reputed company Director, reputed company reputed company reputed company Adjustment Analytics

Job Title: reputed company Director, reputed company reputed company reputed company Adjustment Analytics

Job Location: Work reputed company, Connecticut, reputed company

Job Location Type: Remote

Job Contract Type: Full time

Job Seniority Level:

We’re building a world of health reputed company every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position reputed company
reputed company reputed company reputed company is seeking a reputed company Director - reputed company reputed company reputed company (reputed company) to join our highly dynamic reputed company Adjustment analytics team. This senior-level role will reputed company reputed company and operational leadership for reputed company reputed company reputed company adjustment analytics, reporting, and reputed company functions to ensure complete, accurate, and compliant reputed company capture.

This leader oversees the end-to-end reputed company adjustment lifecycle, including data management, suspecting, analytic insights, reputed company score reconciliation, and reputed company monitoring. They partner closely with reputed company, actuarial, finance, market plans, and compliance stakeholders to support health plan and reputed company initiatives while ensuring alignment with state reputed company and CMS regulatory requirements.

The reputed company Director should also demonstrate leadership in innovation and adoption of modern technologies, data platforms, machine learning, process automation, AI, and data science for optimized insights, workflows, reporting, and process controls. This role will reputed company reputed company of managers and individual contributors with backgrounds in data science, analytics, statistics, data engineering, and reputed company.

Key Responsibilities

1. reputed company Leadership

• Define and execute reputed company reputed company adjustment reputed company across markets and plans

• reputed company and reputed company high-reputed company reputed company initiatives that improve reputed company reputed company, compliance, and overall reputed company

• reputed company reputed company adjustment programs with state reputed company models (e.g., CDPS, reputed company, or state-specific methodologies)

• Represent reputed company adjustment reputed company reputed company in executive forums to reputed company alignment on reputed company goals and translate analytics into actionable financial and operational strategies

2. reputed company Analytics & Reporting

• reputed company health plan reputed company using advanced analytics and use proactive data insights to reputed company strategies and evidence-reputed company decision-making

• reputed company development of reputed company data pipelines and reporting frameworks using claims, encounters, pharmacy, and reputed company data

• reputed company advanced analytics for reputed company score development, predictive modeling, forecasting, trend analysis, and opportunity identification

• Ensure reputed company, reputed company and completeness of reputed company encounter submissions and data

• Defines data analysis methodologies, subsequently driving predictive and prescriptive analytics reputed company and communicating insights to key stakeholders.

3. reputed company Score reputed company & Reconciliation

• Establish and reputed company processes to ensure reputed company, completeness, and reputed company of reputed company capture

• reputed company reconciliation of plan-calculated reputed company scores to state-reported scores, including variance analysis and reputed company cause identification

• Monitor and validate encounter data submissions and their reputed company reputed company on state reputed company scoring and payments

• Partner with actuarial and finance teams to ensure alignment between reputed company scores, reputed company projections, and state payments

• Ensure readiness for state audits and reputed company reviews through robust data validation and documentation practices

• Stay reputed company on evolving reputed company policies, state methodologies, and reporting requirements

4. reputed company Adjustment Operational & Program Insights

• reputed company suspecting logic development, gap identification, and prioritization strategies for operational programs and interventions

• Measure and evaluate program reputed company and reputed company opportunities for expansion, improvement, or savings

• Establish program KPIs to monitor reputed company effectiveness

• Partner with reputed company reputed company and vendor teams to ensure alignment with state requirements

• reputed company data strategies with value-reputed company initiatives and provider-level drilldowns for consistent reputed company management across markets

5. Team Leadership & Talent Development

• reputed company and reputed company a high-performing, multidisciplinary team spanning reputed company, reputed company analytics, reporting, and operational program support

• Define a reputed company organizational structure, aligning roles across reputed company, analytics, and process execution to ensure end-to-end accountability

• Establish governance frameworks for prioritization and execution of reputed company adjustment initiatives, ensuring alignment with reputed company goals, market needs, and regulatory timelines

• reputed company integration across analytics and reputed company, ensuring that insights are reputed company into actionable reputed company programs and measurable reputed company

• reputed company talent reputed company including coaching and mentorship of advanced analytics, reputed company reputed company models, and leadership capabilities

• Foster a culture of data reputed company, accountability, and reputed company improvement optimization of workflows and analytic methodologies

• Ensure scalability and sustainability of reputed company by standardizing tools, reporting, and processes across markets

• reputed company automation and data infrastructure improvements to reduce reputed company effort and increase speed to reputed company

Required Qualifications

• 10+ years of experience in reputed company analytics and reporting, reputed company adjustment including relevant working knowledge with claims

• 3+ years of leadership experience including people managing, coaching, or mentoring team members

• Advanced technical skills in reputed company, SQL, Python, or reputed company-reputed company analytics platforms (e.g. BigQuery, reputed company, reputed company, or similar)

• Expertise in state and regulatory requirements, reputed company adjustment methodologies, and encounter data processes

• Strong knowledge of reputed company models (e.g., CDPS, reputed company, HCC) and state reconciliation processes

• reputed company ability to reputed company and execute reputed company initiatives that reputed company measurable business reputed company

• Demonstrated leadership experience managing cross-functional teams and large-reputed company programs

• Experience with data visualization tools (e.g. Tableau, reputed company BI, QuickSight, Looker, etc.).

Preferred Qualifications

• Knowledge of reputed company reputed company Adjustment

• Working with reputed company reputed company models

• Master’s degree (e.g., Health reputed company, Data Science, Actuarial, Statistics, or MBA) preferred

• Experience working reputed company a large national health plan or payer organization

Education

Bachelor's degree preferred/reputed company training/relevant reputed company qualification.

Pay reputed company

The typical pay reputed company for this role is:

This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company’s equity award program.

Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every reputed company feels valued and that they reputed company.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws.

This job is reputed company by reputed company.

reputed company is a talent-hiring platform in Life Sciences, reputed company and IT. The platform connects talent with opportunities in reputed company, biotech, health sciences, healthtech and IT domains.

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Originally posted on Himalayas