Prior Authorization Representative in United States

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. Job Summary The Representative I is the initial point of contact for Prior Authorization requests from members, providers, and a diverse customer base. The Rep I will make the determination if a complex request should be transferred to a pharmacist for assistance. Additionally, the Rep I is responsible for maintaining complete, timely, and accurate documentation of all approvals and denials. In order to be successful in this role you will need proficiency pronouncing drug names and diagnosis and recognizing medical terminology. As well as navigating multiple software systems to document conversations and outcomes, which require keyboarding skills. This position requires schedule flexibility including rotations through nights, weekend and holiday coverage. Required Qualifications - 1 year experience in customer service or call center environment - Must be able to work from home - Have high speed internet Preferred Qualifications - Previous experience in pharmacy or healthcare industry. - Associate's or Bachelor's Degree. Pharmacy Technician License Education High School Diploma or equivalent GED Anticipated Weekly Hours 40 <p sty

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. Position Summary This position is for a Clinical Pharmacist working in the Prior Authorization team. - Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. - Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. - One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes. - Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations. - Establishes and maintains communicat

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. Position Summary - Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews. - Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation. - Reviews potential prior authorization denial language to ensure NCQA requirements are met. - Follows prior authorization workflow, policies, and procedures during the course of the workday. - Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions. - Maintains a balance of productivity, quality and timeliness of work. - Participates in training and continuing education as required. - Participates in team/departmental meetings as required. - Excellent attendance is a must. - Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions. - Successful pharmacy technicians will possess good written and verbal communication

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. Position Summary The Technician I is the initial point of contact for Prior Authorization requests from members, providers, and a diverse customer base. The Tech I will make the determination if a complex request should be transferred to a pharmacist for assistance. Additionally, the Tech I is responsible for maintaining complete, timely, and accurate documentation of all approvals and denials. In order to be successful in this role you will need proficiency pronouncing drug names and diagnosis and recognizing medical terminology. As well as navigating multiple software systems to document conversations and outcomes, which require keyboarding skills. This position requires schedule flexibility including rotations through nights, weekend and holiday coverage. Required Qualifications - 1 year experience in customer service or call center environment - Must be able to work from home - Have high speed internet Preferred Qualifications - Previous experience in pharmacy or healthcare industry. - Associate's or Bachelor's Degree. Pharmacy Technician License Education High School Diploma or equivalent GED Anticipated Weekly Hours 40<p style="text

At Vanta, our mission is to help businesses earn and prove trust. We believe that security should be monitored and verified continuously, and we empower companies to practice better security and prove it with ease. Vanta has a kind and talented team, and while some have prior security experience, many have been successful at Vanta without it. Vanta for Government (V4G) is how we bring that mission to the public sector. As federal compliance undergoes its biggest shift in a decade — FedRAMP 20x, machine-readable authorization, OSCAL — we're building the platform that turns federal frameworks into automated, continuously monitored product experiences. The GRC Subject Matter Experts on this team are the people who make that possible. As Vanta's GRC Subject Matter Expert for V4G , you'll own federal compliance content used by every customer pursuing or maintaining federal authorization on our platform. This is an interpretation-and-authoring role, not a compliance program administration role: your job is to interpret underlying control requirements, identify where FedRAMP modifies or constrains the NIST framework, and translate those interpretations into precise, technically testable guidance that engineering can build and customers can act on. The content you write ships as product — a five-person startup and a Fortune 100 CSP both receive it — so calibrating depth, precision, and universality is the core craft. You'll join Vanta's Security organization, which directly influences product development, facilitates the creation of automated GRC solutions for customers, and provides expert advisory services across the company. What you’ll do as a V4G GRC SME at Vanta: Build and own federal compliance frameworks — Lead the creation, enhancement, and lifecycle management of controls, evidence requirements, and implementation guidance for FedRAMP (Low/Moderate/High), NIST SP 800-53, NIST SP 800-171, CMMC, DFARS, and StateRAMP. Author clear control rationales, acceptance crite

