Adjuster Job Description Samples

Results for the star of Adjuster

Risk Adjustment Coders (Cms-Hcc, Hhs-Hcc, Ccc, And Cdi)

RISK ADJUSTMENT CODERS

- Aviacode is looking for a handful of risk adjustment coders experienced in CMS-HCC, HHS-HCC, CCC, and CDI for remote Risk Adjustment coding positions.
Reports to: Coding Supervisor/Manager
Employment Status: Remote Contracted (1099) Position
Position: Remote Contracted (1099) Position
Pay:  TBD.  Varies per project but is comparable to $20+ an hour.
Minimum Hours: You must be able to commit a minimum of 15 hours a week
Maximum Hours:  40+ There is no maximum, you can work as much as you want.
Start Date:  Mid-June to Mid-July, 2017
End Date:  Depends on project, but likely February 2018
PROJECT OUTLINE
  • Complete Code Capture (CCC)
  • Hierarchical Condition Category (HCC)
  • Clinical Documentation Improvement (CDI)
  • Risk Adjustment Validation
  • More details will come as we get closer to the project
RESPONSIBILITIES
  • Providing high quality HCC/CCC/CDI coding across multiple clients.
  • HCC/CCC/CDI coding for 2015-2016 year.
QUALIFICATIONS
  • CPC or CPC-A or equivalent through the AAPC or AHIMA
  • CRC preferred, but not required
  • Must have at least 1 year of active HCC coding experience, or
  • Must have at least 1 year of active CCC coding experience, or
  • Must have at least 1 year of active CDI coding experience
  • Must have at least 1 year of ICD-9 coding experience
  • Must have at least 1 year of ICD-10 coding experience
  • Must have proof of passing an ICD-10 Proficiency or Readiness Assessment through the AAPC or AHIMA
  • Must pass background check and drug screening
  • Must pass the Risk Adjustment coding test
  • Signed contract with Aviacode
  • Must reside in the U.S.
ADDITIONAL INFORMATION
  • This is a CONTRACT position for a SHORT TERM project (June 2017-February 2018)
  • There will be multiple projects available consisting of a mix of HCC, CCC, CDI, RA Validation
  • Must complete a certain number of charts per pay period (varies per project).
  • Must maintain a 95% accuracy rate.
  • Must maintain a 95% completeness rate.
  • You will be paid twice a month on the 10th and 25th. The pay periods go from 1-15 and 16-31.
  • This is a 1099 position.
  • Must have a Windows Based Operating System (MAC is not compatible).
  • Dual monitors highly recommended

INTERESTED?

1. Apply here.
2. Please answer questions and take the assessment by using this link:  https://www.surveymonkey.com/r/2017RAassessment
You will be required to take a 2 part coding assessment when you apply.  Part 1 needs to be done at the time you apply (39 questions).  Part 2 needs to be done within 48 hours (8 charts).
Part 2 Instructions:  https://goo.gl/3mKEAa

OTHER OPEN POSITIONS

See here for other open positions: https://goo.gl/vOns5n

FUTURE OPPORTUNITIES

If you are interested in hearing about future coding opportunities at Aviacode, please take the following surveys so that we will have your information and experience on file.  When we have something available that we feel you would be a good fit for, we will reach out to you to see if you are interested.
Please fill out your E/M related coding experience here:  https://www.surveymonkey.com/r/EMexpSurvey
Please fill out your SURGERY related coding experience here:  https://www.surveymonkey.com/r/SurgeryExp
About Aviacode:
Aviacode is a premier provider of technology-enabled medical coding and auditing services. Our proprietary software and dynamic workflow improves the accuracy and efficiency of medical coding. Healthcare providers who use our accurate and compliant coding services experience optimized reimbursements and fewer denials.
“Aviacode does not discriminate on the grounds of race, creed, color, disability, sex, sexual orientation, national origin, age, religion, Vietnam era Veteran’s status, political affiliation, or any other non-merit factor.”

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P&C Assoc Claims Adjuster

We are a proven provider of specialty insurance products and services looking for Inside Property Adjusters who are ready to step into our fast paced energetic environment and drive results while providing exceptional customer service. We are looking for individuals interested in learning our business, growing their expertise, and becoming a future leader.

