SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight combats fraud, waste, and abuse in healthcare through our proprietary data analysis. Requiring the bare minimum in employer involvement, our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes. 

This position is only eligible for legal residents of the United States of America. 

The Data Operations Specialist ensures data is handled accurately, delivered on time, and communicated effectively both within the organization and externally. Responsibilities include managing transmission of data, data structures, monitoring and reporting on data quality, working with cross-functional teams, and resolving data-related issues. 

The ideal candidate should possess strong analytical abilities, in-depth knowledge of IT data processes, and a dedication to maintaining excellence in data operations. 

As part of this role, one will build relationships with other IT professionals, such as developers, data scientists, and business analysts. Collaborate with these professionals to acquire a deep understanding of source systems, able to make decisions quickly, and identify solutions that meet the critical nature of the business. 

This role is a remote position and is also a contract-to-hire. After a successful 3-month contract, you will be eligible for benefits and will transition to full-time employment. 

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States. 

Responsibilities 

• Oversee the end-to-end lifecycle of customer data transmissions, including initial layout reviews, scheduling coordination, data receipt, and ensuring ongoing timeliness and accuracy of data delivery.  

• Remove impediments and blockers to ensure smooth progress. 

• Monitor data transmissions and systems for errors, resolve issues promptly, and implement solutions to prevent recurring problems. 

• Work closely with data engineering, analytics, and business teams to align data requirements, priorities, and enhancements. 

• Develop and maintain comprehensive documentation for data processes, workflows, and troubleshooting guidelines. 

Qualifications: 

• Bachelor’s degree. 

• Familiarity with data transmission protocols (FTP, SFTP, APIs). 

• Experience with file formats (e.g., Fixed Width, CSV) and data validation tools. 

• Knowledge of SQL for data querying and troubleshooting. 

• Basic scripting knowledge (e.g., Python, PowerShell) for automation (optional but valuable). 

• Strong communication and coordination abilities to work effectively with internal teams and third parties. 

• Excellent problem-solving skills for identifying and resolving data-related issues. 

• Familiarity with ETL tools or processes is beneficial. 

• WinSCP, FileZilla, or other FTP clients. 

• Ability to manage multiple responsibilities and prioritize effectively. 

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Job Summary:
In this role, you will develop analytical insights to identify payment anomalies in client’s healthcare claims data.  To be successful in the role, you will have sound knowledge and experience with Statistical Models, Data Mining and building dashboards to deliver insights, insights communication and presentation, as well as demonstrating the ability to combine advanced analytics skills with exceptional business acumen. The Data Analyst II will collaborate with cross-functional teams to translate complex data findings into clear, concise and actionable recommendations.

This position is only eligible for legal residents of the United States of America

Key Responsibilities:

Data Analysis and Interpretation:

• Develop a deep understanding of the key initiative of the organization and be able to provide analytical solutions that provides actionable recommendations to drive the success of the key initiatives.
• On-going monitoring of product lines including but not limited to the success metrics for each model and dashboards required for executive decision-making.
• Collect, clean, and analyze data from multiple sources to identify trends, patterns and insights.
• Apply statistical methods and advanced analytical techniques to solve business challenges and provide forecasts or predictive models.
• Monitor data integrity by conducting regular audits and ensuring accuracy and completeness of datasets.

Data Visualization and Reporting:

• Develop dashboards using claims and eligibility data with analytical insights to assist in executive decision making.
• Work with business stakeholders to understand their goals, challenges and opportunities, and translate their needs into analytical projects.
• Prepare on-demand analyses and ad-hoc reports and insights.
• Present findings to stakeholders and translate insights into strategic recommendations.

Development and Testing:

• Identify opportunities to automate data processes, streamline workflows and improve reporting efficiency.
• Document analytical methodologies, data workflows and insights to ensure transparency and knowledge sharing across the organization.

Business Partner Collaboration:

• Communicate analytical findings and recommendations in a clear and concise way to non-technical audiences, both in oral and written presentations.
• Work closely with Information Management teams to automate recurring tasks and improve processes to continually increase efficiency.