At Vanta, our mission is to help businesses earn and prove trust. We believe that security should be monitored and verified continuously, and we empower companies to practice better security and prove it with ease. Vanta has a kind and talented team, and while some have prior security experience, many have been successful at Vanta without it. Our Software Engineers build and own high-value products for our customers and the infrastructure that lets our business scale. Vanta's team and technology surface are growing quickly, and it's essential that we invest in the right abstractions and systems to scale with our business. As a Software Engineer, you'll build and own full-stack features and platform primitives across our stack, work closely with the teams and partners who depend on what you ship, and grow into broader technical ownership. Your work will directly accelerate Vanta's growth. Our business has found incredible product-market fit and has monetized effectively since the day we signed our first customer. We're growing at a blistering pace, which presents career-defining opportunities for engineers to accelerate their growth and to contribute to a rapidly-scaling company. Visit our Vanta Engineering Blog to learn more about what our team is working on! The Integrations Platform team within Vanta Government Cloud mission is to power the world's largest trust automation ecosystem, enabling any person or agent to build, connect, and automate trust seamlessly. Federal compliance is going through its biggest shift in a decade and this team builds the integration platform underneath Vanta Government Cloud that turns federal frameworks into automated, continuously monitored product experiences. This is a builder role: you'll turn federal control requirements into the platform primitives and integrations that make continuous authorization real. We own Vanta's integration ecosystem within the US Government Cloud, which currently includes a growing set of integrations

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. Position Summary As the Senior Lead Coordinator you will be responsible for implementing and maintaining comprehensive billing review processes. You will identify and quantify trends/issues and effectively communicate/report them to the appropriate members of the management team and payer business partners along with the potential impact. You will assist leadership in building and maintaining a high performing highly engaged team. In this role you will also provide excellent mentorship and support to your colleagues as well as design and implement training classes. The key responsibilities of the Medical Revenue Cycle Senior Lead Coordinator are: Review and analyze patient profiles, benefits, and prior authorizations to identify potential issues affecting clean claims. Collaborate with clinical and administrative teams to ensure accurate documentation is maintained and available for claims processing. Monitor claims submissions and follow up on pending claims to expedite resolution and payment. Identify trends in claims denials and develop strategies for improvement. Conduct training sessions for staff on best practices for claims submissions and compliance. Maintain up-to-date knowledge of insurance policies, regulations, and healthcare trends that impact claims

MongoDB is hiring a Staff Product Marketing Manager to build and own our go-to-market narrative for the Public Sector vertical, with a focus on Federal Government and the broader public sector market. This is a foundational hire for MongoDB’s Industry Verticals product marketing function: you will define how MongoDB’s unified data platform, spanning cloud, on-premises, and hybrid database deployments with integrated, production-ready AI capabilities, shows up for government buyers. You’ll turn a major compliance milestone into a durable competitive differentiator: developing the positioning, messaging, and sales-ready content that helps government agencies, systems integrators, and cloud/public-sector resellers understand why MongoDB is the right data platform for mission-critical, regulated workloads. You do not need prior government or public-sector work experience to succeed in this role — you need to be an excellent product marketer who can get fluent in a new domain quickly and partner closely with the compliance, product, and sales experts who already are. This role can be based in one of our MongoDB hub offices in the U.S. or remotely in the U.S. What you’ll do Own positioning and messaging for MongoDB’s Public Sector go-to-market, leading the federal GTM and launch related activities Translate MongoDB’s data platform capabilities — document database, search, vector search, stream processing, and integrated AI — into mission-relevant outcomes and value propositions for government buyers and the systems integrators who serve them Partner with Compliance, Security, Industry Solutions and Product teams to accurately represent related certification requirements in external-facing content, staying current as MongoDB pursues additional authorizations (e.g., DoD Impact Levels) Build the public sector sales enablement toolkit: battlecards, pitch decks, discovery guides, ROI/value models, and competitive intelligence tailored to federal buying processes and procuremen

Every day, tens of millions of people come to Roblox to explore, create, play, learn, and connect with friends in 3D immersive digital experiences– all created by our global community of developers and creators. At Roblox, we’re building the tools and platform that empower our community to bring any experience that they can imagine to life. Our vision is to reimagine the way people come together, from anywhere in the world, and on any device. We’re on a mission to connect a billion people with optimism and civility, and looking for amazing talent to help us get there. A career at Roblox means you’ll be working to shape the future of human interaction, solving unique technical challenges at scale, and helping to create safer, more civil shared experiences for everyone. As a Strategic Sourcing Manager you will lead the contract and pricing negotiations of software and tools. In addition, you will work with cross-functional teams to ramp efficiently. You will demonstrate domain expertise in software licensing modeling and contract negotiations. You Will: Assist and support stakeholders with the vendor review process for BATNA purposes and articulating business justification. Demonstrate ability to analyze and interpret spend and cost data, including understanding of Total Cost of Ownership Work collaboratively across Roblox and particularly within the Roblox Corp Eng organization. Work closely with stakeholder teams to forecast the Technology needs for our rapidly growing company Showcase your strong contracting experience and understanding of business risks and address them on legal documents with potential suppliers. Work with our Legal team to manage the review and approval of Master Service Agreements, Terms of Service, NDAs, and End User License Agreements with our vendors prior to business being initiated. Drive price and term negotiation processes to ensure that Roblox’s pricing is best in class and with risks mitigated on contract Drive

