CareSource

Operations

• Lead a dedicated team that supports the UM program through multiple functions
• Oversee and manage UM Operations oversight functions such as Corrective Action Plan (CAP) management
• Develop strategy and high-level implementation plans for delivery of new business implementations
• Perform ongoing monitoring and multiple audit activities
• Collaborate with data and analytics, PH and BH clinical teams, compliance and regulatory

Manager, UM Operations Strategy – Implementation

Analyst

• Payment Cycle Analyst IV is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine root cause.
• Collaborating with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive.
• Proactively collaborates with various teams to support contracting implementations and resolution of complex claims issues.
• Validate MCA Tests for expected results and communicate information to Reimbursement Analysts and HP Managers for provider notification.
• Create effective written and oral communication materials that summarize findings and support fact-based recommendations

Payment Cycle Analyst IV

• Conduct both systemic and targeted analysis to identify reimbursement errors and to determine root cause
• Collaborate with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive
• Provide analytical support and leadership for special projects and initiatives related to reimbursement of claims for both providers and members
• Research and provide recommendations to the Reimbursement Committee for reimbursement of services
• Research claim results to determine potential errors/discrepancies attributed to clinical edits, claims coding, payment policies, and application of fee schedule and rates
• Develop business requirements for payment decisions and manage the implementation process with Configuration, CES, IT and Market stakeholders
• Lead special projects to ensure payment discrepancies are resolved and communicated to the appropriate parties
• Provide payment expertise at provider meetings, Medicaid Fairs, market workgroups, and any other industry related events
• Review and interpret regulatory items and policy manuals to ensure test scenarios support the requirements

Payment Cycle Analyst III

🌐
Worldwide
❌ Jobs You've Hidden
⭐️ Saved Jobs
✅ Applied Jobs
✉️ Email Alerts
👤 Account
This job opening is no longer available.
Similar Jobs
Independent US IPOs Analyst

🕒 November 14, 2025

Smartkarma

11 - 50

💸 Finance

💳 Fintech

🤖 Artificial Intelligence

Website
LinkedIn
All Job Openings

Analyst to build ongoing research coverage of US IPOs and direct listings at Smartkarma. Focused on delivering insights and support for institutional clients in capital markets.

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

PMO Analyst

🕒 November 13, 2025

PMO Strategies

1 - 10

📚 Education

🏢 Enterprise

Website
LinkedIn
All Job Openings

PMO Analyst for consulting firm focusing on project management and transformation practices. Remote role with potential travel and collaborative engagement with client teams.

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

Independent IPO Analyst

🕒 November 5, 2025

Smartkarma

11 - 50

💸 Finance

💳 Fintech

🤖 Artificial Intelligence

Website
LinkedIn
All Job Openings

Analyst building ongoing research coverage of US IPOs. Evaluating pre-IPO and post-IPO situations for institutional clients.

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

Behavioral Analyst

🕒 November 4, 2025

State of Florida

10,000+ employees

🏛️ Government

📚 Education

Website
LinkedIn
All Job Openings

Behavioral Analyst responsible for monitoring consumer progress through face-to-face visits and observations. Collaborating with staff and analyzing data to ensure effective behavior plan implementation.

🇺🇸 United States – Remote

💵 $45k - $71.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

Real Time Analyst

🕒 November 1, 2025

Career Developers, Inc.

11 - 50

Website
LinkedIn
All Job Openings

Real Time Analyst managing short-term resource strategies at Booking.com, a leader in hotel reservations. Responsible for monitoring and developing staffing strategies based on operational demands.

