with people you'll be proud to call your teammates. #LI-SP1 The base salary range for this position at the time of this posting is indicated below. Individual compensation varies based on job-related factors, including location, business needs, level of responsibility, experience, and qualifications. We offer a competitive benefits package, click ___ for more details. Pay Range$60,000—$140,000 USD At Ogilvy, our people are at the heart of what we do: a creative agency that sparks game-changing ideas across culture and business through collaboration, integrity, and a celebration of self-expression. We believe in building powerful teams with purpose - and we relentlessly curate transformative initiatives that make our commitment to fairness, and equity a reality. Our ultimate mission is to leave a positive impact on the world, creating a better future for all, while supporting and uplifting the global communities we serve. This is central to our mantra of Borderless Creativity. Ogilvy is an equal opportunity employer and considers applicants for all positions without discrimination or regard to particular characteristics. We are committed to fostering a culture of respect in which everyone feels they belong and has the same opportunities to progress in their careers. If you need any assistance seeking a job opportunity, or if you need reasonable accommodation with the application process, please contact us at . Please note that this contact is only for candidates who are requesting accommodation. Emails for other purposes, including application status requests, will not receive a response.

Consultant AArete is one-of-a-kind when it comes to consulting firm culture. We're a global, innovative management and technology consulting firm with offices in the U.S., India, and Europe. Our name comes from the Greek word for excellence: "Arete." And excellence is exactly what we strive for. We're celebrating our fourth year as one of Forbes' World's Best Management Consulting Firms - and our success starts with our people. From robust career development planning to competitive life and wellness benefits, AArete's "Culture of Care" takes a holistic approach to the employee experience. AAretians (our team members) are leaders at every level. You are encouraged to unlock your full potential by directly contributing to our mission and prioritizing personal development and fulfillment. The Role As an AArete Consultant, you will collaborate closely with clients to understand their most pressing challenges and develop strategies for meaningful change. You will leverage your analytical expertise, entrepreneurial mindset, and commitment to excellence to drive results. With strong critical thinking skills, exceptional communication abilities, and a high-performing mindset, you are recognized as a self-starter. You leverage your analytical reasoning to determine the best ways to evaluate data and identify insightful elements that translate into client findings or recommendations. You take initiative in researching business challenges to understand market conditions, consistently bringing your perspective forward. Your resourceful and innovative approach to problem solving allows you to analyze data and build business cases that support project success and maximize value. In this role, you will apply deep expertise in data analytics, business case development, client stakeholder collaboration, and executive communications. You will be responsible for executing project goals and deliverables with precision while solving complex business challenges for both clients and internal initiatives, giving leadership leverage by providing client-ready, high-quality, insightful deliverables. Your contributions will have a lasting impact, shaping strategies and driving measurable outcomes. Work You'll Do As an AArete Consultant, you will support projects and drive successful outcomes through the following: • Conducting in-depth analysis and research to identify and understand market dynamics, industry leading practices, and business challenges, • Leveraging and conducting data analysis to uncover insights and develop potential solutions for clients, • Identifying potential solutions to business challenges through research, interviews, internal collaboration with other AArete teams and data analysis, • Assisting in the creation of business cases, delivering actionable recommendations, and supporting the implementation of initiatives, including cost savings and operational improvement, • Developing and delivering presentations that communicate key insights and recommendations, concisely presenting information using clear, industry-appropriate language, • Collaborating closely within your project team to ensure alignment and success, acting as an accountable team member who