• Actuarial Analyst I/II/III/IV

    Excellus BlueCross BlueShield (Rochester, NY)
    Job Description: Summary: The Actuarial Analyst performs actuarial services in support of Health Plan operations and monitors and maintains financial ... Population Health Engagement, Marketing & Sales, etc., and how they impact Health Plan operations and financials. Level III (in addition to Level II… more
    Excellus BlueCross BlueShield (07/14/25)
    - Related Jobs

  • Director Clinical Analytics

    Dignity Health (Bakersfield, CA)
    …**Qualifications** **Minimum Qualifications:** - Minimum five (5) years of experience in the health plan and/or healthcare operations industry with extensive ... of the organization including but not limited to analysis of population health metrics, network clinical, financial, utilization, and patient satisfaction in support… more
    Dignity Health (07/30/25)
    - Related Jobs

  • Governance, Risk, & Compliance Analyst IV

    Premera Blue Cross (Mountlake Terrace, WA)
    …Assessment. (Preferred) + IT experience in healthcare. (Preferred) + Demonstrated understanding of health plan operations and applicable security & privacy ... the IT Risk team, championing GRC initiatives across Premera operations , and reports to the Manager of IT Risk,...empathy and advocacy, we change lives. As the leading health plan in the Pacific Northwest, we… more
    Premera Blue Cross (07/31/25)
    - Related Jobs

  • Cybersecurity Threat Intelligence Engineer II

    Premera Blue Cross (Mountlake Terrace, WA)
    …security policy, and standards development. **Preferred Qualifications** + Demonstrated understanding of health plan operations and applicable security and ... and proper workflow of the team in the day-to-day operations . + Review and report to the team IT...empathy and advocacy, we change lives. As the leading health plan in the Pacific Northwest, we… more
    Premera Blue Cross (07/15/25)
    - Related Jobs

  • Vice President, Medical Economics

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …+ Deep and broad understanding of health care delivery system and health plan operations , including knowledge of Medical Economics, Trend Management, ... , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader… more
    Blue Cross Blue Shield of Massachusetts (06/24/25)
    - Related Jobs

  • Sr Advisor, Quality Data Analytics (HEDIS/ Star…

    Commonwealth Care Alliance (Boston, MA)
    …skills and ability to effectively interact with all levels of management. * Knowledge of health plan operations , health care claims and other relevant ... and ability to effectively interact with all levels of management. * Knowledge of health plan operations , health care claims and other relevant data… more
    Commonwealth Care Alliance (07/24/25)
    - Related Jobs

  • Member Services Representative II -Kspa

    Kelsey-Seybold Clinic (TX)
    …put into practice software applications to respond to administrative issues related to health plan operations including claims resolution, premium billing, ... Member Service Representatives II-KSPA provide Concierge Service to members of the health plan which include providing a high level of service to callers and… more
    Kelsey-Seybold Clinic (05/10/25)
    - Related Jobs

  • Provider Engagement Professional

    Humana (Springfield, IL)
    …in this role should have critical thinking/problem solving skills, an understanding of health plan operations , and strong interpersonal skills. The Provider ... resolution. + Understanding of service coordination, prior authorizations, and other health plan processes. + Understanding of value-based payment programs.… more
    Humana (08/02/25)
    - Related Jobs

  • Manager, Enrollment - REMOTE

    Molina Healthcare (Omaha, NE)
    …point of contact for the internal partners, ie Medicare Administration, Compliance and Health Plan Operations . Coordinates and facilitates meetings providing ... processing and maintenance of new members and re-enrollment. Processes and maintains health plan 's member and enrollment records, employer's monthly reports,… more
    Molina Healthcare (08/01/25)
    - Related Jobs

  • Program Analyst, Health Operations…

    Immigration and Customs Enforcement (Washington, DC)
    …ensure the ultimate success and acceptance of the program. Maintains the Health Operations Field Continuity of Operations Plan . Manages access to HOU's ... of Health Systems Support (HSS), and IHSC Health Operations Unit. This is a non-supervisory... plan . Collaborates and assists RHSAs concerning Field Health Operations . Collaborates with the Regional Clinical… more
    Immigration and Customs Enforcement (07/02/25)
    - Related Jobs