Become a part of our caring community Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative 2, where you will play a critical role in addressing client concerns and denials. You will perform thorough reviews of clinical documentation to assess whether grievances, appeals, or additional requests are justified. Then, you will provide final determinations utilizing your expertise and collaboration with clinical and other Humana teams. Your contributions will directly support Humana's commitment to delivering high-quality service and making a positive difference in the lives of those we serve. Must be passionate about contributing to an organization focused on continuously improving consumer experiences. Key Responsibilities: Assign cases to team members for submission to an independent entity for 2nd level review. Monitor and record the number of cases assigned to the team, as well as the distribution of cases among individual associates. Operate within established guidelines to maintain work expectations and quality standards, while exercising discretion in prioritizing tasks and managing timelines with minimal supervision. Demonstrate flexibility and resilience in adapting to evolving processes and a fast-paced work environment. Use your skills to make an impact Required Qualifications Minimum of 1 year of customer service experience Minimum of 1 year of data entry experience Experience in a production-driven environment Must have strong experience using multiple Microsoft systems simultaneously (Teams, SharePoint, Excel, etc.) Ability to manage large volume on inventory daily Preferred Qualifications Previous inbound call center or related customer service experi
Jobs in United States
Member Of Applied Ai Architect Mumbai in United States
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Become a part of our caring community The Market Finance Lead is a key member of the Gulf South Region’s finance team responsible for connecting market financial performance with operational effectiveness. This role will partner closely with Corporate Finance, Network Performance, Network Contracting, and regional Health Services teams. This individual will manage a team covering a diverse set of responsibilities around Medicare Advantage financial business operations with a heavy focus on value-based providers. This role reports to the Market Finance Director. This role analyzes financial results, claims experience, utilization trends, contract performance, membership, and provider performance data to identify opportunities, influence business decisions, and support market growth and operational improvement. The Market Finance Lead will partner closely with regional leadership, actuarial, corporate finance, clinical, risk adjustment, market operations, network performance, network contracting, sales/MarketPoint, and value-based care providers. This individual will translate complex financial and operational data into meaningful insights, recommendations, and action plans that improve performance across the market. As the Market Finance Lead, you will: Manage a team to review value-based providers’ financial performance, membership, cost and utilization trends, contractual results, and opportunities for improvement. Lead the financial portion of provider engagement prep sessions prior to joint operating committee meetings to advise the Network Performance team on contract performance and opportunities for improvement. Lead analysis and reporting related to value-based provider and contract performance, including financial results, utilization, claims experience, membership, and operational trends. Leverage data analytics, business ins
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Title: Medical Social Worker Company: Oak Street Health Role Description: The Medical Social Worker is a key member of Oak Street Health Centers, contributing a unique and valuable perspective to care teams to support the psychosocial needs of our patients. In collaboration with the interdisciplinary care team, they will provide assessments, advocacy, and comprehensive care coordination services to our highest-risk patients and their caregivers to help them improve their health status and avoid hospitalizations. Core Responsibilities: Proactively support our highest-need patients by providing comprehensive assessments, telephonic check-ins, and in-person visits. Partner with the patient and their support persons (if necessary) to identify goals, increase engagement in their healthcare, address barriers, and drive the execution of their care plan. Maintain extensive knowledge of community resources and make referrals, as appropriate, to help ensure the patient's healthcare and psychosocial needs are met. Navigate patient insurance benefits in collaboration with the Patient Relations Manager (PRM) to ensure mindful utilization and maximization of plan benefits Provide both longitudinal and episodic comprehensive care coordination with the ultimate goal of empowering patients to independently manage