Associate P&C Claims Adjuster is an entry-level position with significant time spent learning the claims process, software, specialty products, etc. Associate P&C Claims Adjusters review property damage claim information from the Outside Adjuster, complete the investigation, and resolve the claim. This requires strong organizational abilities and empathetic interpersonal skills. P&C Claims Adjusters also are responsible for on-going communication and for providing status updates to the insured and others associated with the claim activity. Successful candidates will be computer literate and comfortable working in a paperless environment. They will enjoy working with customers, be effective at listening and communicating, and have confidence in resolving issues and negotiating fair settlements. Assurant values a diverse workforce where employees are treated with respect, are encouraged to contribute, and have the opportunity for career growth. We offer company-subsidized group benefit plans (including health insurance eligibility on the first day of employment), discounted stock purchase plan, tuition reimbursement, and many additional benefits. This position is located at our beautiful Cutler Bay, Miami campus where we offer a state of the art on-site Child Care and Elementary school, fully equipped gym, dry cleaners, credit union and more! // Special Considerations: May require working overtime and/or weekend hours. An Adjuster’s license is required for states in which the Claims Adjuster performs their job. If you do not currently possess the appropriate license(s), Assurant will assist you in obtaining the license within a specified timeframe and cover any related expenses. Bilingual Spanish and/or Creole is a plus. __ Primary Job Accountabilities/ Responsibilities:Investigate and adjust claims according to applicable laws and policy provisions. * Conduct claim investigations including but not limited to recorded statements, securing public records, and analyzing report findings.

  • Examine claim forms and other records to confirm coverage for loss or damage.

  • Review and audit estimates received and settle claims within prescribed limits of authority.* * * Issue payments or deny claim in a timely manner in accordance with policy conditions.

  • Effectively negotiate settlements with contractors, adjusters, or any insured representative.

  • Recognize and document subrogation and salvage opportunities and refer accordingly.

Build and maintain effective internal and external working relationships. Collaborate with internal support teams and management as appropriate. * Effectively collaborate with various departments and levels in the organization.

  • Maintain industry knowledge and operational skills and attend workshops, seminars, and other training sessions as appropriate.

  • Handle other duties and projects as requested based on business needs.

Basic Qualifications: * High school diploma or GED * One year of professional work experience

  • Demonstrated proficiency with Microsoft Office and the ability to navigate and enter data on multiple screens

  • Must be able to work M-F, 10 a.m. - 7 p.m.

Preferred Qualifications: * Bachelor’s degree highly preferred

  • Excellent verbal and written communications skills and ability to draft business-level communications when responding to customers

  • Proven ability to work independently with minimal supervision to manage schedules and meet deadlines

  • Ability to type a minimum of 40 wpm

  • Strong listening, problem solving, and negotiating skills

  • Strong analytical skills

  • Proven organizational and multi-tasking ability with an ability to adapt quickly in a fast-paced work environment

  • Detail oriented with a commitment to excellence

Job:Claims

Title:P&C Assoc Claims Adjuster

Location:FL-Miami

Requisition ID:50536


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Auto Claims Adjuster

Auto Claims Adjuster

Location :​Gilbert, AZ - - -

Job Summary Are you looking for a position that offers advancement opportunities, great benefits and recognition for a job well done? Join MAFPRE Insurance! MAPFRE Insurance is a forward thinking insurance company offering friendly service from over 2,000 professionals focused on taking care of you and your family. For decades, MAPFRE Insurance has been protecting families and their possessions with quality insurance coverage and a strong commitment to service excellence.   Your Future Starts Here!

Auto Claims Adjuster May be filled at a higher level commensurate with experience.   In this position, individuals will be trained in handling/adjusting of automobile physical damage claims.

This is a multi-state position which will require developing a proficiency in interpreting, understanding and applying multiple policies/products and multi-jurisdictional claim handling requirements. The individual will need to possess or be able to obtain the appropriate state adjuster licenses required by state statute. The individual in this position will handle a pending of automobile property damage claims which will consist of Collision, Other Than Collision, Property Damage & Uninsured Property Damage features.

Primarily be responsible for the screening and processing of losses, determining coverage exposures, liability analysis, negotiating settlements, and making payments. Frequent oral and written communication with customers is required and must be timely and professional.

Job Requirements + Education: Bachelor's Degree or professional level of knowledge in a specialized field, or equivalent, related experience.

  • Experience: 0 - 2 years - or Associates Degree equivalent plus 2 - 4 years.

  • Knowledge: Limited to moderate knowledge of industry practices, standards, and concepts within field of work. Learns to apply them to the job.

  • Decision Making: Makes decisions related to a wide variety of situations within management limits.

    Interprets guidelines and procedures, applying judgment and discretion. Decisions influence portions of a project, client relationships and/or expenditures.

  • Supervision Received: Works independently under moderate to general supervision, receiving specific and detailed instructions on new types of work.