works together with others to reach a common goal, • Learning from senior team members and attending trainings to continuously develop your skills and expertise, showing eagerness, curiosity, and reception to feedback, • Leading and mentoring Analysts, fostering their growth and development by modeling strong communication, accountability, and teamwork, • Preparing polished deliverables, with a focus on storytelling, for final review with the engagement manager, • Exercising excellent judgment, clear communication, and a solution-oriented approach in all aspects of your work, • Managing client stakeholder and vendor relationships to understand challenges, develop solutions and implement improvements, • Delegating tasks as necessary to accelerate delivery within our Intern, Analyst and global support teams, • Collaborating across other AArete solutions in identifying client challenges and escalating to leadership to contribute in cross-selling and up-selling, • 2+ years of experience in consulting, professional services, healthcare operations, or other relevant industries with demonstrated project-based, analytical, and client-facing responsibilities, • Bachelor's degree required, • Advanced proficiency utilizing Microsoft Office applications, especially Excel and PowerPoint, and basic SQL for data analysis, • Strong analytical skills, with the ability to analyze and interpret data, identify client profitability improvement opportunities, and develop actionable business cases, • Strong professional communication skills, including expertise in written, verbal, and interpersonal communication, as well as in-person presentations, • Passion to solve challenges for our clients in the healthcare industry, particularly within payer processes and data, • Ability to work within diverse project teams both internally and client facing, • Enthusiasm for joining a fast-paced, high-growth company and contributing to the development of business architecture in technology applications and tools, • High self-motivation, accountability, and a collaborative spirit, • Willingness to engage in direct client interaction, including travel to client locations, • Strong preference for experience in the payer and healthcare industry, including candidates with provider backgrounds who have worked with payers (e.g., managed care contracting), • Experience with healthcare claims analytics and/or network analytics, with strong understanding of payer/provider contracts, reimbursement language, and key terms, • Experience with AArete's other focus industries: Pharmacy, Financial Services, Retail, Manufacturing, Higher Ed, or Technology & Professional Services, • Cost reduction and process improvement experience within relevant client industries (Healthcare, Financial Services, Retail, Higher Ed, etc.), • Experience in healthcare systems and digital platforms, including Provider Data Management, Claims Adjudication (e.g., Facets, QNXT, etc.), and related tools, with the ability to leverage these systems to improve data quality, operational efficiency, and end-to-end healthcare processes, • Based in Chicago, IL, and able to work from our Chicago office as needed Compensation & Benefits • Flexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidays, • Own Your Day flexible work policy, • Competitive majority employer-paid benefits: Medical, Dental, Vision, 401K Match, • Generous paid parental leave options, • Employer paid Life Insurance, Short-Term Disability, and Long-Term Disability, • Charitable contribution matching program, • New client commission opportunities and referral bonus program AArete will accept applications until the position is filled. The job posting will be removed once the role is no longer available. We put humans at the center of our work We're a global management and technology consulting firm specializing in strategic profitability improvement, digital transformation, and strategy & change for clients. Our cross-industry solutions are powered by a digital-first mindset, market intelligence, and data-driven approach to deliver purposeful change, actionable insights, and guaranteed results. But what sets us apart is our people. We are guided by our deeply embedded guiding principles: Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion. And we've been recognized as a top firm to work for by companies like Forbes, Top Workplaces Chicago Tribune, and Consulting Magazine. We've earned aGreat Place to Work Certification and been named a World's Best Management Consulting Firm by Forbes, Vault'sTop 50 Firms to Work For, Crain's Chicago Business Fast 50, Inc 5000'sFastest Growing Firms, and Consulting Magazine'sFastest Growing Firms. We are an Equal Employment Opportunity Employer All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. #LI-DNI

