SmartLight Analytics

Analyst

• Identify and investigate healthcare billing activities leading to improper payments.
• Review claims data and conduct analysis to look for patterns of potential FWA and other improper payments.
• Utilize information from claims data analysis, plan members, and other sources to conduct confidential claims data reviews, relevant investigative activities, document actionable findings and report any suspect billing that could result in an overpayment through designated channels.
• Conduct data analysis to review claim and case history.
• Review claims history, medical reviews, provider files, etc. and utilize data analysis techniques to detect irregularities, billing trends, and financial relationships using state boards, licensing sites, Secretary of State sites, etc.
• Identify and resolve issues related to data discrepancies, missing data, or inconsistencies within clinical datasets.

Payment Integrity Analyst II

QA Engineer

• Designing, executing, and documenting tests for all engineering products
• Testing deliverables from multiple engineering teams
• Documenting testing results and communicating status on issues through ticketing systems
• Isolative troubleshooting and root cause analysis to determine severity/scope/validity of reported bugs

Software QA Analyst

Support Engineer

• Define, analyze, and troubleshoot both internal and external end-user issues of our applications
• Communicating with both internal and external stakeholders through ticketing systems (Such as Jira)
• Proactively communicating with members of leadership when potentially critical issues arise
• Utilize reporting tools (Excel, Jira) to track and document escalated issues

Data & Support Analyst

• Discover, track, analyze, and record bugs through documented testing methods
• Testing deliverables from multiple engineering teams
• Documenting results and communicating with other members of engineering and leadership on issue status through ticketing systems
• Designing, executing, and documenting tests for all engineering products
• Isolative troubleshooting and root cause analysis to determine severity/scope/validity of reported bugs

Junior Software QA Analyst

Data Engineer

• Develop and maintain T-SQL stored procedures for data processing and transformation
• Design and optimize SQL Server databases for healthcare analytics workflows
• Build data extraction and transformation processes using raw T-SQL
• Collaborate with cross-functional teams to understand data requirements and deliver solutions
• Support data quality initiatives and troubleshoot data processing issues
• Learn and utilize myDBR reporting tool for creating reports and visualizations
• Assist in developing healthcare claims processing workflows and data validation
• Participate in code reviews and maintain documentation for data processes
• Monitor and optimize database performance for large healthcare datasets
• Support ad-hoc data analysis requests from stakeholders

SQL Server Data Engineer

Data Analyst

• Develop a deep understanding of the key initiative of the organization and be able to provide analytical solutions that provides actionable recommendations to drive the success of the key initiatives
• On-going monitoring of product lines including but not limited to the success metrics for each model and dashboards required for executive decision-making
• Collect, clean, and analyze data from multiple sources to identify trends, patterns, and insights
• Apply statistical methods and advanced analytical techniques to solve business challenges and provide forecasts or predictive models
• Monitor data integrity by conducting regular audits and ensuring accuracy and completeness of datasets
• Develop dashboards using claims and eligibility data with analytical insights to assist in executive decision making
• Work with business stakeholders to understand their goals, challenges, and opportunities, and translate their needs into analytical projects
• Prepare on-demand analyses and ad-hoc reports and insights
• Present findings to stakeholders and translate insights into strategic recommendations
• Identify opportunities to automate data processes, streamline workflows, and improve reporting efficiency
• Document analytical methodologies, data workflows, and insights to ensure transparency and knowledge sharing across the organization
• Communicate analytical findings and recommendations in a clear and concise way to non-technical audiences, both in oral and written presentations
• Work closely with Information Management teams to automate recurring tasks and improve processes to continually increase efficiency

Data Analyst II

• The Senior Clinical Analyst role combines clinical data expertise with relationship management to ensure accurate claims processing, resolve billing discrepancies, and optimize carrier performance.
• The analyst plays a key role in identifying improper payments, communicating findings, and driving resolution through data-backed insights.
• Possess a clear understanding of the identification and investigation of issues and billing activities leading to improper payments is required as this work involves reviewing medical claims data (professionals, facilities, insured members, or the broker community).
• Utilize information from claims data analysis, plan representatives and other sources to accurately present the company’s findings to carriers in a way ensuring they will understand the issues and take recommended actions to remediate said inappropriate payments.
• Identify, analyze, and interpret trends or patterns in complex data sets
• Leverage available resources and systems (both internal and external) to analyze claim information and take appropriate action for payment resolution
• Perform review of claims resulting from overpayments related to benefits and policies
• Consider the financial impact of referrals with regard to identified savings and the potential of favorable resolution during the approval process
• Communicate and document findings, including trends and recommendations
• Ability to review and analyze medical records.