  • Leadership: Works as an individual contributor. Learns the job.

  • Problem Solving /Operations/Direct Work Involvement: Applies knowledge to help solve problems of relatively limited scope and complexity which require independent thinking.

  • Client Contacts: Contacts other departments and or external organizations or parties frequently.

    Contacts are primarily at or below upper management levels. Represents organization on specific projects. Communication may involve persuasion, and negotiation.  Additional Knowledge, Skills and Abilities A minimum of one year Contact Center Claim Services or equivalent claims adjusting, or related work experience is required.

    The ability to obtain necessary licensing for geographic area assigned to the position based on business need is also required.

    This position requires excellent written and oral communication skills and the demonstrated ability to organize and prioritize work to assure productivity goals of managing a pending are met. Strong telephone customer service skills and the ability to empathize is needed.

    Must possess basic CRT / PC skills with accurate keyboarding abilities. Must possess good math skills and be able to work in a fast paced environment. MAPFRE is committed to recognizing our employees as our most valuable resource.

    We know our employees are the foundation for our accomplishments. That’s why we offer so many opportunities to share in the success they help us achieve.  We are MAPFRE. We are people who take care of people. If you require an accommodation for a disability so that you may participate in the selection process, you are encouraged to contact the MAPFRE Insurance Talent Acquisition team at talentacquisition@mapfreusa.com. We are proud to be an equal opportunity employer. #INDEED123

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Palletizer Adjuster Machine Operator

Currently we have openings on 2nd and 3rd shift for this position. The Palletizer Adjuster Operator works in a high-speed manufacturing environment, including: + Operating, troubleshooting, repairing, all palletizing and packaging equipment, including palletizers, banders, stretch wrapper, and other related equipment.

  • Completing assigned TMPs and associated documentation.

  • Maintaining required traceability, activity and maintenance records.

  • Give breaks as needed to palletizer operators. This position requires:

  • A High School diploma or equivalent, and at least two years experience in a manufacturing environment is preferred.

  • A mechanical aptitude with the ability to working independently, using manuals to learn and master equipment operation and solve production issues.

  • The ability to pass a basic written mechanics test..

  • Able to work overtime during the week (up to 12 hour shifts) with possible overtime on Saturdays or before and after shifts as required.

  • Ability to work in a physically demanding environment, standing, walking, sitting, stooping/bending, frequent up/down stairs. Pay/Benefits: $20.86 to $21.04 per hour plus $.50/hour shift differential + Health, Dental, Life, Disability and Vision Insurance + Retirement Plan

  • Paid Vacation and Holidays

  • Paid Training and Tuition Reimbursement + Uniforms Provided Requisition ID: 8931

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Claims Adjuster

Bring your expertise to California Casualty, a family-owned property & casualty insurance company since 1914. We provide protection and peace of mind for the people that serve our communities including educators, firefighters, law enforcement, and nurses.

The insurance industry is always evolving. Our dedicated teams ensure we stay one step ahead. Now is your chance to join our topnotch specialists who make a real difference in the lives of our customers.Claims AdjusterAccidents happen.

And when they do, our claims department is right there, investigating and evaluating claims; and then negotiating settlements that are fair to our customers and our company. As a Claims Adjuster, you will conduct investigations of various auto and property claims over the phone, accurately recording information, and analyzing photos and police/medical reports. You will also determine coverage and liability by applying provisions of policy contracts in compliance with regulatory requirements and internal quality procedures.

Use your people skills and business smarts to provide excellent customer service by communicating with policyholders, claimants and vendors to promptly resolve problems. We seek candidates with: + Knowledge of investigation and negotiation techniques, as well as legal and medical terminology, homeowner and comparative negligence concepts, fraud recognition and insurance coverages + Bodily Injury experience (preferred) + Excellent verbal/written communication skills and sound judgment + A strong sense of organization to keep you on top of the large volume of calls you'll be working + High School diploma (some college preferred) + Ability to meet state licensing requirements Minimum starting annualized salary: $47,229 + (Can increase depending on experience).Launch your insurance career with us and you’ll make a huge impact on our future, as well as your own. Here, we are one big team and collaborative working is the backbone of our culture.

We not only expect our people to share ideas and support each other; we value individual contributions and recognize the unique talents of each employee. Our insurance company offers competitive salaries, a comprehensive benefits package, career support and a great work environment. Experience why California Casualty is such a dynamic place to work — and the right place for you!



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Unrepresented Commercial Adjuster

Description :

Where good people build rewarding careers.