Sr RW Programmer/Sr Data Scientist/Analyst - Real World Data(US and UK Only) Syneos Health is a leading fully-integrated life sciences services organization built to accelerate customer success. We partner with innovators at every point across the drug development and commercialization continuum, helping them navigate complexity, anticipate change and accelerate progress. Our Clinical Solutions team members act with a drug development mindset, applying their years of experience and deep expertise to truly understand customer needs and represent those in the solutions we shape. Whether you join us in a Functional Service Provider partnership or a Full-Service environment, you'll collaborate with passionate problem solvers, innovating as a team to help our customers achieve their goals. We are agile and driven to deliver - for one another, our customers, and, most importantly, for those in need. Discover what your 25,000 future colleagues already know: Why Syneos Health • We are passionate about developing our people, through career development and progression; supportive and engaged line management; technical and therapeutic area training; peer recognition and total rewards program., • We are committed to building an inclusive culture - where you can authentically be yourself. Central to this is our purpose - Driven to Deliver - which captures the passion of our colleagues to show up each day and shape solutions that have the ability to dramatically impact someone's life., • We are continuously building the company we all want to work for and our customers want to work with. Why? Because we know that when we bring together smart colleagues from across the world, we can shape the future of healthcare, driving impact for customers and defining the pace of patient progress. Job Responsibilities * Open to US and UK only - No sponsorship available for this role. * This position is very heavy programming and data review for RW data analyses. Experience with commercial databases such as Optum, HealthVerity or PharmMetrics will be important. Also support for protocol and SAP review in support of the epidemiologist is critical. ICD knowledge and experience will also be important. Roles within the Statistical Programming job family are responsible for developing programs and providing statistical programming support for the epidemiologists or for client or business use to address needs for sourcing, organizing (creating statistical tables, listings, and graphs), and interpreting complex data sets utilizing codes and programs. This includes developing codes that create analysis datasets, tables, and figures, evaluating programming processes, and suggesting revisions geared toward increasing productivity. Impact and Contribution Individual contributors with responsibility in a professional or technical discipline or specialty, but may manage two or fewer employees. May direct the work of lower level professionals or manage processes and programs. The majority of time is spent contributing to the design, implementation or delivery of processes, programs, and policies, using knowledge and skills typically acquired through advanced education. Individual contributor with developing subject matter expertise and responsibility for processes. In-depth knowledge and skills within a professional discipline, understanding the impact of work on related areas. May be responsible for entire projects or processes within area of responsibility. • Data Experience:, • eHR, • Claims Data: Optum, HealthVerity, or IQVIA PharmMetrics, • Nice to have: MarketScan, VA data, Medicaid, Medicare, • Programming Language: SAS or R, Must have SQL experience., • Programmatic Cohort derivation experience, • Index date definition, • Modeling/Programming, • GLM, • Logistic, • Cox, • Propensity Score Matching, • Incidence computation, • Prepare data specs and develop a strong understanding of study protocols., • Review data and program outputs against protocol requirements, flagging issues or questions, and escalating as appropriate., • Ability to address messy data, • Identify issues and possible solutions, • Understand follow up period and impact, • Use of ICD or other related clinical terminology, • Ability to address messy data, • Identify issues and possible solutions, • OMOP CDM understanding, • Transform healthcare data into a common format, • Use of AI/ML for LLM and workflow and scaffolding is ideal., • Nice to have:, • AI/ML modeling., • Github experience and versioning., • Uses R, SAS, Python or other software to develop custom programming code to generate summary tables, data listings, graphs and derived RW datasets as specified in the statistical analysis plan and programming specifications., • Development of programming specifications., • Works to ensure that outputs meet quality standards and project requirements. Performs validation programming and works with other Programmers, Biostatisticians, Epidemiologists and other project team members