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Title: Medical Social Worker Company: Oak Street Health Role Description: The Medical Social Worker is a key member of Oak Street Health Centers, contributing a unique and valuable perspective to care teams to support the psychosocial needs of our patients. In collaboration with the interdisciplinary care team, they will provide assessments, advocacy, and comprehensive care coordination services to our highest-risk patients and their caregivers to help them improve their health status and avoid hospitalizations. Core Responsibilities: Proactively support our highest-need patients by providing comprehensive assessments, telephonic check-ins, and in-person visits. Partner with the patient and their support persons (if necessary) to identify goals, increase engagement in their healthcare, address barriers, and drive the execution of their care plan. Maintain extensive knowledge of community resources and make referrals, as appropriate, to help ensure the patient's healthcare and psychosocial needs are met. Navigate patient insurance benefits in collaboration with the Patient Relations Manager (PRM) to ensure mindful utilization and maximization of plan benefits Provide both longitudinal and episodic comprehensive care coordination with the ultimate goal of empowering patients to independently manage
Graphcore Director-Post Silicon Validation (Functional) Graphcore is a globally recognised leader in Artificial Intelligence computing systems. The company designs advanced semiconductors and data centre hardware that provide the specialised processing power needed to drive AI innovation, while delivering the efficiency required to support its broader adoption. As part of the SoftBank Group, Graphcore is a member of an elite family of companies responsible for some of the world’s most transformative technologies. We are opening a new AI Engineering Campus in Austin, Texas which will play a central role in Graphcore's work building the future of AI computing. We are developing the next generation of AI compute, a large-scale system-on-chip (SoC) designed to power future high-performance AI systems. Job Summary We have an exciting opportunity to be part of a collaborative, cross-functional development team validating cutting-edge, high-performance AI chips and platforms. You will play a key role in supporting new product introductions and validation. You will lead a team delivering post-silicon validation across the full AI SoC, working across silicon, firmware, and platform levels. The role requires a deep technical understanding, strong hands-on debug experience, and the ability to collaborate effectively with hardware, software, and systems engineering teams. Working within the Validation team, you will be involved with bringing first silicon to life, functionally validating it and working closely with many other teams to help it become a fully characterised and working product, reporting project status/progress to program management on a regular basis. You will have the opportunity to provide technical guidance to other engineering team members. In this role, you can leverage our experience and industry knowledge to architect and drive implementation of continuous improvements to test infrastructure and processes. Th
About the Team OpenAI’s AI Success Engineer team partners with the world’s most ambitious government & partner organizations to translate cutting edge AI into real business and mission impact for governments of all levels from Local, State, Federal, and International. We guide customers and users journey from the first time they try ChatGPT Enterprise, automate a workflow, develop and execute a new skill, and create their first agent to scaled enterprise adoption of ChatGPT, Codex, our API and other novel capabilities. Our work spans technical integration and enablement, workflow transformation, inspiring and upskilling AI literacy and confidence across the workforce, sustained program, product and new capability delivery. Most importantly, we help each member of our customer's workforce, their teams, programs and missions meet their total potential. Our government customers have vital missions, and we must meet them with game-changing technology. Every engagement is an opportunity to shape how AI changes work, productivity, and innovation. This role sits at the center of that mission. About the Role Governments work at a scale that is truly exponential on missions that are of critical importance to people, communities and nations. The AI Success Engineer role is the primary post-sales relationship for OpenAI’s most important customers. You are responsible for the end-to-end account management of critical Government and Partner customers. You will be helping Government Leaders/Partners appropriately and effectively use AI for their mission, while simultaneously investing in ensuring their people are AI-enabled and ready to advance positive outcomes that their constituents depend on them for. You will drive: the impact of our tools on their mission, account health and adoption, ensuring technical readiness, creating and executing on the deployment strategy, enabling, educating and training their workforce, identifying new use cases and upsell opportunities, and d
Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting. As a Utilization Management Registered Nurse: You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?) You will communicate with providers, members, or other parties to facilitate care and treatment. You will help deliver coordinated care for our members You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Use your skills to make an impact Required Qualifications: Must hold Compact Registered Nurse (RN) license in your state of residence Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting. Must be passionate about contributing to an organization focused on improving consumer experiences Preferr
$195.7K – $253.2K/yr
At Gilead, we’re creating a healthier world for all people. For more than 35 years, we’ve tackled diseases such as HIV, viral hepatitis, COVID-19 and cancer – working relentlessly to develop therapies that help improve lives and to ensure access to these therapies across the globe. We continue to fight against the world’s biggest health challenges, and our mission requires collaboration, determination and a relentless drive to make a difference. Every member of Gilead’s team plays a critical role in the discovery and development of life-changing scientific innovations. Our employees are our greatest asset as we work to achieve our bold ambitions, and we’re looking for the next wave of passionate and ambitious people ready to make a direct impact. We believe every employee deserves a great leader. People Leaders are the cornerstone to the employee experience at Gilead and Kite. As a people leader now or in the future, you are the key driver in evolving our culture and creating an environment where every employee feels included, developed and empowered to fulfil their aspirations. Join Gilead and help create possible, together. Job Description As an Associate Director, Global Commercial Project Management at Gilead you will report to the Senior Director, Global Commercial Project Management and will serve as the project manager of early Commercialization and Commercialization Teams (eCTs / CTs). This role will lead strategic execution and support governance while coordinating cross-functional teams and initiatives to ensure successful delivery and operational execution of their teams’ priorities. This role will primarily support Gilead’s programs in Liver and Inflammation with the opportunity to support other therapeutic areas as needed. The successful candidate will be dynamic, with excellent project management capabi
From $189K/yr
Why join us Brex is the intelligent finance platform that enables companies to spend smarter and move faster in more than 200 markets. By combining global corporate cards and banking with intuitive spend management, bill pay, and travel software, Brex enables founders and finance teams to accelerate operations, gain real-time visibility, and control spend effortlessly. Brex’s AI-native automation and world-class service eliminate manual expense and accounting tasks for customers so they can focus on what matters most. Tens of thousands of the world's best companies run on Brex, including DoorDash, Coinbase, Robinhood, Zoom, Plaid, Reddit, and SeatGeek. Working at Brex allows you to push your limits, challenge the status quo, and collaborate with some of the brightest minds in the industry. We’re committed to building a diverse team and inclusive culture and believe your potential should only be limited by how big you can dream. We make this a reality by empowering you with the tools, resources, and support you need to grow your career. Legal at Brex The Legal team helps the company grow responsibly, advocating for Brex and for the thousands of growing businesses we serve. We provide strategic advice and guidance to all Brex teams, protect Brex, advise on risk, and represent the company externally, negotiating with partners and interacting with regulators. Reimagining the financial system in a highly regulated environment requires creativity and resourcefulness, and we welcome the challenge. What you’ll do As Commercial Counsel at Brex, you will be an integral and versatile member of the Legal team and will support all aspects of the Company's commercial legal efforts. You will handle legal review and negotiation of Brex customer contracts, working closely with sales and other revenue-supporting teams to close deals efficiently while protecting the Company's interests. You'll also support vendor and partner contracting, negotiating a range of contracts that serve tea
From $220K/yr
Why join us Brex is the intelligent finance platform that enables companies to spend smarter and move faster in more than 200 markets. By combining global corporate cards and banking with intuitive spend management, bill pay, and travel software, Brex enables founders and finance teams to accelerate operations, gain real-time visibility, and control spend effortlessly. Brex’s AI-native automation and world-class service eliminate manual expense and accounting tasks for customers so they can focus on what matters most. Tens of thousands of the world's best companies run on Brex, including DoorDash, Coinbase, Robinhood, Zoom, Plaid, Reddit, and SeatGeek. Working at Brex allows you to push your limits, challenge the status quo, and collaborate with some of the brightest minds in the industry. We’re committed to building a diverse team and inclusive