Think that working in the insurance field can't be exciting, rewarding and challenging? Think again.

You'll help us reinvent protection and retirement to improve customers' lives. We'll help you make an impact with our training and mentoring offerings. Here, you'll have the opportunity to expand and apply your skills in ways you never thought possible.

And you'll have fun doing it. Join a company of individuals with hopes, plans and passions, all using and developing our talents for good, at work and in life.

Job Description

Under limited supervision, this job is responsible for investigating moderately complex and occasionally complex, unrepresented commercial auto or property claims which may include: (1) uninsured or underinsured motorist (UM/UIM) claims in single or multi car accidents in which commercial policy holders are involved; (2) Injury Casualty Soft Tissue (ICST); and (3) unrepresented moderate or major claims. The individual takes recorded statements, resolves loss of use claims, issues payments to appropriate parties, and negotiates and settles or refers bodily injury issues that cannot be resolved.

The individual delivers compassionate service that is fast, fair, and easy, to ensure customer retention, while analyzing coverage, investigating and determining liability, and negotiating and settling moderately complex and occasionally complex claims. The individual provides work guidance and direction to less senior employees. The individual works independently, prioritizing the individual's own responsibilities, and managing the individual's own workload. The individual also consistently meets band level behaviors, production, quality, and/or customer service goals.

Customer Service

? Makes and maintains a connection with the customer by understanding and meeting their needs; serves the customer with empathy; and follows up to ensure that customer needs have been met

? Researches and responds to moderately complex and occasionally complex customer communications, concerns, conflicts or issues

? Reviews customer satisfaction results; works independently to create personal action plans

File Documentation and Reporting

? Summarizes documents and enters into claim system notes

? Documents a claim file with notes, evaluations and decision making process

Coverage, Liability and Evaluation

? Determines and explains minimum coverage limits in moderately complex and occasionally complex commercial claims involving single or multiple claimants

? Sets initial reserve, updates reserve, documents rationale and claim summary notes

? Obtains photos and/or conducts scene investigation

? Takes recorded statements from claimants, insured's, witnesses, medical providers, etc., conducts investigations into moderately complex and occasionally complex accidents involving commercial policy holders, determines liability, and prepares summaries

? Determines claim value

Negotiation and Settlement Guidance

? Negotiates and settles claims in accordance with business unit best practices

? Reviews medical reports in preparation for claims settlement evaluation

Other Projects and Responsibilities

? May participate in one or more moderately complex or occasionally complex special assignments

? May serve as a committee team lead for medium-sized projects or as a committee team member on medium to large projects

? May serve as a subrogation or arbitration panelist

? May serve as an agent advocate

? May participate in oversight activities

Job Qualifications

  • Bachelors degree in related field preferred or equivalent experience

  • Commercial experience preferred

  • Ability to interact effectively with internal or external customers and act with empathy

  • Applies general and occasionally broad knowledge of insurance policy, coverage, and regulations

  • Applies general and occasionally broad knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards

  • Applies general and occasionally broad industry knowledge to discipline practices, including best practices, to support the business unit

  • Applies general and occasionally broad knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data

The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.

Good Work. Good Life. Good Hands?.

As a Fortune 100 company and industry leader, we provide a competitive salary ? but that's just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, you'll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy.

Learn more about life at Allstate. Connect with us on Twitter, Facebook, Instagram and LinkedIn or watch a video.

Allstate generally does not sponsor individuals for employment-based visas for this position.

Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.

For jobs in San Francisco, please see the notice regarding the San Francisco Fair Chance Ordinance.

For jobs in Los Angeles, please seethe notice regarding the Los Angeles Ordinance.

It is the policy of Allstate to employ the best qualified individuals available for all jobs without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity/gender expression, disability, and citizenship status as a veteran with a disability or veteran of the Vietnam Era.

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Adjuster (Resident)

Location: Orlando RegionalAre you looking for a job in a growing industry with new products, new markets and new technology?With locations across the country, Amica Mutual Insurance Company offers opportunities to join this dynamic field with a financially strong and respected insurance provider.

Amica, based in Lincoln, RI, is a national writer of auto, home, marine and umbrella insurance. Amica Life Insurance Company, a wholly owned subsidiary, offers a full line of life insurance products.We are recognized as a leader in customer service and credit this success to our 3,500 employees in 44 offices across the country. Our benefits package includes high-quality medical, dental and vision coverage, short-term and long-term disability insurance and more.Our office located in Orlando, FL is seeking a motivated, confident and experienced Adjuster to work remotely in the South Florida region.

