Edifecs is a leading healthcare technology company with the mission to improve healthcare outcomes, reduce costs and accelerate innovation. In a world that includes hundreds of millions of consumers and millions of care delivery sites and people, we deliver a single point solution to connect to all information exchange partners and to ingest, correlate and optimize digital health data.

We are disruptors, scientists, data nerds, doctors and artists. And we believe information technology can revolutionize healthcare.

Our Story
Early in his career, Sunny Singh realized that there had to be a better, more accurate way to track and process information. He understood the need for data processing technology that would save vast man-hours, money and paperwork. In 1996, he drew $200,000 on his savings and credit cards and, working from a small room in his condo in Issaquah, developed and launched Edifecs’ First product – SpecBuilder. When HIPAA was introduced, the code was reworked to include its specifications and demand for SpecBuilder soared.

Today, Edifecs is one of the fastest growing companies in healthcare IT. We are a profitable, debt-free multinational company with over 350 customers serving more than 215 million lives.

Our Values
Our corporate credo is passion, innovation, integrity, wisdom, collaboration and respect. These beliefs have helped us create a vibrant company culture where innovation and creativity flourish and careers thrive. Our commitment to these values distinguishes us from the competition. And we apply them relentlessly to help improve the healthcare system, better serve our clients, and to take care of our planet and one another.

Customers & Partnerships
Our customers lead the industry using Edifecs software—to manage healthcare coverage for more than 200 million people in the US. Our customer include:

• Over 350 healthcare customers internationally
• Over 50 non-healthcare customers internationally
• 73% of the BlueCross BlueShield plans, covering 39 U.S. states
• 60% of the US Medicaid program
• 50 of the largest commercial health plans, managing 82 million members across the United States
• 70 provider organizations across 23 U.S. states

Our Financial Strength and Growth

• Rated A+ by the Better Business Bureau

We are seeking a highly skilled and motivated individual to join our team as a Sr. Business (Risk & Quality). In this role, you will be responsible for ensuring the success of risk and quality management initiatives while analyzing business data to identify care gaps and opportunities for improvement.

What you will do:

• Manage and oversee risk and quality management programs to ensure compliance with industry standards and regulations.
• Collaborate with cross-functional teams to develop and implement strategies for mitigating risks and improving quality of care.
• Conduct regular audits and assessments to identify areas of improvement and recommend corrective actions.
• Analyze business data and performance metrics to identify care gaps and opportunities for optimization.
• Develop and maintain reports and dashboards to track key performance indicators and communicate insights to stakeholders.
• Work closely with stakeholders to prioritize initiatives and drive continuous improvement in risk and quality management processes.
• Provide support and guidance to operational teams to ensure adherence to best practices and standards.
• Stay updated on industry trends and best practices in risk and quality management to inform decision-making and drive innovation.

What you will bring:

• Bachelor's degree in business administration, healthcare management, or related field; advanced degree preferred.
• Proven experience in risk and quality management within the healthcare industry.
• Strong analytical skills with the ability to interpret complex data and generate actionable insights.
• Excellent communication and interpersonal skills with the ability to collaborate effectively with cross-functional teams.
• Experience with business intelligence tools and data visualization techniques.
• Ability to prioritize and manage multiple projects simultaneously in a fast-paced environment.
• Strong attention to detail and a commitment to delivering high-quality results.
• Knowledge of healthcare regulations and compliance requirements.
• Certification in risk management or quality improvement (e.g., Certified Professional in Healthcare Risk Management - CPHRM) is a plus.