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Responsibilities Perform audits of Medicaid managed care and managed long-term care (MLTC) claims transactions processed by health plan administration associates for a specific customer Be responsible for following the customer quality process and tools for…

HealthEdge develops operational technology for health insurance companies. The Technical Operations Associate II serves as the first point of contact for incidents and service requests and monitors production jobs, files, and batch workflows.

Responsibilities Investigate and triage job failures, fallouts, and reprocessing requests raised by L1 Perform initial analysis using application logs, database queries, monitoring tools, and upstream/downstream dependency checks to support root cause…

HealthEdge is hiring a USRN to process and review complex member and provider appeals and grievances. The role evaluates medical necessity, prepares recommendations and correspondence, and maintains accurate documentation in line with service-level agreements…