culture and believe your potential should only be limited by how big you can dream. We make this a reality by empowering you with the tools, resources, and support you need to grow your career. Legal at Brex The Legal team helps the company grow responsibly, advocating for Brex and for the thousands of growing businesses we serve. We provide strategic advice and guidance to all Brex teams, protect Brex, advise on risk, and represent the company externally, negotiating with partners and interacting with regulators. Reimagining the financial system in a highly regulated environment requires creativity and resourcefulness, and we welcome the challenge. What you’ll do As Commercial Counsel at Brex, you will be an integral and versatile member of the Legal team and will support all aspects of the Company's commercial legal efforts. You will handle legal review and negotiation of Brex customer contracts, working closely with sales and other revenue-supporting teams to close deals efficiently while protecting the Company's interests. You'll also support vendor and partner contracting, negotiating a range of contracts that serve tea
From $220K/yr
Why join us Brex is the intelligent finance platform that enables companies to spend smarter and move faster in more than 200 markets. By combining global corporate cards and banking with intuitive spend management, bill pay, and travel software, Brex enables founders and finance teams to accelerate operations, gain real-time visibility, and control spend effortlessly. Brex’s AI-native automation and world-class service eliminate manual expense and accounting tasks for customers so they can focus on what matters most. Tens of thousands of the world's best companies run on Brex, including DoorDash, Coinbase, Robinhood, Zoom, Plaid, Reddit, and SeatGeek. Working at Brex allows you to push your limits, challenge the status quo, and collaborate with some of the brightest minds in the industry. We’re committed to building a diverse team and inclusive culture and believe your potential should only be limited by how big you can dream. We make this a reality by empowering you with the tools, resources, and support you need to grow your career. Legal at Brex The Legal team helps the company grow responsibly, advocating for Brex and for the thousands of growing businesses we serve. We provide strategic advice and guidance to all Brex teams, protect Brex, advise on risk, and represent the company externally, negotiating with partners and interacting with regulators. Reimagining the financial system in a highly regulated environment requires creativity and resourcefulness, and we welcome the challenge. What you’ll do As Commercial Counsel at Brex, you will be an integral and versatile member of the Legal team and will support all aspects of the Company's commercial legal efforts. You will handle legal review and negotiation of Brex customer contracts, working closely with sales and other revenue-supporting teams to close deals efficiently while protecting the Company's interests. You'll also support vendor and partner contracting, negotiating a range of contracts that serve tea
From $220K/yr
Why join us Brex is the intelligent finance platform that enables companies to spend smarter and move faster in more than 200 markets. By combining global corporate cards and banking with intuitive spend management, bill pay, and travel software, Brex enables founders and finance teams to accelerate operations, gain real-time visibility, and control spend effortlessly. Brex’s AI-native automation and world-class service eliminate manual expense and accounting tasks for customers so they can focus on what matters most. Tens of thousands of the world's best companies run on Brex, including DoorDash, Coinbase, Robinhood, Zoom, Plaid, Reddit, and SeatGeek. Working at Brex allows you to push your limits, challenge the status quo, and collaborate with some of the brightest minds in the industry. We’re committed to building a diverse team and inclusive culture and believe your potential should only be limited by how big you can dream. We make this a reality by empowering you with the tools, resources, and support you need to grow your career. Legal at Brex The Legal team helps the company grow responsibly, advocating for Brex and for the thousands of growing businesses we serve. We provide strategic advice and guidance to all Brex teams, protect Brex, advise on risk, and represent the company externally, negotiating with partners and interacting with regulators. Reimagining the financial system in a highly regulated environment requires creativity and resourcefulness, and we welcome the challenge. What you’ll do As Commercial Counsel at Brex, you will be an integral and versatile member of the Legal team and will support all aspects of the Company's commercial legal efforts. You will handle legal review and negotiation of Brex customer contracts, working closely with sales and other revenue-supporting teams to close deals efficiently while protecting the Company's interests. You'll also support vendor and partner contracting, negotiating a range of contracts that serve tea
$105.1K – $161.8K/yr
