Jobs at CareSource

Designs, develops, deploys, and supports complex, scalable software systems. Leads architecture and technical solutions, implements AI-enabled and agentic applications, integrates systems, performs testing and troubleshooting, and ensures quality, security, reliability, and performance. The role also supports incident management, CI/CD, Agile delivery, code reviews, mentoring, stakeholder collaboration, and adoption of AI-assisted engineering tools.

Owns CareSource’s EDI platform vision, roadmap, backlog, and delivery. Translates healthcare, regulatory, and integration requirements into technical specifications; partners with engineering, architecture, QA, DevOps, trading partners, and business teams; coordinates releases and Agile delivery; monitors transaction performance, defects, SLAs, and platform telemetry; drives data quality, observability, automation, compliance, documentation, and continuous improvement across EDI capabilities.

Designs, validates, and operationalizes predictive, machine learning, and artificial intelligence models using large structured and unstructured datasets. Performs statistical analysis, feature engineering, exploratory analysis, visualization, and clinical program outcome validation. Collaborates cross-functionally to integrate solutions, prepares end-to-end model pipelines, and communicates analytical findings to stakeholders to improve business processes.

Develop complex healthcare reports, ETL solutions, databases, and Power BI dashboards for LTSS and Dual Eligible programs. Analyze multidimensional data, ensure governance and accuracy, identify operational improvements, and deliver actionable insights to leadership. The role translates business requirements into scalable reporting solutions, collaborates with clinical, operational, data engineering, and IT teams, and leads testing, process automation, visualization, and large cross-functional data projects.

Lead enterprise adoption and toolchain integration for business analysis across federated teams. Design enablement curriculum, integrate standards and AI-enabled tooling (Azure DevOps, ServiceNow, Nexus, Power BI), build decision-oriented dashboards and leading indicators, drive adoption and governance, surface portfolio trends, and partner with stakeholders to improve delivery predictability and compliance.

Directs market-specific healthcare quality improvement programs, ensuring compliance with NCQA and state requirements. Oversees quality plans, performance improvement projects, audits, corrective actions, data analysis, risk assessment, reporting, committees, and regulatory initiatives. Partners with enterprise stakeholders, represents the organization externally, supports budgeting and strategic planning, and leads quality outcomes for Medicaid or managed care markets.

Designs and deploys lightweight AI applications and user interfaces using low-code platforms, Python, SQL, and cloud data technologies. Translates generative AI, agentic AI, and NLP capabilities into scalable business workflows, collaborating with data engineering, data science, IT, and architecture teams. Responsibilities include application testing, troubleshooting, optimization, accessibility, compliance, production deployment, incident support, and Agile development. The role requires five years of application development experience and two years deploying cloud-based applications and modern data platforms.

Leads digital strategy, transformation, and roadmap development across member and provider experiences. Directs personalized engagement programs, omni-channel adoption, performance measurement, vendor partnerships, budgets, and digital teams. Aligns technology with business needs, defines customer journeys, promotes user-centered design, and drives organizational change. The role also hires and develops talent, presents digital vision to executives, and manages large initiatives under tight timelines.

Leads enterprise business analysis strategy across multiple programs and portfolios. Partners with executives on business cases, investment decisions, requirements, prioritization, risks, value realization, and transformation initiatives. Establishes governance, methodologies, standards, and performance measures while guiding complex requirements efforts. Analyzes operational and financial data, supports payer regulatory compliance, drives AI and automation adoption, and mentors business analysts and project teams.

Provides administrative support to the Market President and office, including preparing presentations, correspondence, reports, calendars, meetings, travel arrangements, expense reports, and meeting minutes. Serves as an office gatekeeper and coordinates facilities, shipping, equipment, visitor badges, and market events. Requires discretion, confidentiality, strong communication, organization, problem-solving, and Microsoft Office proficiency.

Manages information security risks, vendor and third-party risk reviews, mitigation plans, policy exceptions, and compliance reporting. Partners with stakeholders and Enterprise Risk Management to maintain risk policies within tolerance. Serves as a technical expert, supports risk awareness and accountability, monitors security controls, and contributes to operational goals. The role requires expertise in IT audit, security monitoring, access management, encryption, networking, incident response, SOX compliance, and project management.

Lead a small actuarial team responsible for pricing, forecasting, reserving, and actuarial modeling for supplemental benefits. Develop assumptions, evaluate experience and trends, support rate filings and IBNR reserve estimates, provide strategic recommendations, and ensure compliance with actuarial standards.

Lead the actuarial function to drive pricing, forecasting, rate filings, and financial analysis. Develop statistical models, ensure regulatory compliance, mentor staff, support senior management and business development, and implement AI-enabled solutions to improve efficiency and insights.