HealthEdge

General

• Telephonic coordination and delivery of clinical behavioral health services
• Utilize clinical experience and skills in collaborative assessments and care coordination
• Review, research and authorize requests for healthcare services
• Contact medical personnel for treatment alternatives
• Analyze and prepare documentation for retrospective review requests and appeals
• Establish and communicate discharge planning needs
• Develop and deliver targeted education for provider community

RN, Behavioral Health

SDET

• Develop automation in existing tools and frameworks and extend those tools and frameworks as necessary.
• Execute both white- and black-box testing.
• Create and execute test plans and test cases based on requirements and user stories revolving around complex data scenarios.
• Identify current testing gaps, process flaws, suggest and implement improvements to increase product quality.
• Contribute to the relevant DevOps work and help improve the CI/CD for the team.
• Interact with product managers and developers to clarify requirements and drive projects to on-time, seamless releases.
• Participate in product Demos.

Software Development Engineer in Test, SDET

Business Operations

• Lead end-to-end ownership and execution of process and technology improvement initiatives across Claims Adjudication BPaaS customers.
• Own operational excellence delivery across a portfolio of BPaaS client accounts, balancing performance, risk, and value realization at scale.
• Manage complex program planning and delivery, including timelines, resource allocation, risk management, and executive stakeholder communication.
• Conduct operational assessments and partner with functional leaders to identify inefficiencies, scalability constraints, and improvement opportunities.
• Develop clear requirements focused on desired business outcomes for customer requested changes and other strategic initiatives.
• Perform root cause analysis and develop actionable recommendations for process optimization and measurable performance improvement.
• Document work instructions and plan training programs to support Operations enablement and change management.
• Develop and maintain program dashboards to track KPIs, cost savings, efficiency gains, and transformation outcomes for tracking.
• Coordinate cross-functional teams to implement process improvements, automation, and workflow optimization at scale.
• Ensure standardization and scalable adoption of processes and best practices across customer accounts.
• Collaborate with technology teams to support and enable automation initiatives (RPA, AI/ML).
• Lead change management efforts to ensure adoption, sustainability, and long-term value realization of improvements.
• Facilitate governance processes, including executive review cadences and escalation protocols.
• Communicate program progress, risks, and outcomes to executive stakeholders and client leadership.
• Mentor and develop team members, building future operational leaders within the operational excellence function.

Director, Business Operations Support Enablement

Learning and Development

• Developing call centers' education materials, including written and digital presentations, how-to manuals, and instructional videos.
• Preparing procedures and policies regarding call handling techniques and appropriate agent conduct.
• Scheduling and conducting training sessions on various call center topics to prepare and support new employees.
• Training experienced employees on new or updated call center procedures and scripts to improve their performance.
• Observing the daily operations of call center employees and identifying any areas of improvement.
• Monitoring recorded calls to identify training opportunities and upskilling requirements.
• Liaising with team leaders and managers to conduct on-the-job coaching.
• Measuring the effectiveness of training sessions and preparing individual or team progress reports.

Training Facilitator

Business Analyst

• Leading business requirement conversations with customers and internal teams
• Responsible for developing business and functional requirements for Claims, Enrollment, Provider, Authorization, Payment systems
• Collaborate with business users, management, IT, and offshore staff
• Produce the Requirements plan that aligns with the overall Project Implementation plan

Compliance

• Build and sustain a high-performing team of regulatory and reference data SMEs through active coaching, clear expectations, and ongoing feedback.
• Manage workload distribution, prioritization, and delivery across the team to meet regulatory milestones and Source product release commitments.
• Serve as an escalation point for Source-related regulatory issues, guiding the team through complex interpretation and resolution.
• Partner with Product, Engineering, and Client Success stakeholders to ensure regulatory requirements are clearly understood and operationalized in Source.
• Lead, supervise, and develop a team of regulatory compliance professionals with expertise in claims pricing, reference data, and healthcare transparency requirements.
• Conduct regular one-on-ones, performance reviews, and career development conversations.
• Build a team culture grounded in accountability, intellectual rigor, collaboration, and continuous improvement.
• Manage workload planning, capacity, and coverage to ensure consistent delivery against regulatory timelines and data release cycles.
• Drive onboarding and skill development for new and existing team members as Source’s regulatory scope evolves.
• Oversee the team’s monitoring, interpretation, and documentation of federal and state regulatory requirements impacting pricing, reference data and editing.
• Ensure regulatory deliverables - system requirement specifications, and client-facing materials – are accurate , timely , and meet quality standards.
• Manage the team’s review and disposition of regulatory changes relevant to Source across commercial, Medicare Advantage, and Medicaid lines of business.
• Oversee escalation management and resolution of complex regulatory issues affecting Source customers or product functionality.
• Partner with Source Product and Engineering to ensure regulatory requirements are incorporated into roadmap planning and sprint execution.
• Collaborate with Client Success and Implementation teams to support health plan client inquiries related to Source regulatory content.
• Represent the team’s work in cross-functional meetings, regulatory forums, and client-facing engagements as needed.
• Coordinate on enterprise regulatory monitoring and cross-product impact assessments where Source data intersects with other HealthEdge platforms.