Qualifications: 

Education:

• Bachelor’s degree such as Business, Economics Finance or related field 

Experience:

• A minimum of three years of analytical work experience with healthcare claims data
• Experience and understanding of data analysis and appropriate application of these capabilities in a business performance environment
• SQL: 2-3 years (Required)
• Healthcare claims: 2-3 years (Required)
•  

Technical Skills:

• Proficiency in SQL and experience with data querying and database management.
• Experience with data visualization tools such as Tableau, Power BI or QlikView.
• Familiarity with statistical software or programming languages (e.g., R, Python, SAS or SPSS).
• Working knowledge of ETL processes and data pipelines

Key Competencies:

• Demonstrated ability to analyze data and synthesize findings into clear insights.
• Experience with statistical analysis, forecasting, regression models and predictive analysis.
• Strong attention to detail and a commitment to accuracy.
• Proven ability to work independently and collaboratively in a fast-paced, team-oriented environment.

• Curiosity, adaptability, and eagerness to learn and apply new technologies or methods.
• Strong written and verbal communication skills.
• Ability to present complex information in a clear, concise and actionable manner.

This job description serves as a general overview of the role and is not exhaustive. The Data Analyst II may be required to perform additional responsibilities as needed to support the organization’s goals and objectives.

Who is SmartLight Analytics:
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight combats fraud, waste, and abuse in healthcare through our proprietary data analysis. Requiring the bare minimum in employer involvement, our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.

APPLY HERE

Job Summary:
The Director of Engineering will be experienced and innovative and is critical in helping to drive the growth and scalability of our technology organization as we continue to build a cutting-edge product in the healthcare data space. Reporting directly to the CTO, you will lead our engineering teams, spearheading technical strategy, execution and delivery of product development. A deep understanding of healthcare claims data is essential for this position.

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States. 

Key Responsibilities:
Leadership and Development:

• Build, scale and mentor a high-performing engineering team to meet product roadmap and strategic goals.
• Implement best practices for team operations, including agile methodologies, code quality standards and development processes.
• Foster a collaborative, supportive and innovative engineering culture.
• Develop career growth paths for engineers, fostering talent and ensuring skill development aligns with company needs.

Technical Strategy and Execution:

• Collaborate closely with the CTO to define and implement the technical vision and engineering roadmap.
• Lead the team in designing, building and delivering scalable, high-quality software solutions.
• Ensure alignment between technical decisions and business objectives, focusing on product scalability, stability and performance.
• Work cross-functionally with Product, Data Science, Operations and other teams to drive successful execution and launch of new features and products.

Product and System Architecture:

• Provide technical leadership in architecture design and code reviews, particularly around integration with healthcare claims data and data warehousing.
• Oversee and enhance the reliability, security and performance of our technology infrastructure.

Innovation and Continuous Improvement:

• Continuously assess emerging technologies and industry trends to keep the engineering team ahead of the curve.
• Drive innovation in the engineering processes, tools and technologies to increase productivity and product quality.
• Act as a champion for data-driven decision-making and efficient software development methodologies.

Healthcare Claims Data Expertise:

• Provide subject matter expertise on healthcare claims data, guiding teams on how best to handle, process and leverage it.
• Ensure compliance with industry standards and regulatory requirements around data privacy and security.
• Collaborate with Product and Data teams to optimize data structures and processing methods for healthcare claims data.

Qualifications:
Education:
Required bachelor’s degree in computer science, engineering, mathematics, information systems or related field.  

Experience:

• 10+ years of data warehousing, applications development, data analytics experience.
• 5+ years in a leadership role within a technology company, healthcare claims experience preferred.

Technical Skills:

• Extensive experience working with healthcare claims data, understanding data structures, data processing.
• Strong proficiency in programming languages and frameworks commonly used in healthcare technology, data engineering and ETL processes.

Leadership Skills:
Proven track record of building, leading and scaling engineering teams, ideally in a startup or fast-growing company.

Strategic Vision:
Ability to align technical decisions with business goals, influencing both engineering and business strategies.

Communication:
Excellent communication skills with the ability to engage technical and non-technical stakeholders effectively.

