Health Admins

• Own AI architecture across cloud platforms (AWS Bedrock, Google Vertex AI)—you'll make the calls on what we build and how • Design RAG systems end-to-end, from document ingestion and chunking strategy through retrieval optimization and generation quality • Build agentic systems using modern patterns: MCP (Model Context Protocol), tool-use, function calling, and orchestration frameworks like LangGraph • Define observability and evaluation so we know our AI is actually working in production—not just demo-ing well • Manage cost at scale—model selection tradeoffs, token economics, and budget forecasting as we grow • Establish guardrails and compliance patterns, particularly for healthcare data and HIPAA requirements • Mentor and guide implementation-level developers as the team grows • Ship production systems—this isn't a strategy-only role; you'll write code and deploy real solutions

• Lead and manage the consolidated month-end close process across all legal entities, ensuring accuracy, timeliness, and alignment with GAAP. • Ensure Health Admins maintains a state of continuous audit readiness and full compliance with applicable accounting standards and regulatory requirements. • Serve as the accounting subject-matter expert across the M&A lifecycle — from target evaluation through post-close integration. • Act as the accounting representative in systems integration and ERP projects, ensuring financial data integrity is preserved and accounting workflows are properly configured. • Coordinate multi-entity, multi-jurisdiction tax compliance, working with external advisors to ensure timely and accurate filings. • Oversee Finance's role as an operating function in the billing, collections, and escrow management lifecycle. • Maintain complete, accurate, and client-ready accounting records for all TPA customers administered by Health Admins. • Build, manage, and develop an accounting team capable of supporting the company's growth trajectory.

• Review and process medical claims submitted by members or providers promptly and accurately. • Verify the accuracy and completeness of claim information, including patient demographics, diagnoses, procedures, and billing codes when available. • Ensure compliance with insurance policies and industry standards. • Investigate and resolve any discrepancies or issues related to claim submissions. • Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities. • Analyze claim documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies. • Research complex medical billing and coding issues to support claims processing and audit activities. • Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate claim adjudication. • Provide recommendations for improving claims submission procedures and enhancing reimbursement accuracy. • Serve as members' primary point of contact regarding claims inquiries and resolution. • Respond promptly to customer inquiries and concerns with professionalism and empathy. • Collaborate with cross-functional teams to address customer issues and ensure timely resolution.

• Ownership Mapping & Process Documentation • Policy-to-System Translation & Change Management • Cross-System Reconciliation & Analysis • Payment Integrity & Leak Detection • Revenue Validation • Escrow Operations & Governance • Decline Management & Payment Resolution • System Change Review & IT Guardrails • New Client Financial Onboarding • Exception Management & Escalation

• Own the engineering team: manage daily scrums, lead weekly team meetings, and set direction on priorities, blockers, and technical approach • Define and drive the organization's AI and technology strategy, including platform selection, architecture patterns, and build-vs-buy decisions • Design and own AI/ML architecture across cloud platforms (AWS Bedrock, Google Vertex AI), establishing standards for RAG implementations, agent orchestration, and model selection • Contribute directly to production codebases; this is a hands-on role, not management from a distance • Architect agentic systems using modern patterns: MCP (Model Context Protocol), tool-use, function calling, and multi-step orchestration frameworks • Own the full data quality pipeline upstream of RAG: document ingestion architecture, parsing strategies, chunking methodology, and continuous iteration based on retrieval performance • Define and implement observability strategy, evaluation frameworks, production metrics, drift detection, and quality monitoring for deployed AI systems • Own cost optimization: model selection tradeoffs, token economics, usage monitoring, and budget forecasting at enterprise scale • Hire, mentor, and develop engineers; build a high-performing team culture that balances speed with code quality and system longevity • Establish and refine engineering processes: CI/CD pipelines, git workflow standards, SDLC documentation, code review practices, and onboarding programs • Develop AI-assisted development workflows and tooling that create a multiplying effect on team productivity • Define guardrails, compliance patterns, and scalability strategies for AI systems handling PHI • Collaborate with Operations, Compliance/Legal, and business stakeholders to identify, prioritize, and deliver AI use cases • Ensure all engineering and AI implementations comply with HIPAA and organizational data governance requirements • Report to the CTO on team performance, technical direction, and strategic roadmap