Senior Clinical Analyst

Data & Support Analyst I

• Designing, executing, and documenting tests for all engineering products
• Isolative troubleshooting and root cause analysis to determine severity/scope/validity of reported bugs from other stakeholders

Software QA Analyst II

Director

• Lead the pharmacy-related functions within SmartLight Analytics
• Focus on ensuring the accuracy, efficiency, and compliance of pharmacy claims processing
• Identify and prevent fraud, waste, and abuse (FWA) using advanced analytics
• Collaborate with cross-functional teams to develop and implement pharmacy strategies
• Oversee the design, development, and execution of pharmacy programs to support payer and provider partnerships

Director, Pharmacy Analytics

Business Development Rep

• Support execution of marketing strategies and day-to-day operations across campaigns, communications, conventions, trade shows and digital platforms
• Maintain accuracy of sales projects in PipeDrive and manage Customer Contract spreadsheet to track membership counts and invoicing rates
• Maintain RFP responses library and coordinate RFP efforts with the team
• Send client contracts through DocuSign for signatures and manage contract-related workflows
• Create calendar invites for client meetings and coordinate Business Review schedules
• Manage Chief Strategist open action items, projects, and calendar
• Maintain timelines for all conferences and manage annual conference membership dues, registrations and submission materials
• Follow up with stakeholders to track and finalize digital content and submissions, and prepare presentation decks
• Handle booth, panel & speaker registrations; submit headshots and bios; order conference promo items
• Plan booth set-up, arrange shipping of booth items to/from conferences, and manage print jobs
• Arrange travel (flights & hotels) and logistics for conference attendance
• Coordinate with vendors and internal teams to ensure brand consistency and audience engagement

Business Development Administrator

Account Manager

• Act as the primary point of contact for self-insured employer clients, ensuring satisfaction and fostering long-term relationships
• Serve as a trusted advisor, understanding client needs and offering strategic solutions to improve their healthcare programs
• Coordinate and lead regular client check-ins, presentations, and strategic reviews
• Collaborate with internal teams (data, data science, clinical and investigative, executives) to ensure optimal service delivery
• Become fluent in healthcare claims data relevant to Company’s use case and manage data intake with carriers/PBMs/data warehouses
• Utilize advanced analytics tools and techniques to create insights that inform decision-making and cost-saving strategies
• Translate complex data and analytical insights into clear, actionable reports and presentations for non-technical stakeholders
• Coordinate internal resources and timelines to ensure smooth implementation and delivery of projects; troubleshoot client issues
• Monitor KPIs to track success of initiatives and client satisfaction
• Nurture client relationships from implementation through ongoing engagement and support
• Partner with sales and solutions teams to develop strategic plans and assist marketing initiatives to increase business success

Director, Account Management

• Perform quality reviews of Quality Analyst work products
• Review claims data and confirm proper referral case presentation including referral reason, logic for the reason and proposed corrective action
• Compare work with client SPD and industry best practices and validate identified savings values
• Provide feedback to analysts on errors, omissions, or opportunities for improvement
• Contribute to QA standards documentation and serve as a resource for Quality Analysts
• Analyze trends in quality issues and implement root cause/corrective actions
• Support creation of a "culture of quality" among the clinical operations team
• Collaborate with healthcare professional consultants, clinical teams, business analysts, data scientists and engineers to refine analytics tools and understand stakeholder data needs
• Present findings and insights to internal teams, clients, and stakeholders
• Ensure quality, accuracy, and integrity of clinical data by conducting data validation, cleaning, and preparation
• Identify and resolve issues related to data discrepancies, missing data, or inconsistencies within clinical datasets
• Act as final checkpoint before findings are released to clients and carriers; report to Manager of Payment Integrity