to resolve discrepancies or any findings. Keeps project team members informed of programming progress and issues requiring their attention. Follow applicable SOPs, WIs, and relevant regulatory guidelines (e.g. ICH)., • Maintains well organized, complete, and up-to-date project documentation, testing, and verification/quality control documents and programs ensuring inspection readiness., • Manages scheduling and time constraints across multiple projects at a time, sets goals based on priorities from management, and adapts to timeline or priority changes by reorganizing daily workload. Develops specifications for datasets and outputs of any complexity according to statistical and sponsor requirements. Anticipates and addresses potential programming issues, reflects forethought, establishes the basis for efficient programming and accurately defines all variables to be accepted by peer review and sponsor/requestor with little rework., • Prepares in advance for internal meetings, contributes ideas, and demonstrates respect for opinions of others., • Conducts effective internal meetings (appropriate in format, frequency and attendance). Distributes relevant information in advance. Ensures minutes are promptly and accurately distributed. Follows action items through to completion, and maintains order and focus of meetings, working toward consensus. Displays willingness to work with others and assist with projects and initiatives as necessary to meet the needs of the business. Negotiates and establishes accurate time estimates for completion of study programming activities with internal team members and statistical programming management, and completes project programming activities within timeframe allotted., • Reviews and provide input on project documentation such as Statistical Analysis Plan, mock shells, programming specifications, and RW database structure. Provides feedback to the appropriate project team members which reflects forethought and reduces inefficiencies in programming activities., • Participates in sponsor meetings, kickoff meetings etc., as required by sponsor. Contributes to the mentoring of programming personnel through developing training courses, presenting training materials, reviewing work, and providing feedback or guiding new associates in process. Transfers deliverables. Performs other work-related duties as assigned., • Minimal travel may be required. Qualifications: • Undergraduate or master's degree, preferably in a scientific or statistical discipline such as biostatistics, mathematics or epidemiology., • Extensive programming experience in SAS, R, python or other required software, in a RW environment., • Excellent written and verbal communication skills., • Ability to read, write, speak and understand English. At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position may include a company car or car allowance, Health benefits to include Medical, Dental and Vision, Company match 401k, eligibility to participate in Employee Stock Purchase Plan, Eligibility to earn commissions/bonus based on company and individual performance, and flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos complies with all applicable federal, state, and municipal paid sick time requirements. Salary Range: $80,600.00 - $145,000.00 The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate's qualifications, skills, competencies, and proficiency for the role. Get to know Syneos Health Over the past 5 years, we have worked with 94% of all Novel FDA Approved Drugs, 95% of EMA Authorized Products and over 200 Studies across 73,000 Sites and 675,000+ Trial patients. No matter what your role is, you'll take the initiative and challenge the status quo with us in a highly competitive and ever-changing environment. Learn more about Syneos Health. Additional Information Tasks, duties, and responsibilities as listed in this job description are not exhaustive. The Company, at its sole discretion and with no prior notice, may assign other tasks, duties, and job responsibilities. Equivalent experience, skills, and/or education will also be considered so qualifications of incumbents may differ from those listed in the Job Description. The Company, at its sole discretion, will determine what constitutes as equivalent to the qualifications described above. Further, nothing contained herein should be construed to create an employment contract. Occasionally, required skills/experiences for jobs are expressed in brief terms. Any language contained herein is intended to fully comply with all obligations imposed by the legislation of each country in which it operates, including the implementation of the EU Equality Directive, in relation to the recruitment and employment of its employees. The Company is committed to compliance with the Americans with Disabilities Act, including the provision of reasonable accommodations, when appropriate, to assist employees or applicants to perform the essential functions of the job.