About the Team The Personalization-Memory team, within OpenAI's broader Personal AGI organization, is focused on developing agents that can learn from prior interactions in order to become more helpful and efficient over time. We build general-purpose memory and personalization capabilities that transfer across ChatGPT and other agentic products, and we collaborate with applied engineering on the product surfaces that allow users to interact with memory. About the Role As a Research Engineer / Research Scientist on the Personalization-Memory team, you will research and develop improvements to memory usage and personalization in OpenAI's frontier models. Our team works on reinforcement learning, dataset creation, evaluations, and other post-training methods. We partner closely with research and product teams across the company to realize the vision of a truly personalized ChatGPT. We're looking for individuals who have a background in frontier model post-training, are able to iterate quickly, and who are passionate about product-driven research. This role is based in San Francisco, CA. We use a hybrid work model of 3 days in the office per week and offer relocation assistance to new employees. In this role, you will: Own and pursue a research agenda for improving memory use and personalization in frontier models. Build robust evaluations for tracking modeling improvements. Design, implement, test, and debug code across our research stack. Collaborate closely with the research and product teams to influence the shape of technical solutions in the product. You might thrive in this role if you: Are passionate about personalization and building personalized assistants. Have experience working with user signals and human data to turn feedback into reliable signals for training and evaluation. Have a deep understanding of frontier model post-training and machine learning applications. Value principled approaches and research craftsmanship. Are comfortable diving into a lar

About the Team The Personalization-Memory team, within OpenAI's broader Personal AGI organization, is focused on developing agents that can learn from prior interactions in order to become more helpful and efficient over time. We build general-purpose memory and personalization capabilities that transfer across ChatGPT and other agentic products, and we collaborate with applied engineering on the product surfaces that allow users to interact with memory. About the Role As a Research Engineer / Research Scientist on the Personalization-Memory team, your work will span memory architecture, post-training, and developing long-horizon tasks for training and evaluations. We're looking for individuals who have a background in reinforcement learning research, are able to iterate quickly, and who can convert scientific rigor and long-term research into realized product impact. This role is based in San Francisco, CA. We use a hybrid work model of 3 days in the office per week and offer relocation assistance to new employees. In this role, you will: Own and pursue a research agenda for improving long-horizon memory and personalization in frontier models. Build robust evaluations for tracking modeling improvements. Design, implement, test, and debug code across our research stack. Collaborate closely with the research and product teams to influence the shape of technical solutions in the product. You might thrive in this role if you: Love being on the cutting edge of RL and frontier model research. Value principled approaches and research craftsmanship. Are passionate about long-horizon tasks, memory, and turning your research into product impact. Are comfortable diving into a large ML codebase to debug. Thrive in a fast-paced, dynamic, and technically complex environment. About OpenAI OpenAI is an AI research and deployment company dedicated to ensuring that general-purpose artificial intelligence benefits all of humanity. We push the boundaries of the capabilities of AI syst

At Vanta, our mission is to help businesses earn and prove trust. We believe that security should be monitored and verified continuously, and we empower companies to practice better security and prove it with ease. Vanta has a kind and talented team, and while some have prior security experience, many have been successful at Vanta without it. As a Senior Product Designer, Agent Experience at Vanta, you will define how AI agents help security and compliance teams accomplish meaningful work with greater clarity, control, and trust across Vanta and the surfaces where our customers already work. The Agent Experience team builds agent-led experiences that help security and compliance teams achieve outcomes with less manual effort. The team owns the agent harness, including agents, skills, tools, and memory, as well as the patterns that help customers understand, guide, review, correct, and trust agent-generated work. Our goal is to make AI-powered workflows useful, transparent, and dependable in a product where clarity and correctness matter. As a Senior Product Designer on this team, you will shape both the underlying agent experience and the customer-facing workflows built on top of it. You will partner with Product, Engineering, Research, Data, AI Quality, and customer-facing teams to turn ambiguous problems into thoughtful, scalable, and trustworthy experiences. The patterns you establish will influence product teams across Vanta. What you’ll do as a Senior Product Designer, Agent Experience at Vanta: Lead end-to-end design for projects across the agent harness, from problem framing and discovery through launch and iteration. Define how agents, skills, tools, and memory are composed, surfaced, and understood by customers. Design experiences that help customers delegate real security and compliance work while maintaining visibility, control, and confidence. Create patterns for reviewing, correcting, approving, interrupting, and recovering from agent-generated work. De

