Jobs at HealthEZ

Supports utilization review and pre-authorization operations by translating clinical, regulatory, vendor, and operational requirements into authorization rules and documentation standards. Maintains rule libraries, inventories, governance records, version control, and testing scenarios. Collaborates with Medical Management, Clinical Operations, IT, vendors, and delegated utilization management partners to resolve gaps, support implementation readiness, and sustain compliant healthcare operations.

Bridges healthcare claims operations and IT by translating claims processes into requirements, analyzing claims data and workflows, coordinating testing and implementation, investigating production issues, and supporting technology projects. The role covers adjudication, benefits, pricing, payments, integrations, data mappings, root-cause analysis, vendor collaboration, and continuous improvement.