Jobs at CareSource

Supports the design, validation, and operationalization of predictive, machine learning, and AI models. Analyzes structured and unstructured data, develops algorithms, validates outcomes, creates visualizations, and communicates findings to stakeholders. Collaborates cross-functionally to integrate solutions and prepares model pipelines for business use. The role also involves statistical analysis, NLP, exploratory data analysis, feature engineering, and research into emerging technologies.

Leads enterprise-level programs across Enterprise Engineering Solutions, managing integrated plans, scope, budgets, risks, dependencies, governance, stakeholder alignment, reporting, and continuous improvement. Partners with leadership to secure resources and prioritization while coordinating complex, cross-functional initiatives across business and IT teams. Requires expertise in program management, SDLC methodologies, enterprise technology environments, and matrixed collaboration. The role also uses agentic AI development tools to improve software delivery and engineering productivity.

Manages information security risks, vendor and third-party risk reviews, mitigation plans, policy exceptions, and compliance reporting. Partners with stakeholders and Enterprise Risk Management to maintain risk policies within tolerance. Serves as a technical expert, supports risk awareness and accountability, monitors security controls, and contributes to operational goals. The role requires expertise in IT audit, security monitoring, access management, encryption, networking, incident response, SOX compliance, and project management.

Lead enterprise employee relations strategy and governance; advise executives and HR partners on complex, high-risk matters; oversee investigations, policy standardization, training, and leader coaching; analyze ER and HR metrics to mitigate risk, improve performance, and drive organizational effectiveness and change.

Leads enterprise technology architecture, governance, design validation, roadmaps, lifecycle management, vendor assessments, and IT due diligence. Partners across technology teams to establish architecture strategy and standards while improving cost, availability, security, client experience, and flexibility. Requires substantial IT experience, architecture or technical leadership background, AI security expertise, full-stack development experience, and fluency in Python and server-side JavaScript or TypeScript.

Leads health plan enrollment operations, managing staff, enrollment and financial reconciliation, eligibility file processing, audits, regulatory compliance, enrollment technology, and process improvement. Oversees Facets and 834/DTRR activities, coordinates with vendors and IT, analyzes performance data, manages risk and corrective actions, and develops team members. Requires knowledge of Medicaid, Medicare, Dual coverage, HIPAA enrollment transactions, and health plan regulatory requirements.

Analyzes healthcare encounter and claims data, resolves data and process issues, supports CMS and state regulatory submissions, monitors SLAs and performance metrics, and contributes to testing, reporting, automation, and process improvement. The role collaborates with IT, claims, enrollment, vendors, and regulatory stakeholders while ensuring compliant encounter reconciliation and accurate claims data.

Develop and deploy AI-enabled applications, web interfaces, and workflow integrations using low-code platforms and modern programming frameworks. Build Python and SQL automation, integrate generative AI and NLP capabilities, collaborate with data and business teams, and support testing, troubleshooting, Agile delivery, deployment, and incident management. Ensure solutions meet usability, accessibility, compliance, and performance standards.

Leads advanced data science and machine learning initiatives for healthcare payment integrity, including fraud, waste, and abuse detection, anomaly identification, predictive modeling, statistical analysis, dashboards, and recovery investigations. Provides technical leadership, mentors analysts, integrates production analytical solutions, collaborates with legal and business stakeholders, and presents findings to leadership. Requires healthcare expertise, advanced SQL and programming skills, and knowledge of claims, billing, reimbursement, and program integrity.

Provides analytical support for healthcare claims payment policies, clinical edits, reimbursement analysis, regulatory updates, configuration changes, UAT, and post-production validation. Researches payment discrepancies, identifies root causes, documents policy decisions, monitors claims processing accuracy, and communicates findings to providers and internal stakeholders. Requires health plan or provider coding and payment policy experience, strong knowledge of healthcare coding systems, claims operations, managed care, Medicare, Medicaid, and CMS guidelines.

Leads enterprise enrollment operations across healthcare product lines, overseeing enrollment lifecycle activities, system integrations, data integrity, reconciliations, vendors, regulatory compliance, audits, and process transformation. Partners with IT and external agencies, manages CMS and Medicaid transactions, establishes operational controls and reporting frameworks, and develops high-performing teams. Requires extensive leadership experience and expertise in Medicaid managed care, Medicare Advantage, or Dual Special Needs Plans.

Develop complex healthcare reports, ETL solutions, databases, and Power BI dashboards for LTSS and Dual Eligible programs. Analyze multidimensional data, ensure governance and accuracy, identify operational improvements, and deliver actionable insights to leadership. The role translates business requirements into scalable reporting solutions, collaborates with clinical, operational, data engineering, and IT teams, and leads testing, process automation, visualization, and large cross-functional data projects.

Leads enterprise business analysis strategy across multiple programs and portfolios. Partners with executives on business cases, investment decisions, requirements, prioritization, risks, value realization, and transformation initiatives. Establishes governance, methodologies, standards, and performance measures while guiding complex requirements efforts. Analyzes operational and financial data, supports payer regulatory compliance, drives AI and automation adoption, and mentors business analysts and project teams.

Lead a small actuarial team responsible for pricing, forecasting, reserving, and actuarial modeling for supplemental benefits. Develop assumptions, evaluate experience and trends, support rate filings and IBNR reserve estimates, provide strategic recommendations, and ensure compliance with actuarial standards.

Lead the actuarial function to drive pricing, forecasting, rate filings, and financial analysis. Develop statistical models, ensure regulatory compliance, mentor staff, support senior management and business development, and implement AI-enabled solutions to improve efficiency and insights.