Responsible for the daily supervision and operations of the Prior Authorization Specialists. Develops training, trains staff, assigns work, implements policies and procedures, and resolves complex issues to ensure accurate and timely management of prior authorization requests. Maintains compliance with state and federal requirements. Performs quality assurance audits. Imp

Uses SAS and/or SQL coding to pull claims and membership data to support involved healthcare analytics Supports the development of effective medical management programs/initiatives through analyzing, monitoring, and reporting the effectiveness of these programs Develops and implements plans to measure and report on corporate wide health care delivery cost and utilization

The Operations Reporting and Performance Analyst (ORPA) plays an essential role in improving organizational effectiveness by analyzing operational data and identifying opportunities for learning and development. The OPRA collects and analyzes data to assess performance metrics, identifies training needs, and implements strategies to improve employee performance and skill

The WellSense Health Plan Manager of Hospital and Physician Contracts is responsible for the development, implementation and management of a cost effective provider network, maintaining complex and geographically diverse contracts. The Manager leads a team of Hospital and Physician Contract Managers and is responsible for the development of network wide strategies to impr

The Staff Accountant is a key member of the Accounting team and works closely with all members of the team in meeting close deadlines, working with various general ledger modules, preparing account reconciliations, and supporting internal and external audits. Positive and team oriented work ethic is critical to this role.

Designs, implements, and manages the Business Continuity Program for the health plan Collaborates with department directors and the executive team to develop and implement plans to anticipate, address, and mitigate the effects of various business interruptions Develops, updates and executes business continuity program goals, including development and reporting against met

The Manager of Healthcare Analytics is responsible for financial analysis, measurement, and contract compliance as it relates to WellSense's Clinical Vendors. Working closely with Finance leadership, clinical leadership, and leaders from WellSense's Clinical Vendors, the Manager will ensure the financial integrity of these partnerships by leading the development and commu

The WellSense Plan Manager of Ancillary Contracts is responsible for the development, implementation and management of a cost effective provider network, maintaining complex and geographically diverse contracts. Serves as mentor and manage o Ancillary Contract Managers, leading in the development of network wide ancillary strategies to improve efficiencies and access. Und

Position Health Data Analyst III (2 positions available) Location Charlestown (Boston), MA. Report to main office in Charlestown, MA. Eligible to work remotely from anywhere in the U.S. but must work from a state the employer is legally eligible to employ Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland

Under the direction of the Vice President of the Senior Vice President of Behavioral Health, the Senior Director of BH Clinical Programs oversees the BH Care Management, BH Utilization Management and Clinical Programming teams. The Senior Director develops and integrates the strategies to enhancing the quality of care for patients, satisfaction, healthcare outcomes in a c

The Operations Trainer role is pivotal in elevating new and existing employee's performance and capabilities through classroom and virtual training sessions. The role primarily supports Health Plan Operations departments such as Member and Provider Service, Claims, Member Enrollment, and Provider Appeals. The Operations Trainer will also conduct job specific training, inc

Leads the rate development process by providing analyses and recommendations on benefit design, rating factors, trend picks, and projection of future claim cost. Oversees regulatory rate filings and prepares data or response for additional inquiries. Leads the development of monthly IBNR reserve estimates for different line of business. Oversees monthly accruals and contr

Strategy and Vision Contribute to the development and articulation of a comprehensive AI/ML and automation strategy aligned with the overall business objectives, with a particular focus on end to end data quality, specifically in the areas of health equity and encounters. Execute the vision for AI/ML and automation technologies, ensuring alignment with industry trends and

Our Event Manager plays a key role in maintaining WellSense's commitment to community as a remote organization. In this role, you will plan, coordinate and execute WellSense organizational events for 1000+ employees as well as meetings and events at the team or department level. Partnering with leaders, you will gain insight into the goals or objectives of each event. Res

The Business Encounter Data Analyst is responsible for compiling and analyzing encounter data and understanding the claim impact of changes and decision to the business process to ensure that CMS and State Service Level Agreements (SLAs) are achieved. This individual will support the encounter data lifecycle process working closely with business and technical resources as