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

Search More Analyst Jobs
🌐
Worldwide
Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com
Search
Search Jobs by country
Search jobs by city
Search jobs by job title
Search entry-level jobs
Search junior-level jobs
Search senior-level jobs
Search jobs by tech stack
Search jobs by contract type
Search remote internships
Search remote part-time jobs
Remote jobs Anywhere in the World
Companies Hiring Anywhere in the World
Companies Hiring Sales People Anywhere in the World
Companies Hiring Software Engineers Anywhere in the World
Resources
Advice
Tips for finding remote jobs
Interview questions and answers
Resume examples
Cover letter examples
Post a job
Affiliates
Privacy policy
Terms of service
Job board SEO course
AI Apply Copilot
OpenClaw job finder
Jobs by Country
Remote jobs anywhere in the world (Worldwide remote jobs)
Remote jobs United States
Remote jobs Australia
Remote jobs Brazil
Remote jobs Canada
Remote jobs France
Remote jobs Ireland
Remote jobs Germany
Remote jobs Netherlands
Remote jobs Spain
Remote jobs UK
Popular Jobs
Remote data analyst jobs
Remote customer support jobs
Remote executive assistant jobs
Remote marketing jobs
Remote product designer jobs
Remote product manager jobs
Remote project manager jobs
Remote recruiter jobs
Remote sales jobs
Remote software engineer jobs
Jobs by Type
Remote full-time jobs
Remote part-time jobs
Remote contract jobs
Remote internship jobs
Remote entry-level jobs
Remote jobs with no experience required
Remote junior jobs (1-3 years of experience)
Digital nomad jobs
Remote jobs with no degree required
Freelance remote jobs
Temporary remote jobs
Remote jobs hiring now
Stay at home mom jobs

Healthcare Analyst II

🌐
Worldwide
❌ Jobs You've Hidden
⭐️ Saved Jobs
✅ Applied Jobs
✉️ Email Alerts
👤 Account
This job opening is no longer available.
Similar Jobs
Senior Consultant – Epic Ambulatory Clinicals Analyst

🕒 April 24

Nordic Global

1001 - 5000

⚕️ Healthcare Insurance

☁️ SaaS

Website
LinkedIn
All Job Openings

Senior Consultant providing Epic-related consulting services to healthcare clients. Mentoring project teams and resolving client system issues for Nordic organizations.

🇺🇸 United States – Remote

💰 Private Equity Round on 2016-10

⏰ Full Time

🟠 Senior

🧐 Analyst

Revenue Recovery Associate Analyst I

🕒 April 24

Ensemble Health Partners

5001 - 10000

⚕️ Healthcare Insurance

☁️ SaaS

🏢 Enterprise

Website
LinkedIn
All Job Openings

Revenue Recovery Analyst maximizing insurance reimbursement by identifying contractual variances and resolving underpayments. Working collaboratively across departments to improve revenue cycle effectiveness.

🇺🇸 United States – Remote

💵 $45k - $81.8k / year

💰 Private Equity Round on 2022-03

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

Payment Integrity Analyst II – Data Mining

🕒 April 24

Lyric - Clarity in motion.

201 - 500

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

Website
LinkedIn
All Job Openings

Payment Integrity Analyst II focused on data mining to resolve payment errors. Analyzing claims data and improving operational performance in healthcare payments.

🇺🇸 United States – Remote

💵 $3.5k - $5.2k / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

Senior Workday Analyst

🕒 April 24

M&T Bank

10,000+ employees

🏦 Banking

💸 Finance

👥 B2C

Website
LinkedIn
All Job Openings

Workday Senior Analyst leading implementation and configuration of Workday solutions. Serving as a subject matter expert in HR-related specialties while collaborating with various business lines.

🇺🇸 United States – Remote

💵 $85.8k - $143k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

Claims UAT Analyst

🕒 April 24

biBerk Business Insurance

51 - 200

🤝 B2B

💸 Finance

Website
LinkedIn
All Job Openings

Claims UAT Analyst leading user acceptance testing across multiple claims systems. Collaborating with IT and business stakeholders to ensure system accuracy and quality.

