Teams at CareSource

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 health plan enrollment operations, managing staff, enrollment and financial reconciliation, eligibility file processing, audits, regulatory compliance, enrollment technology, and process improvement. Oversees Facets and 834/DTRR activities, coordinates with vendors and IT, analyzes performance data, manages risk and corrective actions, and develops team members. Requires knowledge of Medicaid, Medicare, Dual coverage, HIPAA enrollment transactions, and health plan regulatory requirements.

Analyzes healthcare encounter and claims data, resolves data and process issues, supports CMS and state regulatory submissions, monitors SLAs and performance metrics, and contributes to testing, reporting, automation, and process improvement. The role collaborates with IT, claims, enrollment, vendors, and regulatory stakeholders while ensuring compliant encounter reconciliation and accurate claims data.