Top Tech Jobs & Startup Jobs in Boston, MA

Owns product backlogs and roadmaps, translates stakeholder requirements into user stories and acceptance criteria, prioritizes work, supports sprint planning and reviews, and represents business stakeholders. The role collaborates with Agile teams and Product Managers to deliver solutions meeting contractual requirements, quality standards, and business value. It also contributes to release planning, continuous improvement, and process standardization.

Reviews and processes appeal mail intake for a federal healthcare appeals team. Responsibilities include supporting audits and fieldwork, preparing position papers and jurisdictional reviews, analyzing data, maintaining case records and tracking systems, responding to inquiries, and making recommendations. The role requires collaboration, accurate prioritization, continuing education, and knowledge of federal regulations, CMS programs, and cost report formats.

The Project Director leads complex, cross-functional claims modernization initiatives across operations, IT, PMO, vendors, and government stakeholders. Responsibilities include defining scope and governance, overseeing schedules, resources, risks, quality, costs, readiness, reporting, RAID management, and implementation stabilization. The role provides executive-level communication, drives issue resolution and decisions, coordinates CMS touchpoints, and mentors project teams and managers.

Perform and supervise complex Medicare cost report desk reviews and audits, prepare work papers per Government Auditing Standards and CMS requirements, analyze reimbursement data, handle appeals and exception requests, mentor junior staff, participate in special projects, and support CMS contractual workload with occasional travel and required training.

Analyzes, researches, coordinates, and reports on provider data for internal teams, providers, and regulatory agencies. The role generates reports, performs network and file analysis, supports surveys and ad hoc data requests, validates report accuracy, coordinates with stakeholders, and serves as a technical liaison for provider database information. Responsibilities may also include data support, system enhancements, and testing.

Translates complex PBM business needs into software requirements and solutions. Leads analyst teams, conducts claims and business impact analyses, investigates operational issues, performs root cause analysis, evaluates risks, develops remediation recommendations and business cases, and presents findings to leadership. Partners with Operations, Product, Technology, Finance, Compliance, and Client Services to improve processes, strengthen controls, and support PBM operations initiatives, compliance, audits, and contractual obligations.

Generates and qualifies sales leads through outbound email, phone, and social outreach. Conducts market research, nurtures prospects, schedules discovery meetings, analyzes campaign performance, and reports pipeline results. The role optimizes lead-generation processes, maintains CRM data quality, collaborates cross-functionally on solutions and launches, and ensures activities follow applicable regulations and best practices.