390 data security jobs found

Company : United Concordia Dental Job Description : JOB SUMMARY *MUST BE A US CITIZEN * This job turns data into information, information into insight, and insight into business decisions. More specifically, this job drives and supports all activities related to collecting, analyzing, and reporting on the Organization's key performance indicators including developing dashboards, scorecards, forecasting, trending, tracking results, and executive presentations for the purpose of supporting operational excellence, management intelligence for effective decision-making, and overall tracking of organizational performance. Consults with cross-functional enterprise groups and levels to identify data and analytical needs, conduct analyses, review analyses and findings with leadership, facilitate related process/data improvement efforts and develop executive level presentations. Prepares similar intelligence for customers and interacts with customers as such....

Company : United Concordia Dental Job Description : JOB SUMMARY *MUST BE A US CITIZEN * This job turns data into information, information into insight, and insight into business decisions. More specifically, this job drives and supports all activities related to collecting, analyzing, and reporting on the Organization's key performance indicators including developing dashboards, scorecards, forecasting, trending, tracking results, and executive presentations for the purpose of supporting operational excellence, management intelligence for effective decision-making, and overall tracking of organizational performance. Consults with cross-functional enterprise groups and levels to identify data and analytical needs, conduct analyses, review analyses and findings with leadership, facilitate related process/data improvement efforts and develop executive level presentations. Prepares similar intelligence for customers and interacts with customers as such....

Company : Highmark Inc. Job Description : JOB SUMMARY This job plans, develops, and maintains operational processes and reporting related to group/provider facility and professional reimbursement configurations and other operational processes. Acts as the primary liaison between provider contracting, provider reimbursement, and claims experience. Collaborates with the pricing team to troubleshoot reimbursement issues and works with the Reimbursement Policy and Compliance team team to develop and maintain effective reimbursement quality programs and reporting. ESSENTIAL RESPONSIBILITIES Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have...

Company : Highmark Health Job Description : JOB SUMMARY The Senior Strategy Partner plays a critical role in driving the evolution and optimization of Highmark's Living Health Acceleration operating model. This individual will be instrumental in continuously enhancing the product operating model within PHE and with critical partners, ensuring it aligns with strategic goals and market demands. The Senior Strategy Partner will bring an external perspective on operating model and workforce optimization for the Product organization, collating and subsequently leveraging data to inform decision-making to enhance operating model performance and maturity. This role also encompasses leading strategic communications, managing leadership meetings, and spearheading special projects on behalf of the Product organization and leadership team, to advance the organization's goals and priorities. This role can be hybrid or remote - if you are within 50 miles of an office you are...

Company : Highmark Health Job Description : JOB SUMMARY This role is responsible for supporting the execution of member activation and engagement initiatives across products and solutions, with a particular focus on the clinical side of the business. As part of the Customer Relationship Management (CRM) team, this individual will contribute to developing a center of excellence for creating and managing profitable customer relationships and experiences. Key responsibilities include developing end-to-end strategies that will help with managing relationships with clinical partners, identifying C2V savings, overseeing wellness programs, addressing diagnosis and care gaps, and promoting member health through education and preventative steps. Preferred experience as a clinician or in a clinical setting. This role can be hybrid or remote. If you live with 50 miles of an office you are required to be onsite 3 days a week (T,W,Th). Outside of 50 miles will be remote....

Company : Highmark Health Job Description : JOB SUMMARY The job is an integral member of an agile software engineer team responsible for building scalable software applications across all digital channels to serve our customers. The position will be responsible for taking an enterprise-wide, architectural view of the solutions and the technical execution of products using the technical stack that best meets the needs of the platform. The position will collaborate with the internal/external clients and be involved in every aspect at part of the software application build process from ideation, business analysis, technical design and software development using the latest technologies and design patterns. A principal engineer may be accountable for a team of software engineers to drive and develop products meeting the needs of our clients and product roadmaps. ESSENTIAL RESPONSIBILITIES Lead the resolution of a variety of technical and business problems...

Company : Highmark Health Job Description : JOB SUMMARY The job is an integral member of an agile software engineer team responsible for building scalable software applications across all digital channels to serve our customers. The position will be responsible for taking an enterprise-wide, architectural view of the solutions and the technical execution of products using the technical stack that best meets the needs of the platform. The position will collaborate with the internal/external clients and be involved in every aspect at part of the software application build process from ideation, business analysis, technical design and software development using the latest technologies and design patterns. A principal engineer may be accountable for a team of software engineers to drive and develop products meeting the needs of our clients and product roadmaps. ESSENTIAL RESPONSIBILITIES Lead the resolution of a variety of technical and business problems...

