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Analyze business needs and translate them into application software requirements for payment integrity. Review claim data to identify overpayment trends, extract insights for validation and recovery, work with developers on design and testing, act as liaison with users, produce provider communications and documentation, and support continuous improvement in recovery operations.

Leads outside sales strategy and operations for CarelonRx provider markets. Directs regional sales efforts, builds customer and referral relationships, achieves sales and profit targets, monitors competitors, develops market strategies, and leads sales meetings and training. Manages direct reports through hiring, coaching, performance evaluation, and development while partnering with internal stakeholders and senior leadership.

Designs, develops, and maintains generative AI systems and agentic AI integrations. Collaborates with stakeholders to gather requirements, tunes models and prompts, converts unstructured inputs to specs, implements secure cloud-native services, performs testing and production support, mentors engineers, and ensures observability, privacy, and continuous improvement.

As a PBM Billing Specialist Senior, you will maintain the billing system database, reconcile and analyze billing discrepancies, post to sub-ledgers, coordinate account eligibility, support collections, communicate with internal/external contacts, and handle complex billing situations with minimal guidance.

Leads enterprise information security and operational resilience initiatives, including risk assessments, third-party risk management, business continuity, crisis response, access management, network security, and technology resilience. Develops security requirements, architectures, policies, standards, and incident response strategies; resolves complex technical and TPRM issues; advises stakeholders and vendors; supports major security system projects, mergers and acquisitions, and management reporting.

Leads and plans implementation workstreams across diverse, cross-business-unit service offerings for internal and external clients. Maintains product expertise, partners with product and business leaders, defines implementation requirements, supports testing and operational readiness, analyzes data, and manages timelines, milestones, risks, issues, governance, and stakeholder communications. Drives process improvements focused on implementation quality, compliance, and execution speed, with emphasis on pharmacy benefit management and health insurance services.

Lead architecture and hands-on delivery of scalable, AI-enabled enterprise workflow products. Modernize legacy systems, build LLM/agentic solutions, define enterprise architecture and governance, drive adoption of AI-assisted development, mentor engineers, and partner across product, UX, security, and operations to deliver secure, resilient workflow experiences.

Analyzes complex claims, provider, utilization, and business performance data; identifies anomalies and trends; develops recurring and ad hoc reports; translates business requirements into decision-support tools; and provides analytical insights and consultation to leadership, business teams, and external customers.

Complete a 12-week paid training then process and code health and dental claims under direct supervision. Research and analyze claims issues, ensure accurate payment information, and collaborate with specialists and managers. Must attend mandatory in-person training days and pass pre-employment testing.

Prepares Medicaid non-claim provider payments, researches payment inquiries, communicates financial information to stakeholders, and produces financial and regulatory reports. The role also prepares month-end accruals supporting actuarial reserves and participates in business improvement initiatives. Candidates need a bachelor’s degree in accounting or finance and at least one year of relevant experience or an approved finance internship.