It's fun to work in a company where people truly BELIEVE in what they are doing! We're committed to bringing passion and customer focus to the business. Business Analyst, Provider Networks & Care Management Fractal is a strategic AI partner to Fortune 500 companies with a vision to power every human decision in the enterprise. Fractal is building a world where individual choices, freedom, and diversity are the greatest assets. An ecosystem where human imagination is at the heart of every decision. Where no possibility is written off, only challenged to get better. We believe that a true Fractalite is the one who empowers imagination with intelligence. Fractal has been featured as a Great Place to Work by The Economic Times in partnership with the Great Place to Work® Institute and recognized as a 'Cool Vendor' and a 'Vendor to Watch' by Gartner. Please visit Fractal | Intelligence for Imagination for more information about Fractal Note: This position is not eligible for Immigration Sponsorship at this time Location: Remote Role Overview: We are seeking an experienced Business Analyst (BA) with strong expertise in Provider Network management and Care Management programs. This role partners with clinical, network, operations, IT, and analytics teams to analyze business processes, define requirements, and support initiatives that improve clinical outcomes, operational efficiency, cost management, and regulatory compliance. The ideal candidate has deep knowledge of healthcare payer operations, understands end-to-end care management workflows, and can translate business needs into clear functional and technical requirements. Key Responsibilities • Provider Network Analysis, • Analyze provider network operations including contracting, credentialing, directory management, network adequacy, and access standards., • Support initiatives related to network optimization, provider performance, and value-based care arrangements., • Gather and document requirements for provider data management, directory accuracy, and compliance reporting., • Act as a liaison between business users and technical teams for provider network systems. Care Management & Clinical Programs, • Analyze Care Management workflows, including utilization management, case management, disease management, and population health programs., • Support process improvements around prior authorization, referrals, transitions of care, and closure of care gaps., • Translate clinical and operational needs into clear business and system requirements., • Assist in the measurement and reporting of care outcomes, quality metrics, and utilization trends. Business & Systems Analysis, • Conduct stakeholder interviews, workshops, and current-state/future-state process analysis., • Develop Business Requirement Documents (BRDs), Functional Requirement Documents (FRDs), process flows, and user stories., • Support system enhancements, integrations, and data initiatives related to provider and care management platforms., • Validate solutions through UAT planning, execution, and defect triage. Data, Reporting & Compliance, • Analyze healthcare data related to cost, utilization, quality, risk stratification, and provider performance., • Support reporting for regulatory and accreditation requirements (e.g., CMS, NCQA, state mandates)., • Ensure alignment with healthcare standards such as ICD-10, CPT, HCPCS, HEDIS, and FHIR where applicable. Qualifications, • 6-10+ years of experience as a Business Analyst in healthcare., • Strong hands-on experience with Provider Network operations and Care Management programs., • Experience working with payer systems or healthcare platforms supporting network and care management functions. Domain Knowledge, • Provider contracting, credentialing, and directory management., • Care Management, Utilization Management, Case/Disease Management models., • Value-Based Care, ACOs, and quality improvement initiatives., • Understanding of payer workflows and end-to-end member/provider lifecycle. Technical & Functional Skills, • Requirements elicitation and documentation (BRD, FRD, user stories)., • Process modeling tools (Visio, Lucidchart, BPMN)., • Agile and/or Waterfall delivery methodologies., • Data analysis using SQL, Excel, or BI tools (reported or self-service)., • Familiarity with healthcare platforms such as care management systems, provider data systems, and claims platforms. Soft Skills, • Strong communication skills with clinical, business, and technical stakeholders., • Ability to translate complex clinical and operational concepts into actionable requirements., • Analytical mindset with strong problem-solving capabilities., • Proven ability to manage multiple priorities in a fast-paced environment. Nice-to-Have, • Experience supporting HEDIS, Stars, Risk Adjustment, or Quality programs., • Exposure to FHIR-based integrations and healthcare interoperability initiatives., • Certification such as CBAP, CCBA, or PMI-PBA., • Experience in payer modernization or digital health transformation initiatives. Success Metrics, • Improved efficiency and accuracy of provider network and care management processes., • Successful delivery of system enhancements aligned to business needs., • Reduction in rework or defects through clear requirements and UAT support., • Positive stakeholder feedback and measurable impact on care quality and operational outcomes. Pay: The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Fractal, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current base salary is up to $195,000. Benefits: As a full-time employee of the company or as an hourly employee working more than 30 hours per week, you will be eligible to participate in the health, dental, vision, life insurance, and disability plans in accordance with the plan documents, which may be amended from time to time. You will be eligible for benefits on the first day of employment with the Company. In addition, you are eligible to participate in the Company 401(k) Plan after 30 days of employment, in accordance with the applicable plan terms. The Company provides for 11 paid holidays and 12 weeks of Parental Leave. We also follow a "free time" PTO policy, allowing you the flexibility to take time needed for either sick time or vacation. Fractal provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us! Hiring Related Queries India: Outside India: Please share resume via job postings Not the right fit? Let us know you're interested in a future opportunity by clicking Introduce Yourself in the top-right corner of the page or create an account to set up email alerts as new job postings become available that meet your interest!