Cote Korean Steakhouse, located in the Miami Design District, is the carnivorous vision of proprietor Simon Kim that blends together the dining experience of Korean Barbeque together with the hallmarks of a classic American Steakhouse. Cote serves the highest quality USDA Prime beef accompanied by an impeccable 1200+ label wine list and a suite of classic-but-creative cocktails. We are professionals committed to ensuring exceptional hospitality and service to our customers. At COTE, we follow a simple mantra: 🥩 + 🔥 + 🍸 = 😊 Prep Cooks are dynamic hospitality professionals responsible for the preparation of delicious dishes by the culinary team, setting up workstations in the kitchen, and preparing ingredients for the cooking process and assisting the Chef de Cuisine (“CDC) and Sous Chefs with their daily tasks. Prep Cooks work with all members of the Back of House team to ensure a smooth continuation of service. Essential Job Duties & Responsibilities: Job duties and responsibilities include, but are not limited to the following: Sets up and sanitizes the workstations prior to starting prep work. Produces all assigned menu dishes according to the daily prep list issues by the Chefs. Measures ingredients and seasonings and prepares cooking ingredients for service. Undertakes basic cooking duties such as cutting, slicing, peeling, monitoring stock levels, reducing sauces, preparing pickles and kimchi. Ensures all food and other items are stored properly and tagged, date-labeled, covered, and rotated effectively. Complies with nutrition and sanitation guidelines. Supervises food and cooling room temperatures. Labels, stocks, and organizes all ingredients on shelves for easy accessibility. Works efficiently with kitchen team members and complies with company procedures and food safety standards. Keeps utensils and equipment clean and sanitary at all times. Avoids cross contamination by adhering to preparation standards set by the CDC. Reports to

At Vanta, our mission is to help businesses earn and prove trust. We believe that security should be monitored and verified continuously, and we empower companies to practice better security and prove it with ease. Vanta has a kind and talented team, and while some have prior security experience, many have been successful at Vanta without it. Being an SDR at Vanta is, first and foremost, about hitting targets and driving revenue. But beyond that, it’s about joining a community that is deeply committed to your success and career growth. We believe that the future of our sales organization lies with our SDRs, which is why we place a strong emphasis on enablement and career advancement. You’ll receive the training, support, and mentorship you need to excel, with a clear path to advance within our sales team. Vanta is growing quickly, we're profitable, and we're continually outpacing our growth targets while maintaining very strong NPS scores. Needless to say, it's an exciting time! We're scaling our Sales Development team with customer-focused SDRs who will take ownership of our outbound sales engine and help to build pipeline as we move up market, and distinguish Vanta as best-in-class to prospects in a burgeoning competitive landscape. If this sounds like you, and you're excited to join a growing team, we'd love to hear from you. What you’ll do as a Sales Development Representative at Vanta: Have a strong understanding of Vanta’s value proposition and product Master the process of identifying strategic accounts using tools like Salesforce, ZoomInfo, Outreach, Linkedin Sales Nav, and 6Sense, that will help us move up market Organize a multi-channel approach to prospecting and and maximize efforts by developing sequences in Outreach Coordinate meetings on account executive’s calendars and log activities Efficiently and gracefully counter objections, as well as have excellent interpersonal & technical skills How to be successful in this role: Have an enthusiasm for

At Vanta, our mission is to help businesses earn and prove trust. We believe that security should be monitored and verified continuously, and we empower companies to practice better security and prove it with ease. Vanta has a kind and talented team, and while some have prior security experience, many have been successful at Vanta without it. As an Enterprise Account Executive at Vanta, you will play a critical role in expanding our footprint in the Enterprise segment through net-new logo acquisition. This is a high-impact role focused on a land and expand model, requiring a results-driven seller capable of closing 5+ six-figure opportunities per quarter. You’ll be joining a team that is building and scaling our upmarket motion, and you’ll help shape Vanta’s strategy and execution in some of our most strategic segments. This role requires someone who is equally confident navigating complex deals independently and working cross-functionally with product, engineering, and the channel. Success in this role means driving full-cycle deals from prospecting through close - both directly and through partners. At Vanta, our mission is to help businesses earn and prove trust. We believe security should be monitored and verified continuously, and we empower companies to practice better security and prove it with ease. The ideal candidate for this role at Vanta has prior security or adjacent domain experience. We’re growing quickly, continually outpacing our targets and leading the market in compliance and security. If you’re excited by the opportunity to drive strategic, high-value deals and work in a fast-paced, high-growth environment—we’d love to hear from you. What you’ll do as an Enterprise Account Executive at Vanta: Own and drive net-new business acquisition within the Enterprise segment Close 5+ six-figure opportunities per quarter, managing the full sales cycle from initial outreach through contract execution Build and maintain a strong pipeline through outbound prosp