Job Search Results for healthcare payer

Healthcare Data Quality Consultant

A healthcare payor client is hiring for a highly analytical and process-driven Data Quality & Governance consultant to spearhead the integrity and usability of their enterprise data assets. This is a... More hybrid role that demands a unique blend of technical data profiling expertise and strategic oversight. The ideal candidate will be a Collibra power user who views data governance not just as a set of rules, but as a technical framework for ensuring "high-fidelity" data across the organization. You will be responsible for the end-to-end data lifecycle?from defining metadata standards to building automated quality dashboards and leading our Stewardship/quality ceremonies. Core Job Functions Include: DATA QUALITY: ? DQ Automation: Design and implement automated data quality rules and monitoring within the Collibra Data Quality & Observability module.? Profiling & Remediation: Conduct deep-dive data profiling to identify anomalies, duplicates, and inconsistencies. Work directly with technical teams to resolve root-cause issues in data pipelines.? Metric Development: Establish and track DQ KPIs (Accuracy, Completeness, Consistency, Timeliness, Validity, and Uniqueness) for critical data domains.? Standardization: Manage the reconciliation of legacy data into standardized canonical models, ensuring vendor and internal data alignment (e.g., NPI or provider data reconciliation).DATA GOVERNANCE ? Collibra Stewardship: Act as the primary administrator for the Collibra Data Intelligence Cloud, managing the Business Glossary, Data Catalog, and Lineage.? Council facilitator: Facilitate the Data Governance Council meetings, translating technical DQ findings into actionable business decisions for executive stakeholders.? Change Management: Act as a diplomat between IT and Business units to foster a "quality-first" data culture.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

REMOTE Healthcare Business Analyst

A large healthcare insurance client is seeking a Business Analyst to partner with internal stakeholders to understand workflows, gather and document requirements, and translate business needs into... More clear, actionable documentation. The role involves guiding business owners through BRD creation, supporting front-end and IT teams with technical business flows, and contributing to data analysis and reporting. Strong communication is key, as roughly half of the role is stakeholder engagement, with the remaining time split between requirements gathering and analytical support.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Denials Specialist (Appeals & Revenue Cycle)

Insight Global is seeking a fully remote Denials Specialist to support a Healthcare AI client. This is a part-time opportunity working approximately 10?20 hours/week where candidates will leverage... More their denials and appeals expertise to evaluate and improve AI-driven denial resolution strategies. This role is highly analytical and requires a strong understanding of payer requirements, denial root causes, and effective appeal strategies across multiple payer types. Laptop and equipment will be provided.Shift Times: Flexible scheduling within Monday-Friday, 9am-8pm PST (can't work weekends)(must be available 10-20 hours/week from 9am-8pm PST // ideal for individuals seeking additional income)Duration: 3-month contract (potential to extend)Responsibilities:? Review denied claims and evaluate AI-generated denial analysis and appeal recommendations? Assess the quality, logic, and persuasiveness of AI-generated appeal strategies across various denial types (medical necessity, authorization, coding, technical, etc.)? Identify discrepancies where AI recommendations diverge from effective real-world denial management practices? Analyze and explain successful appeal strategies, including payer-specific nuances and documentation requirements? Evaluate appealability and determine optimal approach based on denial type, payer guidelines, and supporting documentation? Provide detailed reasoning behind appeal strategies to help improve AI decision-making models? Identify patterns and trends across denials to highlight systemic issues impacting reimbursement? Partner with product and GTM teams to critique presentations and provide subject matter expertise on denial workflows and payer behaviorWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Remote Prior Authorization Specialist

Insight Global is seeking a fully remote Prior Authorization Specialist to support a Healthcare AI client. This is a fully remote, part-time opportunity working 10-20 hours/week where candidates will... More leverage their prior authorization expertise to evaluate and improve AI-driven authorization strategies. This role is highly analytical and requires a strong understanding of payer policies, documentation strategies, and real-world authorization workflows. Laptop and equipment will be provided.Shift Times: Flexible scheduling within Monday-Friday, 9am-8pm PST (can't work weekends)(must be available 10-20 hours/week from 9am-8pm PST // ideal for individuals seeking additional income)Duration: 3-month contract (potential to extend)Responsibilities:? Review pending authorization requests and evaluate AI-generated prior authorization recommendations and strategies? Assess the quality, logic, and effectiveness of AI recommendations across multiple payers and clinical policies? Identify gaps where AI recommendations differ from real-world prior authorization best practices and explain discrepancies? Provide detailed insights into payer-specific nuances, including portal workflows, policy requirements, and documentation phrasing strategies? Share operational knowledge with product teams to enhance AI-powered authorization processes? Partner with GTM teams to critique presentations and provide subject matter expertise on prior authorization workflowsWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

REMOTE Java Developer with TypeScript!

