
1001 - 5000 employees
Founded 2005
🏥 Healthcare
💼 Consulting
⚕️ Healthcare Insurance
Healthcare • Consulting • Healthcare Insurance
HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.
🔥 0 minutes ago
🇺🇸 United States – Remote
💵 $90k - $115k / year
⏰ Full Time
🟠 Senior
⚙️ Operations
🦅 H1B Visa Sponsor
👻 Ghost score 0%
Improve your chances of getting an interview by checking your resume score before you apply.

1001 - 5000 employees
Founded 2005
🏥 Healthcare
💼 Consulting
⚕️ Healthcare Insurance
Healthcare • Consulting • Healthcare Insurance
HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.
• Manage operational excellence for technology delivery • Generate SLA and operational reports for customers and management in a timely manner • Drive issue resolution and root cause analysis for incidents • Manage day-to-day production support for a mid-size health plan, including core administrative systems for enrollments, claims, adjudication and payments • Support surrounding applications/products and downstream and upstream vendors • Drive customer calls and priorities • Prioritize daily operational events and issues • Manage incidents in service management systems such as JIRA and ServiceNow • Manage change and issue resolution activities with network, middleware, hardware, operating system, database and external application groups • Plan system maintenance and upgrade events across multiple vendors • Resolve customer escalations • Work across multiple time zones in a hybrid or remote work environment
• Bachelor’s degree in a related field • Minimum of 6 years’ experience managing a mid to large size customer facing production support environment • Strong experience working with healthcare payer platforms (e.g., Facets, QNXT, NASCO) • Strong experience with service management, SLA tracking and operational reporting to customers and management • Strong experience with file transfer management solutions (e.g. MoveIt, EDIFECS) • Experience in setting up processes using service management tools, preferably Service Now and Jira Service Management • Experience with Healthcare EDI highly desirable (e.g. 270, 271, 276, 277, 834, 835) • Experience managing health of production application environments • Experience working in a technical support role in complex architecture environment • Experience with SQL required • Experience with Cloud AWS/GCP desirable • Experience with SOAP desirable • Experience ETL processing desirable • Understanding of ITIL practices and software delivery • ITIL certification or strong working knowledge of ITIL-based operations • Practical knowledge of working with SOWs, SLAs, and Change Requests • Experience working with SaaS providers and HealthEdge applications is a plus • Experience in delivery management and customer partner or account interaction is a must • Experience working in an onshore/offshore model is a must • Ability to work across multiple time zones • Candidates may be required to complete a pre-employment criminal background check
• Remote work environment • Hybrid or remote work environment • May require travel dependent on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity employer and workforce diversity commitment
Apply Now🔥 13 minutes ago
Renewal Operations Manager owning weekly forecasting, Salesforce data integrity, and save plays. Supporting Instructure’s learning and personal development technology business.
🇺🇸 United States – Remote
💵 $135k - $148k / year
💰 Private Equity Round - Instructure on 2024-07
⏰ Full Time
🟡 Mid-level
🟠 Senior
⚙️ Operations
🦅 H1B Visa Sponsor
🔥 16 minutes ago
Operations standards manager leading SOP governance, change management, and process improvement. Supporting GT Independence’s national financial management services for self-directed care.
🔥 16 minutes ago
Operations standards manager improving SOPs, change management, and process consistency for GT Independence’s national financial management services. Supporting technology adoption and continuous improvement across U.S. markets.
🔥 39 minutes ago
Executive Protection Operations Manager supporting Cummins’ global executive security program. Coordinating protective services, vendors, processes, and executive travel operations.
🇺🇸 United States – Remote
💵 $120k - $180k / year
💰 $75M Grant on 2024-07
⏰ Full Time
🟡 Mid-level
🟠 Senior
⚙️ Operations
🔥 1 hour ago
Senior pharmacist optimizing prior authorization reviews and clinical operations. Building technology-enabled workflows for SmithRx’s next-generation pharmacy benefit management platform.
🇺🇸 United States – Remote
💵 $144.5k - $204k / year
💰 $20M Series B on 2022-03
⏰ Full Time
🟠 Senior
⚙️ Operations