Senior Technical Specialist – Healthcare

🕒 Agosto 13

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $85.000 - $105.000 / ano

⏰ Tempo Integral

🟠 Sênior

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Cotiviti

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

Cotiviti é uma empresa de tecnologia e análise em saúde que se especializa em melhorar a precisão e o desempenho dos pagamentos por meio de soluções avançadas de análise de dados. Eles se associam a planos de saúde, agências governamentais e provedores de serviços de saúde para fornecer insights que aprimoram a qualidade e a eficiência na prestação de cuidados. Com soluções como ajuste de risco, gerenciamento de políticas de pagamento e engajamento de membros, a Cotiviti busca otimizar os resultados financeiros e clínicos para o ecossistema de saúde.

Descrição

• Receive business rules from various internal Cotiviti teams • Collaborate with internal partners to clarify rule intent and context • Design and develop rule logic for integration into the Business Rules Management System (BRMS) • Test and validate rules in non-production environments • Implement validated rules into production environments • Communicate rule deployment outcomes and changes to operations and stakeholders • Maintain documentation and version history for business rules • Perform impact analysis for new or revised rules • Conduct root cause analysis and identify gaps in audit or operational results • Recommend and implement corrective actions to improve rule effectiveness • Identify and remediate technical limitations and performance constraints • Lead design and integration of additional exclusions functionality • Partner with operations teams to socialize rules and gather user feedback • Develop reporting and insights on rule effectiveness, audit outcomes, and content trends • Explore automation and workflow enhancements using tools such as Power Automate, JIRA, and Asana • Identify opportunities to transition support, training, or documentation tasks to downstream teams • Complete annual Performance Plan responsibilities and assigned special projects

🎯 Requisitos

• High School Diploma required • Bachelor’s degree in education, technical writing, communications, or related fields strongly preferred • Equivalent experience may be considered in lieu of a degree • Experience in the healthcare industry • Basic coding skills and ability to write and understand SQL, Java, or other programming languages • Familiarity with Access, HUE, Datameer, Power BI, or SQL Server Management Studio (SSMS) • Familiarity with complex business rules and products such as DROOLS in RedHat Decision Manager • Experience analyzing large datasets and auditing payment inaccuracies • Ability to work independently and collaborate with others • Excellent analytical and problem-solving skills • Ability to manage multiple assignments while meeting deadlines and quality standards • Excellent organization, communication, and presentation skills • Flexibility to work different shifts as required • Strong working experience with Microsoft Word, Excel, PowerPoint, Visio, and Outlook • Ability to diagnose and solve complex technical issues • Critical-thinking and complex-analysis abilities • Industry-specific knowledge of relevant technologies, systems, or products • Systems-thinking and pattern-recognition abilities • Ability to prioritize technical issues • Empathy, patience, and ability to provide clear explanations when interacting with customers or users • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance • Must be able to perform duties with or without reasonable accommodation

🏖️ Benefícios

• Discretionary bonus consideration • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance • 401(k) savings plan • Paid family leave • 9 paid holidays per year • 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service • Remote work arrangement • Dedicated, secure work area and office setup support requirements