Business Analyst in US Healthcare. Healthcare Lead Business Analyst. The role will involve leading business analysis activities across claims, benefits, enrollment, and payment lifecycle initiatives, while working closely with business stakeholders, product owners, and technology teams to deliver co

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Job Description Job Title: Data Analyst Grade: 22 Salary: $80,698- $113,989 The Research Foundation for Mental Hygiene is seeking a qualified candidate to fill a full-time Data Analyst position. Mental Health Data Science provides statistical collaboration, data analytic methodological development, and data management for psychiatric and mental health research conducted within the Department of Psychiatry, Research Foundation for Mental Hygiene (RFMH), and the New York State Psychiatric Institute (NYSPI). We participate in extensive statistical collaborations with over 50 psychiatry researchers in any given year, providing statistical expertise and analysis to projects, including: biomarkers from brain imaging and neurocognitive tasks for mood and anxiety disorders and psychosis; clinical trials of new pharmacotherapies and psychotherapies for psychiatric and neurological disorders, including building treatment decision rules; implementation studies of support service programs for mental health treatment and prevention; measurement studies for improving psychometrics of diagnosis instruments in substance use disorders, depression, and biological aging; cohort studies of child-adolescent development of psychiatric and substance use disorders; causal analysis of prescribing practices monitored from medical claims records; momentary assessment studies of cardiovascular response to emotions and stress markers related to suicide; and much more. Seeking a qualified candidate to fill a full-time position of biostatistical data analyst in Mental Health Data Science division at The Research Foundation for Mental Hygiene affiliated also with the Department of Psychiatry at Columbia University Irving Medical Center. Duties and Responsibilities: • Specific duties will include the statistical analysis of clinical, epidemiological, and biological data., • The position will include planning and performing statistical analyses and writing reports for various externally funded research projects., • Excellent oral and written communication skills are highly preferred as is any prior experience in statistical consulting and analyzing data arising from psychiatric research. Solid academic training in biostatistics methods include techniques such as generalized linear modeling, multilevel and longitudinal models. To Apply: Submit an application through our website at . Please note only applications submitted through our website will be considered. The Mission of the Research Foundation for Mental Hygiene, Inc. (RFMH) is to promote the mental health of all New Yorkers, with a focus on providing hope and supporting recovery for adults with serious mental illness and children with serious emotional disturbances. Applicants with lived mental health experience are encouraged to apply. RFMH is deeply committed to supporting underserved individuals, organizations, and communities. To this end, RFMH is focused on implementing activities and initiatives to reduce disparities in access, quality, and treatment outcomes for underserved populations. A critical component of these efforts is ensuring that RFMH is a diverse and inclusive workplace where all employees' unique attributes and skills are valued and utilized to support the mission of the Agency. RFMH is an equal opportunity/affirmative action employer. The Research Foundation is a private not-for-profit corporation and is not an agency or instrumentality of the State of New York. Employees of the Research Foundation are not state employees, do not participate in any state retirement system, and do not receive state fringe benefits. Excellent Benefits Package. Affirmative Action/Equal Opportunity Employer - Disabled/Veteran, 41 CFR 60-741.5(a) and 41 CFR 60-300.5(a) compliant. Job Posted by ApplicantPro

The Senior Financial Analyst will play a critical role in supporting financial planning, analysis, and reporting for our Claims Solutions Division.This is a hands-on and highly analytical role that will cross-functionally partner with our Accounting, Finance, Operations, and Sales teams.The Senior F

Position Overview The Salesforce Analyst is accountable for performing analysis and administrative support specifically to Salesforce (SF) for the Claims Department. Incumbent will triage new cases and route/reroute cases as needed, assign salesforce cases to staff, will monitor, analyze, track and trend salesforce cases, will assist with compilation of key salesforce case metrics and will perform routine administrative case functions within the salesforce system. Salesforce will also make recommendations for improvement to the SF application to improve department efficiency and quality. Scope of Role & Responsibilities • Under direction from manager, coordinates the administration aspects of the Salesforce tool and inventory management of cases., • Under direction from manager, manually assigns cases to staff and/or routes to queues., • Triages new cases, tracking and trending and routing appropriately., • Assists with monitoring of case age and routing., • Performs administration case updates in salesforce application as appropriate., • Supports preparation of case activity and production reports., • Works with Salesforce IT team to develop reports., • Assists with any Salesforce training needs., • Performs other duties, as assigned by management. Required Education, Training & Professional Experience • Bachelors degree required., • Minimum 3 years health plan experience with a CRM tool; Salesforce a plus., • Proficient in MS Office applications. Professional Competencies • Integrity and Trust., • Customer Focus., • Functional/Technical skills., • Excellent verbal and written communication skills, with the ability to effectively communicate., • Strong organizational and analytical skills., • Ability to solve practical problems and recommend solutions., • Ability to plan work, work with staff, at all levels of the organization., • Show initiative and flexibility., • Ability to manage time and make decisions within the scope of assigned authority., • Ability to multi-task., • Must be able to work in a fast-paced environment. #LI-Hybrid #MHP50

