Jobs at CareSource

Provides financial leadership for a healthcare market, including reporting, forecasting, budgeting, financial modeling, reimbursement analysis, regulatory filings, audits, internal controls, and revenue optimization. Partners with actuarial, contracting, risk adjustment, quality, and market leadership teams. Manages departmental staff and budgets, supports strategic payment arrangements, oversees process improvements, and ensures accurate and compliant financial operations.

Leads enterprise business analysis strategy across programs and portfolios, partnering with executives to define requirements, evaluate investments, measure business value, manage risks, and guide transformation initiatives. Establishes standards and governance, analyzes operational and financial data, supports regulatory compliance, and mentors analysts. The role also advances AI-enabled tools, automation, and analytics to improve decision-making and business outcomes within a healthcare payer environment.

Owns product strategy, vision, operating models, governance, and roadmaps for data migration, integrations, and enterprise transformation initiatives. Translates business and technical objectives into prioritized delivery plans, coordinates cross-functional teams and vendors, oversees readiness, testing, implementation, stabilization, and transition to operations. Manages risks, dependencies, stakeholder expectations, compliance, and executive reporting while guiding product owners and delivery teams.

Oversee cost reporting, financial reconciliations, Medicaid filings, audits, encounter variance analysis, and financial reporting processes. Lead data management, SQL code auditing, and process development in Databricks. Manage staffing, performance, and team development while partnering with finance and encounters teams. Ensure compliance with accounting principles, internal controls, and reporting requirements, and provide financial analysis and leadership support.

Supports membership enrollment and retention through community outreach, educational presentations, direct marketing, relationship management, lead generation, and coordination with community, government, provider, and business organizations. Maintains regulatory compliance, documents sales activity in CRM systems, monitors market trends, and manages territory-based membership goals. The role requires regular travel, health insurance knowledge, state insurance licensing, and collaboration with internal teams.

Provides financial leadership for a healthcare market, including reporting, forecasting, budgeting, financial modeling, reimbursement analysis, regulatory filings, audits, risk assessment, and support for pricing and contracting strategies. The role manages finance staff and budgets, oversees internal controls, coordinates with actuarial and operational teams, and supports market leadership with financial insights and process improvements.

Leads systems research and business analysis to identify impacted systems, interfaces, dependencies, and affected business areas. Elicits and documents requirements, creates Agile features and stories, facilitates stakeholder workshops, performs root cause analysis, supports QA testing, and develops training and documentation. Serves as a liaison between technical teams and business users while analyzing complex processes and enterprise systems in a healthcare environment.

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 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 financial leadership for a market or region through reporting, budgeting, forecasting, business reviews, reimbursement and pricing analysis, regulatory filings, audits, risk assessment, internal controls, and quality improvement initiatives. Partners with executives, regulators, actuaries, providers, and market leaders while managing finance staff and supporting growth, revenue maximization, and strategic decision-making.

Leads ElderServe Health’s legal, compliance, regulatory, governance, and risk functions. Advises executive leadership, oversees legal and regulatory strategy, ensures compliance with healthcare laws and government program requirements, manages significant transactions and partnerships, represents the organization with regulators and stakeholders, and develops departmental capabilities, budgets, talent, and performance measures.

Promotes CareSource health insurance products through community outreach, educational presentations, enrollment events, and relationship management. Builds partnerships with community organizations, agencies, providers, government groups, and targeted industries to drive membership acquisition and retention. Maintains territory plans, CRM records, reports, regulatory compliance, and marketing budgets. The role requires regular travel, potentially exceeding 50%, throughout the assigned North Georgia territory.

Provide financial leadership and oversight for a region/market: reporting, budgeting, forecasting, regulatory filings, rate advocacy, risk and IBNR analysis, audit coordination, staff management, and strategic support to market and corporate leaders to meet targets.

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.