CareSource
CareSource
CareSource — Medicaid, Marketplace және Medicare Advantage жоспарлары арқылы мүшелеріне қызмет көрсететін медициналық сақтандыру компаниясы. Оның қамту және қолдау қызметтері табысы төмен ересектер мен отбасыларды, балаларды, жүкті әйелдерді, егде жастағы адамдарды және мүгедектігі бар жандарды қоса алғанда, әртүрлі топтарға арналған. CareSource сондай-ақ стоматология, көру, есту, дәріхана қызметтерін және COVID-19 бойынша қолдау ресурстарын ұсынады. Онлайн және мобильді құралдар мүшелерге медициналық көмекті басқаруға көмектеседі.

CareSource Director of Claims Process Optimization (Facets)

Lead claims optimization at CareSource, advancing automation and AI across health plan operations. Improve adjudication, financial results, vendor performance, and regulatory readiness.

Сипаттама

  • Lead automation and AI initiatives across claims operations, from design through ongoing oversight.
  • Spot opportunities for intelligent automation, develop business cases, coordinate delivery with configuration, IT, and vendor partners, and verify lasting production results.
  • Oversee claims adjudication and adjustment workflows.
  • Monitor operating budgets and vendor performance.
  • Manage managers, analysts, and process specialists.
  • Account for operating results, including inventory, throughput, auto-adjudication, accuracy, and regulatory turnaround times.
  • Develop and maintain the claims automation and AI roadmap.
  • Measure and report realized benefits against pre-launch baselines.
  • Assess workflows through process maps, time studies, and production data.
  • Make the case for automation and process improvement investments, then report actual results.
  • Monitor cost per claim and capacity use to guide staffing, sourcing, and automation priorities.
  • Set and track budgets for assigned functions and technology initiatives.
  • Lead root cause investigations and work with upstream owners to resolve recurring defects.
  • Maintain procedures, controls, and audit evidence for internal, state, federal, and delegated reviews.
  • Lead daily production, weekly operations, and monthly business reviews.
  • Oversee outsourced, offshore, and technology vendors against service levels, quality requirements, and delivery commitments.
  • Contribute to vendor selection, statements of work, and renewal decisions.
  • Handle other job-related duties as assigned.

Талаптар

  • Bachelor's degree in business, health administration, data analytics, or a related field; equivalent relevant work experience may substitute.
  • At least seven years of experience in health plan claims or healthcare operations.
  • At least five years of leadership experience.
  • Practical knowledge of automation and AI applications for claims operations.
  • Working knowledge of claims adjudication platforms, provider reimbursement methods, and coding standards such as CPT, HCPCS, ICD-10, and revenue codes.
  • Strong analytical ability.
  • Demonstrated skill in leading change.
  • Strong financial judgment.
  • Clear written and verbal communication, including presenting technical details and operational risks to executives.
  • Work in a general office setting and be able to sit or stand for extended periods.
  • Travel is generally not required.
  • Salary range of $113,000–$197,700 per year.

Артықшылықтар

  • May be eligible for a bonus based on company and individual performance.
  • Comprehensive total rewards package.
  • Support for employee well-being.
  • Remote work arrangement.

Ұқсас жұмыс орындары

Exelixis

Field-Based Marketing Director, Key Customer Team

Exelixis

Lead oncology brand strategy and engagement with key opinion leaders across New York, Massachusetts, and Connecticut. Coordinate advisory boards, speaker programs, and account plans with Exelixis teams.

Ашу
SLR Consulting

Senior Legal Counsel, Fixed-Term Contract

SLR Consulting

Advise SLR Consulting on complex commercial contracts across the APAC region, managing negotiations, contractual risk and legal governance. The role is based in Brisbane or Sydney and follows a hybrid work arrangement.

Ашу
decircle

Senior DeFi Marketing Lead (UK Remote)

decircle

Lead marketing for Spark Finance, building its DeFi and onchain capital-markets ecosystem. Own content, public relations, key opinion leader campaigns, partnerships, distribution, and events.

Ашу
Hostinger

Senior Commercial and Technology Legal Counsel

Hostinger
501 – 1 000 Қызметкерлер
B2BB2CSaaS

Lead commercial contracting and technology law at Hostinger, an AI-first web hosting business. Partner with product and marketing teams while developing legal tools and processes that can scale.

Ашу
HelloCollege

Director of Marketing

HelloCollege
51 – 200 Қызметкерлер
Білім беруКонсалтинг

Lead HelloCollege’s nationwide college admissions marketing operation, driving lead growth and quality across acquisition channels. Oversee analytics, budget, team performance, and AI-enabled optimization.

Ашу
Nuitée

Executive Marketing Manager, Remote in Spain

Nuitée
201 – 500 Қызметкерлер
SaaSЖасанды интеллектСаяхат

Lead brand, PR, events, social, and content for Nuitée’s global hotel booking API platform. Shape the company’s growth story across travel, fintech, and technology.

Ашу
Dentons
Cosmos Sport SA

Omnichannel Marketing Executive

Cosmos Sport SA

Deliver marketing campaigns and store activations across Cyprus for Cosmos Sport, spanning sports events, sponsorships, and influencer partnerships. Help connect in-store and digital experiences across the company’s retail banners.

Ашу
group.one

Head of Marketing, DACH SaaS

group.one

Lead Shore’s marketing strategy and SaaS growth across the DACH region. Guide a five-person team spanning search, paid media, AI automation, analytics, and revenue growth.

Ашу
Endless Studios

Director of Marketing

Endless Studios

Lead brand, content, and student acquisition marketing for Endless Studios, a global youth game-making studio and learning community. Direct U.S. marketing and support growth efforts in the Middle East.

Ашу