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The Analyst, Professional Billing Analyst is responsible for supporting the implementation, maintenance, and optimization of the Epic Professional Billing (PB)/ Claims Remittance application. Analyst, Professional Billing Analyst. The Analyst, Professional Billing will report to Director of Revenue

The Commission & Cash Receipts Analyst is responsible for accurate and timely balancing of premium processing, claims refunds, and miscellaneous receipts via lockbox, ACH, ICL, credit card, and onsite deposits.

Epic Certified Hospital Billing Claims Analyst will bring experience in managing applications, with a strong background in managing day-to-day operations, client stakeholder relationships, and collaboration with offshore teams. A minimum of one year of experience as an Epic Hospital Billing Claims A

Details Client Name Metroplus Health Plan Job Type Travel Offering IT Profession Technical Specialty Business/Systems Analyst Job ID 35443512 Job Title Data Quality Analyst (000094) Weekly Pay $2571.7 Shift Details Shift Day - 7x5 - 08AM Scheduled Hours 35 Job Order Details Start Date 05/25/2026 End Date 07/18/2026 Duration 8 Week(s) Job Description Job Title: Data Quality Analyst Profession: Data Quality Analyst Specialty: - Duration: 8 months Shift: Full time Hours per Shift: 35 Experience: Minimum years of experience not specified License: - Certifications: - Must-Have: In-depth knowledge of claims processing protocols and payment schemes. Thorough knowledge of plan benefits. Proficiency in data analytics toolsets. Strong customer service skills. Excellent written and verbal communication skills. Description: The Data Quality Analyst will be responsible for ensuring standard handling and representation of data. They will assist in developing processes and coding to classify and standardize data for meaningful use and analyses. The role includes validating data for completeness and accuracy based on established guidelines. This position involves collaborating with data staff and other departments to identify and mitigate potential data issues. The analyst will regulate and assist with advising protocols and processes to maintain the cleanliness of data. Cleaning large datasets as needed in a timely and thorough manner will be part of the responsibilities. Auditing and reporting the quality control of data analysis and visualizations is essential. The analyst will respond to all claim inquiries from provider personnel. They will coordinate and track appropriate problem resolution activities across various departments. Managing and ensuring appropriate follow-up and closure for all inquiries is crucial. Data entry and performing claim adjustments to correct erroneous payments will also be required. Participation in special projects involving claim status investigations is expected. The position may involve resolving member bills referred from member services. Strong analytical thinking and ability to anticipate data issues are preferred. Attention to detail and exceptional quality control abilities are necessary for success in this role. Client Details Address 50 Water Street City New York City State NY Zip Code 10004 Job Board Disclaimer By applying for jobs on this website, you consent to receive daily messages from CYNET about assignments that match your profile. Email or text HELP for more info, or STOP to unsubscribe. Your mobile info will not be shared with third parties for marketing. Standard messaging and data rates may apply.

The Analyst, Professional Billing Analyst is responsible for supporting the implementation, maintenance, and optimization of the Epic Professional Billing (PB)/ Claims Remittance application. The Analyst, Professional Billing will report to Director of Revenue Cycle Applications. EPIC Application Re

The successful candidate will be the initial point of contact for surety bond claims and have primary responsibility for the distribution of claims, correspondence and other materials received by the surety claims department and providing other support services as identified below. Claims Services S