🇺🇸 United States – Remote

💵 $65k - $80k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

Search More Analyst Jobs
🌐
Worldwide
Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com
Search
Search Jobs by country
Search jobs by city
Search jobs by job title
Search entry-level jobs
Search junior-level jobs
Search senior-level jobs
Search jobs by tech stack
Search jobs by contract type
Search remote internships
Search remote part-time jobs
Remote jobs Anywhere in the World
Companies Hiring Anywhere in the World
Companies Hiring Sales People Anywhere in the World
Companies Hiring Software Engineers Anywhere in the World
Resources
Advice
Tips for finding remote jobs
Interview questions and answers
Resume examples
Cover letter examples
Post a job
Affiliates
Privacy policy
Terms of service
Job board SEO course
AI Apply Copilot
OpenClaw job finder
Jobs by Country
Remote jobs anywhere in the world (Worldwide remote jobs)
Remote jobs United States
Remote jobs Australia
Remote jobs Brazil
Remote jobs Canada
Remote jobs France
Remote jobs Ireland
Remote jobs Germany
Remote jobs Netherlands
Remote jobs Spain
Remote jobs UK
Popular Jobs
Remote data analyst jobs
Remote customer support jobs
Remote executive assistant jobs
Remote marketing jobs
Remote product designer jobs
Remote product manager jobs
Remote project manager jobs
Remote recruiter jobs
Remote sales jobs
Remote software engineer jobs
Jobs by Type
Remote full-time jobs
Remote part-time jobs
Remote contract jobs
Remote internship jobs
Remote entry-level jobs
Remote jobs with no experience required
Remote junior jobs (1-3 years of experience)
Digital nomad jobs
Remote jobs with no degree required
Freelance remote jobs
Temporary remote jobs
Remote jobs hiring now
Stay at home mom jobs

Quality Analyst III

Medical Reviewer

• Conduct claim reviews against medical records to determine claim accuracy for claims payment
• Conduct meetings to present identified clinical issues and associated research to Medical Directors and physician experts for validation
• Conduct, participate or contribute to on-site audits and investigations of medical professionals, subcontractors, and contracted entities
• Assist the audit and investigative teams in the development of clinical and coding based audit tools
• Draft proposed provider education and formal corrective action plans for clinical and coding deficiencies
• Collaborate with other departments including Pharmacy, Medical Management, Provider Relations, Claims, Contracting, Case Management and Legal
• Responsible for maintaining confidentiality of all sensitive investigative information
• Develop and maintain SIU specific clinical and investigative training materials to include processes (SOPs)

Program Integrity Clinical Reviewer II, Readmission Experience Preferred

Customer Support

• Assist members/beneficiaries or providers with routine service inquiries
• Resolve member/beneficiaries or provider routine service inquiries
• Ensure all HIPAA, State and/or Federal requirements/regulations are always adhered to
• Research, follow up, and resolve all open/pending issues in a timely manner
• Build and strengthen member or provider relationships by providing quality customer service
• Maintain complete and accurate documentation of all of telephone and written communications

Customer Care Specialist I

Procurement

• Analyze healthcare utilization to identify patterns, variation, and outliers
• Identify and quantify opportunities to reduce medical costs within the markets
• Evaluate the effectiveness of medical cost reduction initiatives
• Develop tools to efficiently compare market performance across and within products
• Provide analysis and recommendations to inform network provider performance improvement
• Monitor the efficiency and efficacy of clinical programs, interventions and processes
• Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization
• Identify the variables and methodologies (e.g., qualitative, quantitative, spatial) that define population cohorts that can be positively impacted through targeted programs and interventions
• Segment population data to gain holistic intelligence via longitudinal trend analyses and advanced cluster analyses
• Conduct root cause analyses of adverse population health outcomes based on demographic, socioeconomic and clinical factors

Healthcare Analyst II – Vendor Management

Security Engineer

• Managed day to day, short and long term information security risks and ensures activities are within risk tolerance and in compliance with approved risk management policies, procedures and limits
• Measure, monitor, and report on information security risks
• Review and report on vendor/third party risk to support vendor risk management activities
• Engage staff and/or vendors to develop information security risk mitigation plans to address risks identified in Vendor risk reviews
• Monitor and report on information security risk mitigation plans to ensure timely execution
• Engage employees in the management of information security risk and ensure they are aware of their accountabilities with regard to information security risk management
• Regularly assess and report to management any exceptions to information risk management policies, procedures and limits
• Engage with the Enterprise Risk Management office to ensure information risk management policies, procedures and limits are aligned with Enterprise Risk Management policies and guidance
• Contribute and provide input to the development of operational department goals
• Acts as technical expert in functional domain
• Recommends technical advancements to improve CareSource customer and partner experiences
• Perform any other job related instructions as requested