The selected candidate will handle the outside investigation and settlement of homeowners and auto liability claims, help advance our presence in the South Florida area and potentially assist with marketing efforts as needed. Strong organizational, interpersonal, and communication skills with the ability to handle volume are essential to the success of any candidate. The ability to work independently is required as the position involves working in the field with limited office time.

One year of field adjusting at Amica is required.Equal Opportunity Policy: All qualified applicants who are authorized to work in the United States will receive consideration for employment without regard to race, religion, sex, color, national origin, ethnicity, age, genetic information, disability or sexual orientation. The Age Discrimination in Employment Act prohibits discrimination on the basis of age with respect to individuals who are 40 years of age or older.

Employees are subject to the provisions of the Workers' Compensation Act.IND15MON16Posted by StartWire. Apply now!.



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Independent Claims Adjuster

Looking for an Independent Claims/Road Adjuster.

Must be able to service anywhere between New Brunswick and NY.

Must have field experience and comfortable being on the road 50% of the time.

Know how to bill hours worked while out in the field, doing full caption reports, and loading case flies.

They would also consider a Road Adjuster or (TPA)Third Party Adjuster/Admin

Qualifications:

  • Bodily & Injury
  • Casualty

Licenses:

  • Auto & Casualty
  • General Adjusters 

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Risk Adjustment Coding Analyst

Description: Position Purpose: Audit vendor and internal risk adjustments coding to ensure accuracy and identify and mitigate any risks.

  • Validate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records + Review and identify trends in coding discrepancies and notify applicable department for potential training and education

  • Determine coding issues and discrepancies and make updates as necessary + Identify issues, determine impact to risk adjustment models and reports results for various products and services + Coordinate delete files with leadership from Medicaid, Medicare, and Marketplace and Encounters department

Qualifications: Education/Experience: High school diploma or equivalent and 2 years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry OR Associate s degree in health related field and 1 years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry. Experience with various risk adjustment methodology and chart audits. Licenses/Certifications: CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA or CPMA required. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Job:Health Insurance Operations

Organization:G&A-Operations

Location:Maryland-Linthicum Heights

Requisition ID:1043507


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Director, Risk Adjustment Analytics & Reporting

It’s Time For A Change… Your Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day.

We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely.

We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it. What You’ll Be Doing: Evolent Health is rapidly building a world-class analytics function leveraging advanced evaluative methodologies, data mining tools and analytic techniques (e.g., predictive modeling, optimization), and quasi-experimental and experimental study designs to enable fact-based decision making.

The Director of Risk Adjustment Analytics & Reporting will develop and design the overall suite of analytic capabilities and actionable reports to solution problems and monitor performance related to Risk Adjustment as well as other priority initiatives at Evolent such as CMS Quality Stars measures program. Provide Analytic & Reporting solutions for our Risk Adjustment + Maintain and enhance standard RA performance data and reports for MA, HIX/ACA, NextGen and Medicaid + Liaise with RA Account Executives, Market Teams and Actuary to prioritize and respond to client requests identify specific opportunities for risk adjustment as well as quality stars improvement + Develop and execute automated models to assess the impact of Risk Adjustment initiatives.

  • Oversees the performance of audits using data sources and reports to ensure accuracy and completeness – liaise with RA education and audit team to provide results and drive strategies + Collaborate with other teams/departments to deliver scalable reporting solutions + Master existing processes for tracking and prioritizing deliverables + Drive innovation into RA analytic solutions for specific client situations as needed + Monitor industry trends and influence the Stars product roadmap + Liaise with IT and provider requirements for the build out of web-based RA reporting within the Identifi platform + Oversee a team of high performing senior analysts and analysts to deliver advanced analytic capabilities and reports The Experience You’ll Need (Required): + Bachelor’s degree + 5 years of professional experience in an analytics role at a health plan/payer/insurer, consulting firm, hospital system + 3 years of professional experience managing and developing teams, including resource planning, mentorship, and skill development Finishing Touches (Preferred): + Graduate Degree with a quantitative, healthcare, business, or technical focus (e.g., science, math, economics, statistics, actuarial sciences, health services management, computer science, engineering, informatics, finance) + Exceptional SQL and/or SAS skills and proficient building Excel models + Detailed knowledge of CPT/HCPS/ICD9/ICD10 + Ability to simultaneously be both detail oriented and big picture in an unstructured environment + Collaborative working style with the ability to work across different matrix organizations Evolent Health is an Equal Opportunity/Affirmative Action Employer

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