Job Description Senior Financial Data Analyst - Healthcare Salary: $87,647.11 - $98, 603.00 Must reside in NY, NJ or CT Join VillageCare as a Full-Time Senior Financial Data Analyst in the dynamic healthcare sector and play a pivotal role in shaping the financial strategies that impact our community. This position offers work-from-home flexibility, allowing you to balance your professional responsibilities with your personal life while contributing to meaningful healthcare solutions. Based in New York, NY, you will be part of a dedicated team that values excellence and customer-centricity in its mission to provide outstanding healthcare services. Your analytical expertise will drive decision-making in an energetic and forward-thinking environment. With a competitive salary range of $87,647.11 to $98,603.00, this opportunity not only offers rewarding challenges but also financial recognition for your skills and contributions. Take the chance to apply and further your career in a company that embraces innovation and integrity. VillageCare: Our Story VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years. Make a difference as a Senior Financial Data Analyst - Healthcare As a Senior Financial Data Analyst at VillageCare, you will play a crucial role in developing, documenting, and maintaining reports and analytics that empower leadership with key insights to drive financial success. You will ensure the accuracy and timeliness of routine and ad hoc reports, collaborating closely with both internal and external customers to guarantee successful report roll-ups and high customer satisfaction. Utilizing advanced tools such as SQL, Tableau, and RedShift, you will create customized dashboards for the Finance department, while working with the IT team to automate these reports for efficient metric monitoring. Your responsibilities will also include supporting the monthly close process, conducting claim reserve analysis, and creating member economics reports to aid strategic decision-making. Additionally, you will lead medical claims reinsurance reporting, support the preparation of provider group financial statements, and ensure compliance with regulatory reporting requirements, all while demonstrating VillageCare's commitment to Service Excellence. Does this sound like you? To excel as a Senior Financial Data Analyst at VillageCare, you will need a robust skill set and a solid professional background. A minimum of five years of relevant experience, particularly in an actuarial role focused on claims reserves, claims triangles, and IBNR estimation, is essential. Your ability to conduct complex data analyses and develop insightful reports and dashboards in a healthcare environment will be crucial. Proficiency in technical tools such as MS Excel, SQL, Tableau, Access, and Python is required, enabling you to manipulate and present data effectively. Additionally, the capacity to multi-task while maintaining a high level of attention to detail is vital for success in this role. Strong communication skills, both verbal and written, along with robust presentation capabilities, will enhance collaboration with internal and external stakeholders. A Bachelor's degree in Healthcare, Finance, or a related field is required, or equivalent years of experience, to support your analytical and problem-solving abilities in a fast-paced setting. Knowledge and skills required for the position are: • Minimum 5 years of relevant professional work experience, • Experience working in an actuarial function with a focus on building the claims reserve updating claims triangles and IBNR estimation, • Ability to perform complex data analysis and report/dashboard development in a health care setting, • Excellent technical skills (MS Excel, SQL, Tableau, Access, Python, etc.), • Capacity to multi-task at high detail-oriented level, • Strong communication skills (verbal, written, presentation, interpersonal), • Strong analytical and logical skills paired with strong attention to detail Job Posted by ApplicantPro

Job Description Hi, we're Oscar. We're hiring a Senior Analyst to join our Payment Integrity team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: This role is responsible for supporting process improvement and issue resolution in the Oscar claim environment for both the Oscar Insurance business and +Oscar clients. The Senior Analyst, Payment Integrity role organizes, scopes, prepares, investigates and/or executes on solutions and process improvements within edits and ideation. This is accomplished by leveraging a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement. You will report into the Sr. Manager, Payment Integrity. Work Location: This position is based in our New York City office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid Pay Transparency: The base pay for this role is: $72,036 - $94,547 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits., • Respond to internal and external inquiries and disputes regarding policies and edits., • Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope., • Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change., • Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions., • Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems., • Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate., • Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership., • Compliance with all applicable laws and regulations, • A bachelor's degree or 4+ years of commensurate experience, • 3+ years of experience in claims processing, coding, auditing or health care claims operations, • 3+ years experience in medical coding within payment integrity, • Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA), • Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices., • 2+ years experience deriving business insights from datasets and solving problems, • 1+ years experience improving business workflows and processes, • 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar), • Process Improvement or Lean Six Sigma training At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.