Preferred Qualifications:

• Previous experience working directly with healthcare data warehousing solutions or healthcare data interoperability.
• Familiarity with modern data architecture approaches, including cloud platforms (e.g., AWS, Azure) and big data solutions.
• Any Certifications such as Certified Scrum Master (CSM) or other Agile certifications and/or Certified Solutions Architect

Key Competencies:

• Ability to drive change and implement process improvements based on data insights.
• Excellent interpersonal and communication skills, with the ability to work with cross-functional teams and external partners.
• High attention to detail and a commitment to quality and compliance.
• A proactive, solution-oriented approach to addressing challenges and improving operational efficiency.

Who is SmartLight Analytics
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight combats fraud, waste, and abuse in healthcare through our proprietary data analysis. Requiring the bare minimum in employer involvement, our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.

APPLY HERE

Job Summary:
The Director of Pharmacy will lead the pharmacy-related functions within SmartLight Analytics. This leadership role will focus on ensuring the accuracy, efficiency and compliance of pharmacy claims processing, with a particular emphasis on identifying and preventing fraud, waste and abuse (FWA) using advanced analytics. The Director will collaborate with cross-functional teams, including analytics, operations, technology, to develop and implement pharmacy strategies that optimize payment integrity, reduce costs and enhance overall performance.
This position will also involve overseeing the design, development and execution of pharmacy programs that support payer and provider partnerships, while building and developing pharmacy team.

Key Responsibilities:
Leadership and Strategy:

• Develop and execute the strategic direction for pharmacy operations within the company, with a focus on improving payment integrity, optimizing reimbursement accuracy and reducing fraud, waste and abuse (FWA).
• Lead, mentor and develop a team of pharmacy professionals, pharmacy analysts, and operational staff to ensure alignment with organizational objectives.
• Work closely with senior leadership to shape the vision and goals for pharmacy-related payment integrity initiatives.

Pharmacy Payment Integrity and Claims Management:

• Utilize analytics to identify potential payment errors, overpayments, underpayments and fraud within the pharmacy reimbursement cycle.
• Develop and implement solutions to reduce costs for clients in relation to pharmacy claims processing.
• Optimize PBM Rebate programs and incentives to benefit clients.
• Review and recommend improvements to ASO PBM Contracts.
•  

Data Analytics and Reporting:

• Work with the data analytics team to develop and implement AI models and algorithms that identify trends, discrepancies and opportunities for improving pharmacy payment integrity.
• Use advanced analytics tools (e.g., AI/ML, business intelligence platforms) to analyze pharmacy claims data, detect anomalies and recommend actionable solutions.
• Develop and present comprehensive reports to leadership, stakeholders and external partners detailing performance metrics, insights and recommendations.
•  

Regulatory Compliance and Industry Standards:

• Stay up to date with evolving healthcare regulations, pharmacy industry standards and payer requirements to ensure compliance in all pharmacy-related processes.
• Ensure that pharmacy payment integrity initiatives align with government regulations (e.g., CMS, HIPAA), payer contract and industry standards.
•  

Qualifications:

Education:

• PharmD, with a Managed Care Residency preferred

Experience:

• Minimum of 6–8 years of experience in pharmacy operations, healthcare payment integrity or pharmacy benefit management (PBM), with at least 3 years in a leadership role.
• Strong expertise in pharmacy claims auditing, payment integrity processes and fraud detection.
• Experience with pharmacy reimbursement models, pharmacy compliance and healthcare regulatory frameworks (e.g., CMS, HIPAA).
• Background in using data analytics or business intelligence tools to enhance pharmacy claims management and payment integrity.

Skills:

• Strong leadership, team building and management skills.
• Advanced knowledge of pharmacy benefits, payment integrity, claims adjudication and fraud prevention.
• Excellent problem-solving, critical thinking and strategic planning abilities.
• Strong communication skills with the ability to present complex data and insights to both technical and non-technical stakeholders.

Key Competencies:

• Strong analytical mindset with the ability to identify patterns, trends and anomalies in pharmacy data.
• Ability to drive change and implement process improvements based on data insights.
• Excellent interpersonal and communication skills, with the ability to work with cross-functional teams and external partners.
• High attention to detail and a commitment to quality and compliance.
• A proactive, solution-oriented approach to addressing challenges and improving operational efficiency.

Who is SmartLight Analytics
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight works on behalf of self-funded employers to reduce their healthcare costs through our proprietary data analysis. Our solution works behind the scenes to reduce costs without interrupting employee benefits or requiring employee behavior changes.

APPLY  HERE