We are seeking a Senior Java Developer with strong healthcare payer experience to design and support scalable, cloud-native applications supporting mission-critical payer systems.Responsibilities?... More Lead development of enterprise Java applications using Spring Boot and Spring Batch? Design and support batch and event-driven workflows for payer systems (care/case/disease management & population health)? Contribute Python scripting and TypeScript development as needed (their rules engine tool is built on TypeScript)? Deploy, maintain, and troubleshoot applications on OpenShift? Implement messaging and streaming solutions using Kafka? Participate in architecture decisions, code reviews, and Agile deliveryWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Change Manager

One of Insight Global's clients is seeking a Change Manager who will support enterprise technology adoption and transformation initiatives within a healthcare payer environment. This individual will... More work closely with both IT and business stakeholders to drive organizational readiness, manage incoming change demand, and ensure successful adoption of new systems and processes. The dynamic individual will lead change management efforts across multiple initiatives, coordinate stakeholder engagement, develop communication and training strategies, and support prioritization of incoming transformation efforts. This role requires the ability to assess change impacts, manage competing priorities, and ensure alignment across teams while driving measurable adoption outcomes.The ideal candidate will have strong experience managing change within complex, technology-driven environments, specifically within a payer organization. Experience supporting AI or emerging technology adoption initiatives is a plus.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Senior ETL / Data Integration Engineer

We are seeking a ETL / Data Integration Engineer to support a healthcare data initiative focused on building a unified ?golden provider record.? This role will be responsible for aggregating,... More transforming, and enriching provider data from multiple systems to drive better referral decision-making and provider insights.Key Responsibilities:? Design, develop, and optimize SQL-based data pipelines across PostgreSQL and Snowflake environments? Integrate data from multiple sources including claims, payer feeds, and credentialing systems? Build and maintain golden provider records through data aggregation, normalization, and enrichment? Perform data profiling, quality validation, reconciliation, and cleansing to ensure accuracy and reliability? Implement entity matching, deduplication, and survivorship logic to support a single source of truth? Collaborate with cross-functional teams to ensure data supports downstream applications and analyticsWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Follow Up Representative

Insight Global is looking for a Follow-Up Representative to support a large hospital system in the Maryland/DC area. This person will support the Denials Appeals & Performance (DAP) team, a... More centralized hospital denial group supporting 10 hospitals across the Maryland/DC region.This role focuses on post-appeal and post-submission insurance follow-up, helping offload administrative and payer-chasing work from RN teams. Follow-Up Reps will manage a mixed inpatient and outpatient inventory, working with primarily commercial payers and MCOs. This is not an appeal-writing role, though there is opportunity for growth and cross-training over time. The environment is fast-paced, documentation-driven, and collaborative, with a strong emphasis on accuracy, persistence, and accountability.Primary Responsibilities? Perform post-appeal insurance follow-up on hospital denial accounts? Productivity is quality-focused, not quota-driven? Looking for someone who has experience touching <40 accounts/day ? Check claim and appeal status via: ? Payer portals? Phone calls to insurance companies? Written payer correspondence? Work accounts originating from: ? Denials Appeals & Performance (DAP) RNs? Acute Case Management (ACM) RNs? Document all follow-up actions clearly in the appropriate system? Identify cases with insufficient or unclear documentation and escalate appropriately? Track payer responses, timelines, and next steps? Support rebilling or resubmission efforts when required? Navigate long hold times and high-touch payer follow-up while maintaining productivity? Collaborate with: ? RN reviewers? Other follow-up representatives? Leadership as needed? Participate in: ? Team huddles? Workflow updates? Ongoing training and cross-training initiatives? Adapt to evolving workflows as the DAP team continues to expand and absorb new workstreamsWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Finance Oracle Solution Architect

We are seeking a Solution Architect Lead with deep Oracle Fusion experience to support enterprise healthcare provider clients across Finance, Supply Chain, HR, and Payroll domains. This role is... More highly consultative and advisory in nature, partnering closely with clients to guide decision-making and shape best-practice solutions based on real-world healthcare operations experience.This position is ideal for a leader who has come up through healthcare provider operations, led complex Oracle Fusion implementations, and can translate that experience into confident, opinionated guidance?not just presenting options, but recommending the right approach.Note: Candidates must come from a healthcare provider environment. Insurance or payer-only backgrounds will not be considered.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Payroll Oracle Fusion Architect

We are seeking a Solution Architect Lead with deep Oracle Fusion experience to support enterprise healthcare provider clients across Finance, Supply Chain, HR, and Payroll domains. This role is... More highly consultative and advisory in nature, partnering closely with clients to guide decision-making and shape best-practice solutions based on real-world healthcare operations experience.This position is ideal for a leader who has come up through healthcare provider operations, led complex Oracle Fusion implementations, and can translate that experience into confident, opinionated guidance?not just presenting options, but recommending the right approach.Note: Candidates must come from a healthcare provider environment. Insurance or payer-only backgrounds will not be considered.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less