I can give you an ex-insiders perspective. There tends to be a bit of a divide in the people who drift into staffing these companies. Most are highly intelligen

I can give you an ex-insiders perspective. There tends to be a bit of a divide in the people who drift into staffing these companies. Most are highly intelligent, and at least have an appreciation for the logistics behind the business process. There's going to be a functional piece somewhere sitting in the midst of the datasets, and making the best decisions possible. The dividing line I personally witnessed though was the finance first vs. patient outcome first people. The patient outcome first people tend to congregate in areas like CS, clinical, QA, compliance, etc... They realize it's a complex space, a lot of data to sift through and learn from, but are constantly working to make sure people ultimately get what they need. The finance first group are sort of the opposite. They're doing everything they can to target Fraud/Waste/Abuse, not necessarily to the exclusion of patient outcome, but the priorities are 100% different. The problem is the output of their analysis tends to turn into inputs for the Prior Auth, formulary management, and claim denial logic, which, lets call that what it is: population scale social engineering to the end of nudging people to save money for the company. The "surprised pikachus" are probably the finance first/raw number crunchers who have never had a number bite back in their life. The people who are actually concerned with patient outcome already know exactly what's going on, and are completely unsurprised. It's really Upton Sinclair's wisdom at work: It is hard to get a man to understand that which his salary depends on him not understanding.