Information Security GRC Analyst III

• Responsible for designing and developing technologies and processes to monitor operation of IT systems to detect suspicious activity
• Apply creative thinking in problem solving and identifying opportunities for improvements in security
• Administer and configure network and computing devices/systems that enforce security policies and IT internal controls
• Share ideas, discuss alternatives, and recommend means to decrease vulnerability of systems, applications and processes
• Monitor vendor and other advisory systems for patches and other security alerts
• Design and implement technical solutions to contractual and regulatory requirements
• Assist in completion of and responses to internal and external security assessments and audits
• Recommend, complete, and/or coordinate the application of fixes, patches, and updates
• Research emerging technologies in support of security enhancement and development efforts
• Provide subject matter expertise and assistance with risk assessments, penetration tests, and cyber-crime response efforts
• Perform project leadership tasks on select security projects

Information Security Engineer III

Manager

• Engage with the enrollee in their homes and other community settings to establish an effective, complex care management relationship
• Function as a liaison between healthcare providers, community resources, and enrollees
• Perform required assessments on a timely basis
• Engage enrollees in care plan development and implementation
• Lead the interdisciplinary care team (ICT)
• Oversee enrollee utilization of long-term services and supports
• Assist members in accessing community resources
• Educate members about their benefits and available services
• Follow up with members after hospitalizations or significant health events
• Work closely with primary care physicians and specialists
• Advocate for the needs and preferences of enrollees within the healthcare system

Clinical Care Manager, RN, LICSW or LMHC

• Provide analytical support and leadership for project impacting Claims and key internal Claims projects
• Represent claims on cross-functional project work teams
• Submit, monitor and prioritize IT tickets for the Claims department
• Review special projects and identify issue trends and potential resolutions
• Assist with Onbase reporting and processes
• Develop and draft P&P’s and job aides for Claims
• Assist in training claims staff on claims processing policy and procedures
• Assist in educating/training Business Partners on claims functions
• Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data
• Perform analysis of all claims data in order to provide decision support to Claims management team
• Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
• Represent Claims Department at requested provider calls and visits
• Provide feedback and/or face-to-face interaction with providers for claims research and resolution
• Responsible for research and resolution of claims issues for all assigned provider inquiries and submissions
• Responsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase)
• Provide input for claims business requirements, testing processes and implementation tasks and plans
• Perform any other job related instructions, as requested

Operations Specialist II

• Collaborate with members of an inter-disciplinary care team to improve quality
• Engage the member and their natural support system through strength-based assessments
• Develop and regularly update a person-centered individualized care plan
• Identify and manage barriers to achievement of care plan goals
• Educate the member/natural supports about treatment options and community resources
• Document care coordination activities and member response

Care Manager, Mom & Baby Social Worker

Medical Director

• Assume responsibility for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing
• Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices
• Participate in regulatory/accreditation reviews
• Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)
• BH coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting
• Oversight and quality improvement activities associated with case management activities
• Provide guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services
• Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
• Represent CareSource as the primary clinical liaison to members, providers and State agencies
• Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs
• Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
• Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
• Collaborate with market/product leaders to help define market strategy
• Community collaborative participation
• Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
• Provide cross-coverage for other Medical Directors and/or markets, as needed
• Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings
• Perform any other job duties as requested

Behavioral Health Medical Director – Clinical Appeals

Architect

• The Clinical Systems Configuration Architect is responsible for all architectural disciplines, decision making, drive communication, and collaboration for the enterprise
• Accountable for creating and maintaining the architecture disciplines that will guide the organization's technology decisions
• Define and communicate clinical systems implementation standards, best practices, and guidelines
• Work closely with business leaders and technology teams to understand needs and ensure alignment with business goals
• Maintain familiarity with a wide range of solutions and approaches clinical systems operationalization
• Develop policies, standards, and guidelines that direct the selection, development, implementation, and use of platforms within the enterprise
• Provide guidance, training, and mentorship to team members and leaders throughout the department
• Troubleshoot existing clinical configuration to identify errors or deficiencies and develop innovative solutions