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world. Technology - Design for Technology - UX/UI Design - Manager At EY, our purpose is to shape the future. The insights and quality services we provide help build trust and confidence in the capital markets and economies all over the world. We develop outstanding leaders who are teamed to deliver our promises to all our stakeholders. In so doing, we play a critical role in building a better working world for our people, for our clients and for our communities.? The opportunity The Platforms Practice specializes in mission-critical, intelligent platforms for the world's most ambitious organizations. Using our product-driven, AI-centric approach, we empower organizations to build for the intelligent digital...

Company : Highmark Inc. Job Description : JOB SUMMARY This role involves support of Highmark’s diversified businesses, including dental, vision, and pharmacy lines of business. This position involves investigating factual situations, conducting independent legal research and analysis, and providing creative, well-reasoned solutions. The successful candidate will offer timely and accurate legal advice and prepare effective documents based on federal, state, and other applicable laws and regulations relevant to the Corporation and its affiliates. This is a senior-level attorney role that requires advanced legal skills and a proven ability to deliver or oversee business-oriented, effective, and efficient legal services. Key responsibilities include project management and strategic counseling on significant projects or matters for specific units of the Corporation. The ideal candidate will possess deep knowledge of the Corporation’s business, maintain...

Company : Highmark Inc. Job Description : JOB SUMMARY This role involves support of Highmark’s diversified businesses, including dental, vision, and pharmacy lines of business. This position involves investigating factual situations, conducting independent legal research and analysis, and providing creative, well-reasoned solutions. The successful candidate will offer timely and accurate legal advice and prepare effective documents based on federal, state, and other applicable laws and regulations relevant to the Corporation and its affiliates. This is a senior-level attorney role that requires advanced legal skills and a proven ability to deliver or oversee business-oriented, effective, and efficient legal services. Key responsibilities include project management and strategic counseling on significant projects or matters for specific units of the Corporation. The ideal candidate will possess deep knowledge of the Corporation’s business, maintain...

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides expertise for moderately to very complex problem solving and complete understanding of system functionality. The incumbent reviews significant amounts of data and analyzes processes to support business unit needs. Troubleshoots errors, conducts impact analyses, and/or solves data rejection. Performs business analyses in one or more operational areas. Identifies process gaps and recommends process improvements for efficiencies. Provides guidance and education to Associate and Intermediate level employees. ESSENTIAL RESPONSIBILITIES Intake operational objectives and gather information. Define, understand, and manage project scope. Perform moderate/complex research to support evaluation of complex output requirements and formats. May translate more complex business initiatives to less experienced employees. Present project deliverables to appropriate audiences. Create reports on...

Company : Highmark Inc. Job Description : JOB SUMMARY HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. This job supervises and coordinates the day to day activities of the various claims processing or claims adjustment units responding to internal inquiries or inquiries received by members, providers, or account representatives across all markets. This job administers the day-to-day activities related to collecting, analyzing and reporting on source data and key performance metrics for the purpose of supporting operational efficiency, overall tracking of business performance and management intelligence for effective decision-making. Along...

Company : Highmark Inc. Job Description : JOB SUMMARY The incumbent is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. Must be able to testify in a court of law, prepare cases for referral to various...

About Integrated Management Strategies (IMS) LLC We are a women-owned small business and management consulting firm that provides an array of business and technical services. IMS is headquartered in the Washington, D.C. metropolitan area, with employees across 39 US states.   What We Do We support the mission critical needs of federal agencies by leveraging our experience, talent and can-do attitude, and solve their strategic and operational challenges.   How We Do It We earn our clients’ trust through our personalized approach and attention to detail, allowing us to collaborate and solve even the most complex problems.   About the role Are you ready for your next career adventure?! Integrated Management Strategies (IMS) is an award-winning, fast-growing woman-owned small business in the Washington DC area, specializing in healthcare, technology, and management consulting. We are seeking an experienced Contract...

Job Title Global Program Lead, Client Transformation Job Description Summary This individual will be accountable for leading a global multi-disciplined project team to ensure that a successful transition of new client accounts and/or expanded account responsibilities. Role requires client facing programmatic leadership and may include leading other client programs, transformation, or improvement efforts. Interacting with stakeholders across multiple geographies functions and layers of the organization, this person will provide both hands on support as well as team leadership in the handoff between the solution design and implementation, assessment of risks related to meeting contractual deliverables and the delivery of our best-in-class solutions to each account. Job Description Provide overall governance and leadership of Transition and Transformation execution thru all phases (BD, Mobilization, Execution, Stabilization, Close Out) Oversee transition resources:...