Manager, Regulatory Compliance

Manager

• Plan, develop, organize, direct and evaluate all aspects of onshore and offshore BPaaS activities
• Serve alongside multiple stakeholders, including Configuration, IT Operations, Contact Center Operations, and Medical Management to deliver customer success
• Establish operational objectives, policies and procedures ensuring compliance with customer contracts and related laws and regulations
• Develop and execute strategies to achieve key performance measures
• Identify, recommend, and implement new processes, technologies, and systems to improve and streamline processes and use of resources
• Establish and administer the department budget
• Provide Executive level briefings to Senior Leadership at regular intervals to keep leadership current with updates and performance levels
• Establish strong, collaborative relationships with client leadership

Senior Manager, Quality Audit

• Manage all operations for a few processes/clients
• Ensure team meets SLAs and KPIs
• Identify process gaps and collaborate with clients to formulate solutions
• Participate in building solutions for new opportunities
• Guide and mentor junior associates
• Lead projects with higher complexity levels

Manager, Quality Audit

Security Engineer

• Contribute to developing and communicating a strategic vision for our global security architecture.
• Help design and implement comprehensive security architectures that encompass network security, application security, data protection, and identity management.
• Identify and assess security risks and develop mitigation strategies to reduce those risks.
• Evaluate and implement advanced security technologies and solutions, working closely with IT teams to integrate security controls into existing and new systems.
• Leverage automation throughout our technology stack.
• Build bridges throughout our organization, leading with education and building influence.

Principal Security Architect

Director

• Unify onshore and offshore operational resources into a cohesive team
• Establish strong cross-cultural relationships
• Ensure international teams deliver across all operational functions
• Monitor offshore performance and manage expectations
• Champion shift from a client-based model to a shared-services model

Director, Performance Integrity Office

Administrative Assistant

• Lead and manage a team in delivering operational excellence
• Ensure adherence to quality standards and compliance metrics
• Drive continuous process improvement and manage corrective actions
• Collaborate with clients and stakeholders for service enhancement
• Conduct capacity planning and maintain operational continuity

Manager II – Performance Integrity Office

Consultant

• The Business Consultant leads and mentors the Service Delivery team in all Tier 1 (Basic) and Tier 2 (Intermediate) consulting initiatives
• The position provides in-depth and comprehensive subject matter expertise related to Burgess products (from basic to advanced features/functionality), payment methodologies/policies (Medicare, Medicaid, and commercial), payment integrity, and healthcare plan operations (e.g., claim life cycle/workflow, network contracting, payment/policy configuration, provider relations, medical management, medical economics, audit, compliance) related to implementation/consulting engagements, strategic user adoption initiatives, and ongoing client support.
• Provide the highest level of product education (from basic to advanced features/functionality to Burgess end-users
• Provide in-depth and comprehensive subject matter expertise related to: Medicare, Medicaid, and commercial payment methodologies/policies
• Payment integrity
• Healthcare plan operations (e.g., claim adjudication life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management, medical economics, audit, compliance)
• Conduct collaborative scoping sessions to identify client needs and appropriate solutions
• Actively manage and/or participate in the development, maintenance, and execution of client facing education services
• Manage issues, questions, inquiries of Tier 1 and 2 escalation
• Serve as escalation point for critical client needs as warranted
• Lead diagnosis and resolution of escalated and more involved/complex client problems and issues
• Act as a liaison between clients and internal support staff (research, development, and product teams) to assure accurate problem interpretation and resolution
• Capture and solicit issues/feedback from clients and internal stakeholders and document issues and client impacts.
• Partner with appropriate Burgess Teams (BA, PM, Development, Account Management, Sales/Business Development, Product, Content, and Service Delivery) to manage problem framing, diagnosis and resolution
• Conduct/ participate in root cause analysis to identify and deliver warranted service improvements
• Maintain communication with customers during the problem resolution process, utilizing superior customer service skills
• Mentor and provide oversight for Tier 1 and 2 Service Delivery staff
• Take direction from and collaborate with Service Delivery Leadership to continually review and enhance performance and strategy.

Business Consultant

Pricing Analyst

• Support pricing strategy and commercial modeling for large, complex deals
• Partner with Sales, Advisory/Consulting, Transformation, FP&A, and Operations teams
• Develop value-based pricing models that are competitive and aligned with margin targets
• Engage stakeholders to ensure alignment on scope, pricing approach, and margin expectations
• Validate pricing assumptions including cost structures and efficiency gains

Strategic Pricing Manager

Financial Planning and Analysis

• Serve as an FP&A business partner to leaders within the Risk Adjustment organization
• Prepare monthly revenue and expense forecasts for HealthEdge’s Risk Adjustment P&L
• Build, maintain, and enhance complex financial models
• Prepare and deliver monthly and year-to-date management reporting packages
• Assist with financial analyses, executive commentary, and presentation materials for reviews
• Provide deep technical and analytical expertise for complex, ad-hoc reporting and data requests
• Partner with Finance, IT, and business stakeholders on system implementations
• Design and enhance automated reporting, dashboards, and data models
• Develop and maintain a quantitative and qualitative analytics framework
• Identify opportunities for process standardization, automation, and efficiency gains
• Support continuous improvement initiatives that enable FP&A to scale effectively

Senior Financial Analyst, Risk Adjustment

Salesforce Administrator

• Build and ship solutions on the Salesforce platform for your GTM domain.
• Lead AI strategy and enablement, partnering with GTM teams.
• Embed yourself in how GTM teams actually work.
• Design solutions for longevity — thinking upstream and downstream.
• Connect what you build to business outcomes.
• Contribute to the team's AI-first operating model.
• Support platform health: data integrity, security, and day-to-day responsiveness.