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The Quality Management Specialist II is responsible for facilitating clinical quality improvement projects, ensuring compliance with clinical practice guidelines, and advancing HEDIS quality metrics. This role involves consulting with various stakeholders, monitoring and evaluating services to meet quality objectives, and ensuring documentation complies with NCQA standards.
The Sr Supplier Management Analyst oversees key suppliers and operational performance by managing supplier relationships, compliance, performance, and strategic sourcing. They partner with internal teams and suppliers to ensure business expectations and contractual obligations are met, with a focus on delivering value through effective project management and problem-solving.
The Sr Systems Analyst is responsible for designing enhancements and new business applications, integrating technical and business requirements, and ensuring system integrity and availability for key applications. This role involves linking business needs to technical solutions and managing databases proactively.
The Tax Accountant III is responsible for providing tax compliance, research, and planning support. This role involves identifying tax savings opportunities, supporting audits, providing tax support for insurance products, analyzing tax issues, and presenting tax law developments to management.
The Coding Compliance Specialist is responsible for researching and analyzing medical records for coding discrepancies. They audit medical records for compliance with coding procedures according to CMS guidelines, review insurance payments and denials, and recommend coding corrections, while also needing to travel 20-30% of the time.
This Senior Financial Accountant position involves closing monthly books, preparing financial statements, and conducting complex financial analysis for HCSC or its subsidiaries. Responsibilities include analyzing performance metrics, managing accounting processes, creating financial models, and coaching team members. The role requires keen analytical skills, attention to detail, and independent working capabilities.
The Sr Analytics Consultant is responsible for constructing forecasts, delivering executive-level reporting, and developing strategic plans based on business data. This role involves analyzing complex problems, creating specifications for reports, and developing advanced analytic models. The consultant provides insights to decision-makers, streamlines processes, and engages with cross-functional teams to address various business issues.
The Senior Manager of Special Investigations at HCSC is tasked with overseeing health care fraud and internal fraud investigations, managing and training investigators, and liaising with health care providers, federal law enforcement, and CMS. This role requires strong organizational and leadership skills to ensure compliance and effective anti-fraud strategies.
The Managing Actuary is responsible for managing the development and analysis of actuarial models, ensuring compliance with actuarial standards, and effectively communicating complex information through presentations. This role includes hands-on management of actuarial analysts and requires a deep understanding of specific actuarial areas or business segments.
This position is responsible for achieving sales targets in health insurance and ancillary products, providing support and mentorship to sales staff, and maintaining extensive knowledge of managed care products and industry trends. Travel may be required for presentations and meetings with brokers.
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