About The Role Grade Level (for internal use): 10 S&P Global has recently announced the intent to separate our Mobility Segment into a standalone public company. For more information, visit www.spglobal.com/mobility. Technology Supplier Management Analyst Position Overview The Technology Supplier Management Analyst supports the end-to-end management of its technology supplier ecosystem, including networking, infrastructure, cloud, cybersecurity, and related technical service providers. This role partners closely with the lead of technology sourcing to execute sourcing initiatives, manage vendor onboarding and renewals, monitor supplier performance and risk, and ensure financial and operational alignment across critical technology vendors. This position is ideal for a highly analytical, systems-minded, and stakeholder-oriented professional who thrives in a fast-paced, governance-driven environment. Core Responsibilities Technology Sourcing &...

Job Requirements Company Description The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state’s future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System’s anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org. Job...

Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews inquiries to determine if they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals; initiates a case file for each grievance and appeal; ensures compliance with organizational and regulatory requirements for member or provider issues; independently coordinates the resolution with internal/external parties as required; and documents and summarizes to all parties involved in the case the investigation results. ESSENTIAL RESPONSIBILITIES Review inquiries to determine if they meet definition of appeal/grievance. Request and review all related relevant documentation and assemble case file. Coordinate resolution results and relay investigative results with all involved parties. Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross...

Company : enGen Job Description : JOB SUMMARY This pivotal role will lead the strategic transformation and optimization of workforce operations across enGen, encompassing both internal resources and external vendors. The Senior Director will be a key driver in establishing robust frameworks for tracking hours, managing financial allocations, and ensuring highly efficient resource deployment. This individual will possess a deep understanding of transformational initiatives, serving as a change expert who can intelligently engage with vendors, internal stakeholders, and senior leadership to align business operations with strategic objectives and deliver significant value. This leadership role is responsible for influencing, shaping, and executing high-impact strategies and initiatives delivering significant enterprise-level value. The Senior Director level demands a high degree of strategic leadership, independent decision-making, and accountability for fostering...

Company : Highmark Inc. Job Description : JOB SUMMARY This job resolves standard and occasional non-standard customer inquiries, comments, and concerns by applying a seamless and positive customer experience gained through many recurring cycles of on the job work engagement. ESSENTIAL RESPONSIBILITIES Engages with customers in a confident and compelling manner, performing the full range of customer service duties and responsibilities, as assigned. Strives to resolve customer concerns in a single interaction via telephone, written, or face to face communication. Responds to a diverse set of customers with an equal level of confidence regardless of the issue at hand. Works independently of support from a senior customer service representative, frequently utilizing the knowledge center, answering customer inquiries. Routinely responds to customers with an in-depth product knowledge achieved through a continuously improving set of...

Company : Highmark Health Job Description : JOB SUMMARY We are seeking a highly motivated and experienced Senior Product Manager with a clinical background to drive the strategic vision and execution for our "Well360" platform, specifically focusing on commercial buyups. This pivotal role defines the product's fundamental value proposition, outlines its vision and execution plans, and gains alignment and support from key strategic partners and stakeholders. The incumbent will oversee the end-to-end execution of this vision, ensuring successful product delivery and market impact. This role also involves providing coaching and guidance to junior team members, fostering their professional growth. The Senior Product Manager will actively attend and participate in milestone reviews with the Delivery team, ensuring seamless collaboration and product development. A strong understanding of both clinical operations and commercial buyouts is essential for success in this...

Company : Highmark Health Job Description : JOB SUMMARY This job is a senior level actuarial analyst position. Participates in Highmark's Actuarial Executive Development Program and is expected to make continued progress towards actuarial credential. Utilizes experience and industry knowledge to define & diagnose a problem, outline data requirements for a study or analysis, and devise potential solutions. Guides and mentors less experienced staff and provides decision support to team members while initiating and leading the development of actuarial studies, analyses, and presentation materials needed to appropriately inform decision makers and making appropriate recommendations to management. Will work to develop efficient processes and will apply actuarial techniques and statistical analysis to several functions which may include insurance premium and pricing development, claim trend analysis, experience studies, medical economics, profitability analysis,...

Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations. ESSENTIAL RESPONSIBILITIES Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid. Conduct research beyond medical policy review to make decisions on medication coverage requests. Other duties as assigned. EDUCATION...

Overview At PNNL, our core capabilities are divided among major departments that we refer to as Directorates within the Lab, focused on a specific area of scientific research or other function, with its own leadership team and dedicated budget. Our Science & Technology directorates include National Security, Earth and Biological Sciences, Physical and Computational Sciences, and Energy and Environment. In addition, we have an Environmental Molecular Sciences Laboratory, a Department of Energy, Office of Science user facility housed on the PNNL campus. The Physical and Computational Sciences Directorate's (PCSD's) strengths in experimental, computational, and theoretical chemistry and materials science, together with our advanced computing, applied mathematics and data science capabilities, are central to the discovery mission we embrace at PNNL. But our most important resource is our people-experts across the range of scientific disciplines who team together to take...