Jobs at CareSource

Design, validate, and operationalize predictive and machine learning models; mine and analyze large datasets; create visualizations and statistical validation; collaborate with teams to integrate solutions and communicate results to stakeholders.

Lead actuarial pricing, forecasting, reserving and modeling efforts. Develop assumptions, maintain actuarial models, evaluate financial experience, support rate filings and IBNR estimates, provide strategic recommendations, manage staff and vendor relationships, and report findings to leadership.

Manage daily accounting and reporting functions, prepare and review internal and external financial statements, ensure GAAP/STAT and NAIC/MAR compliance, lead audits, maintain internal controls, analyze financial trends, oversee payments and accounting for new programs, assist ERP/system implementations, manage departmental staff, and ensure timely filing of financial reports.

Provide behavioral health utilization management, clinical oversight, and quality improvement for members. Develop and implement evidence-based policies, support regulatory/accreditation activities, consult with providers and state agencies, participate in fraud/quality investigations, and provide training and clinical support to staff and markets.

Lead enterprise clinical data governance and integration: build/maintain clinical data inventory, standardize acquisition requirements, prioritize ingestion and interoperability (FHIR/HL7), oversee data quality and vendor performance, drive use cases from concept to deployment, partner with IT/Data Engineering, and manage a team of analysts to support governance and analytics roadmaps.

Lead actuarial team activities including pricing, forecasting, reserving, and model development. Produce strategic recommendations, manage actuarial processes and vendor work, support rate filings and regulatory interactions, oversee IBNR reserve estimates, and communicate results to leadership.

Provide analytical support and lead claims-related projects: manage IT tickets, analyze claims data, resolve provider claim escalations, develop policies/job aides, assist training, report on OnBase and Facets, and support research and resolution activities for provider inquiries.

The Claims Management Analyst III leads eBusiness initiatives, manages EDI trading partners, ensures compliance, and analyzes performance for continuous improvement.

The Configuration Architect oversees the architecture for clinical system configurations, ensures alignment with business needs, evaluates solutions, and leads teams in implementing standards and guidelines while mentoring others in the department.

Lead capacity planning, forecasting, and reporting for multi-site call centers. Develop staffing strategy and budgets, ensure accurate regulatory reporting, implement agent scorecards and speech analytics, drive Lean/Six Sigma continuous improvement, partner with WFM, engineering, finance, and talent acquisition to optimize staffing and operational performance.

The Applied AI Scientist III develops advanced analytics solutions utilizing AI technologies, leading projects in predictive analytics and NLP to enhance healthcare operations and patient care.