[Remote] reputed company Director, reputed company reputed company reputed company Adjustment Analytics

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is building a more connected, convenient, and compassionate health care experience for individuals, families, and communities. The reputed company Director will reputed company reputed company and operational leadership for reputed company reputed company adjustment analytics, reporting, and reputed company, overseeing data management, reputed company scoring, reconciliation, reputed company monitoring, and regulatory compliance. The role also leads multidisciplinary teams and drives the adoption of machine learning, AI, automation, and modern data platforms.

Responsibilities

• 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
• 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
• 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
• 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
• 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

Skills

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

Benefits

• reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above
• Award reputed company in reputed company’s equity award program
• Medical coverage
• Dental coverage
• reputed company coverage
• reputed company time off
• Retirement savings reputed company
• Wellness programs
• Other resources, reputed company on eligibility

reputed company