Senior Visual Designer Description - HP is seeking an exceptional Senior Visual Designer to elevate the visual experience across consumer printing products and services used by millions of customers worldwide. This role will define and deliver visual design across HP’s ecosystem, combining design excellence, strategic thinking, technical expertise, and user insight to create innovative, user-centered solutions while mentoring designers and strengthening collaboration. As a senior member of the design organization, you will apply visual design expertise, systems thinking, and customer empathy to create intuitive, engaging, and differentiated experiences that strengthen HP’s brand and support measurable business outcomes. You will work closely with cross-functional partners to help shape the next generation of connected print experiences. Core Responsibilities Visual Experience Design Create high-fidelity user interface designs for across web, mobile, and printer front-panel platforms. Develop visual concepts, layouts, illustrations, iconography, motion graphics, and interaction patterns that elevate the customer experience. Customer-Centered Design Collaborate with User Experience designers, marketing, program managers, and engineers to deliver world-class product experiences. Coordinate with development teams to ensure feasible, well-implemented design solutions. Deliver wireframes, prototypes, specifications, style guides, and other high-quality visual assets. Design Systems & Brand Excellence Contribute to HP's design systems, visual standards, and component libraries. Ensure consisten
Job Title Field Service Engineer - Medical Imaging (Metro NYC / Tri-State Area) Job Description Field Service Engineer - Medical Imaging (Metro NYC / Tri-State Area) You will be responsible for customer relationship management through the effective use of technical knowledge to install, troubleshoot, service, and maintain equipment at customer sites nationally. The ideal candidate will be able to travel nationally but will be located in the greater New York City area. We expect this FSE to live within a 45-minute commute to Manhattan, with travel to other sites as required. Your role: Deliver exceptional customer service by setting clear expectations, meeting commitments and arrival times, and resolving customer issues efficiently. Build strong customer relationships by understanding their business environment while contributing to service revenue growth. Collaborate as an active member of the regional team to improve processes, identify training gaps, and share best practices. Continuously expand capabilities by learning new tools and becoming qualified across multiple modalities as needed. Complete all required administrative and compliance tasks in accordance with company, state, and federal regulations. This includes accurate documentation for timesheets, service work orders, expense reports, PMs, FCOs, installations, and adherence to quality and safety standards. Diagnose and resolve electronic, mechanical, and network-related system issues using established tools, resources, and escalation processes. Perform preventative maintenance, field changes, installations, and corrective service within required timeframes. Travel extensively (approximately 90%) with the ultimate focus being in the assigned territory to support customer sites, but will require overnight stays and air travel nationwide
$130.7K – $205.2K/yr
AI Solution Engineer Description - We are seeking an innovative and results-driven AI Solution Engineer to design, develop, and deploy next-generation AI-powered solutions that transform document workflows, business processes, and customer experiences. This role will leverage technologies such as Artificial Intelligence (AI), Large Language Models (LLMs), Natural Language Processing (NLP), AI Agents, Computer Vision, and Edge AI to create intelligent solutions for enterprise customers. As a key member of the imaging team, you will work closely with product management, imaging and software architects, and development partners to prototype, develop, integrate, and deploy imaging algorithms and scalable AI solutions that deliver measurable business value. You will help identify emerging technology opportunities, translate customer and business requirements into innovative products, and bring new imaging and AI-enabled capabilities to market. The ideal candidate combines strong software engineering skills with hands-on experience in AI application development, image science, machine learning technologies, and cloud-based services. You are passionate about innovation, thrive in a collaborative environment, and enjoy solving complex business challenges through technology. Responsibilities: Design, develop, and deploy AI-powered applications and solutions that improve productivity, automate workflows, and enhance customer experiences. Prototype and evaluate emerging technologies, including Large Language Models (LLMs), Natural Language Processing (NLP), AI Agents, Computer Vision, and Edge AI solutions. Develop intelligent document workflow solutions that leverage AI to extract insights, automate decisions, and streamline business processes. Collaborate with product managers, architects, and engine
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