• Ownership Mapping & Process Documentation • Document and maintain clear accountability for every step of the payment lifecycle, from initiation through bank reconciliation. • Map and formally document who is accountable for each segment of the payment journey across all systems and teams. • Identify gaps where no named owner exists and work with the Operations and Finance to resolve ambiguity. • Policy-to-System Translation & Change Management • Translate complex financial rules into actionable system requirements and serve as the communication bridge between Finance, Operations, and IT. • Partner with the Financial Controller to document governing policies (contribution-to-coverage eligibility, escrow governance, revenue recognition, exception authority, delinquency and reinstatement rules) and convert each into clear If/Then logic. • Own the validation loop: when a process or system change is deployed, verify it operates as designed through structured testing and parallel runs. • When it breaks, diagnose the root cause and re-validate. • Serve as the primary change communication point. • Cross-System Reconciliation & Analysis • Execute monthly reconciliation processes across all financial systems, investigate variances, and produce analytical reporting. • Payment Integrity & Leak Detection • Proactively audit financial systems to identify payment failures and billing anomalies that create financial exposure. • Develop and maintain dashboards or reporting views that surface payment integrity risks on a weekly cadence. • Revenue Validation • Ensure administrative fee draws are calculated against settled, stable payment data and flag variances before they flow into financial reporting. • Escrow Operations & Governance • Execute day-to-day escrow account operations while maintaining fiduciary controls and proper segregation of duties. • Decline Management & Payment Resolution • Own the full decline lifecycle as a structured, data-driven process—from detection through resolution.

• Ownership Mapping & Process Documentation • Policy-to-System Translation & Change Management • Cross-System Reconciliation & Analysis • Payment Integrity & Leak Detection • Revenue Validation • Escrow Operations & Governance • Decline Management & Payment Resolution • System Change Review & IT Guardrails • New Client Financial Onboarding • Exception Management & Escalation

• Develop and execute a strategic sales plan to grow Health Admins' self-funded solution offerings nationally, with territory defined by existing and developing broker relationships. • Build, cultivate, and maintain strong relationships with brokers and benefits consultants across the country to generate new business opportunities. • Serve as a trusted advisor to brokers and prospective employer clients, educating them on the value of Health Admins' self-funded plans and Smart Healthcare Platform. • Manage the full sales cycle from prospecting and proposal development through negotiation and close. • Collaborate with internal teams — including underwriting, operations, account management, and marketing — to deliver tailored solutions that meet client needs. • Monitor market trends, competitor activity, and regulatory changes within the self-funded space to identify opportunities and refine go-to-market strategies. • Represent Health Admins at industry conferences, broker events, and networking functions. • Track and report on pipeline activity, sales forecasts, and performance metrics to senior leadership. • Contribute to the development of sales collateral, presentations, and RFP responses.

• Ownership Mapping: Formally document who is accountable for every step of the payment journey from initiation to bank reconciliation. • Policy Translation: Convert complex financial rules into clear If/Then logic for Technology to build into the system correctly. • System Reconciliation: Perform monthly three-way matches between merchant processors, escrow bank accounts, and the member database. • Leak Detection: Audit the system weekly to find never-initiated payments. • Revenue Validation: Ensure administrative fee draws are calculated against settled, stable contribution data. • Escrow Governance: Oversee fiduciary bank accounts to ensure proper segregation of duties and authorized fee-draw workflows. • Decline Management: Move payment failure investigations from Member Services to a structured, data-driven Accounting process. • IT Guardrails: Act as the final financial sign-off for system updates that touch the payment lifecycle. • New Client Standards: Define the mandatory financial data requirements for new clients. • Exception Oversight: Standardize the approval process for high-dollar write-offs, refunds, and retroactive coverage reinstatements.

• Ownership Mapping • Policy Translation • System Reconciliation • Leak Detection • Revenue Validation • Escrow Governance • Decline Management • IT Guardrails • New Client Standards • Exception Oversight