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 Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process complex non-routine Provider Refunds and Returned Checks. Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. Review and handle relevant correspondences assigned to the team that may result in adj
Jobs in United States
Senior Solution Engineer Manufacturing in United States
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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 Senior Manager, Medicare Product Operations (NCOD) is responsible for providing leadership, operational oversight, and people management for the Non-Clinical Organization Determination (NCOD) team. This leader is accountable for ensuring accurate, timely, compliant, and member-centered coverage determinations while maintaining adherence to CMS regulations, and internal policies. The role oversees a team of managers and analysts responsible for evaluating member requests, issuing organization determinations, maintaining documentation, and supporting appeals- and grievance-related activities. This position serves as a key operational leader, driving quality, compliance, performance, process optimization, workforce development, and cross-functional collaboration. The Senior Manager partners with Compliance, Product, Appeals, Grievances, Eligibility, Technology, and vendor partners to ensure operational excellence and a best-in-class member experience. Responsibilities Include: Strategic Leadership Provides oversight for the NCOD operation, ensuring alignment with organizational goals, regulatory requirements, and member experience objectives. Establishes operational strategies, and performance standards that support long-term scalability and sustainability. Leads implementation of new NCOD workflo
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 a Digital Analytics Senior Analyst, you will work closely with product teams to evolve and improve our digital experiences for customers and patients. You will use your analytical and problem-solving skills to define success metrics and measurement approaches to ensure our digital experiences stay healthy. You will collaborate with other motivated teammates across UX, Customer Experience Management, IT, Site Optimization, Marketing and Merchandising. Required Qualifications 1+ years of relevant experience for those in a CVSH leadership program (such as DAP, Leadership development, GMDP, etc.) OR 2+ years of relevant experience for others Preferred Qualifications Knowledge of online analytics tools such as Adobe, Coremetrics, Localytics, Webtrends, etc Experience in Tableau/Power BI, SQL (Teradata, Hadoop, Google Cloud Platform, etc.) Experience with highly quantitative analytics Project oriented, pro-active, and self-motivated work style with proven ability to manage effectively multiple projects and changing priorities in an extremely fast paced environment and constantly deliver superior results within given deadlines Strengths in structured and logical thinking, problem solving, issue resolution, and attention to detail Education - Bachelor’
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 Collaborate with other Design, Product, and Development managers to ensure alignment across projects Collaborate with Design and cross functional teams to ensure Design team quality, efficiency and velocity meets team needs Develop deep understanding of customer journeys, personas and segmentation within your portfolio of projects Translate complex cognitive challenges across multiple projects into elegant user experiences delivered across multiple channels Gain stakeholder support for designs by clearly communicating design vision and rationale Conceptualize, design and define breakthrough user experiences, drawing inspiration from research, user goals, and the world around you Required Qualifications 7+ years of professional work experience Has a minimum of 5 years’ experience in Desktop, native app design, including XD and visual design Has proven experience in driving and delivering design from initial concepts to in-market experiences Has 3 ye
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 Senior Actuary - Network position within the network analytics team provides the financial tools and analytics to support network strategy in alignment with market/business growth priorities. The market-specific responsibilities will provide individuals with the opportunity to develop in-depth knowledge of market dynamics and to establish strong cross-functional relationships with key business partners, including network, MEU, and commercial actuarial teams. Additional core areas of focus include network discounts, emerging trend analytics, and pricing and contracting support. Key responsibilities will include: Discounts – Develop a quarterly, market-level discount review process to inform Regional Leads and Chief Network Officers of changes in benchmarking based on the latest view, identifying gaps and pressured areas to consider for future negotiations. Provide meaningful information to the field on the impact and expected timing of new negotiations beyond current consultant benchmarking. Emerging Trend Analytics – Engage cross-functionally with Network, MEU, and other teams to drive enhanced contract negotiation strategies using data-driven recommendations for MedRx and Behavioral Health. Pricing – provide support for Aetna Whole Health / APCN Plus (Performance Networks), joint ventures, and narrow network pricing across all
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 Senior Assistant, Print Production will be operating a computer, file prep, preflighting and scanning documents to manipulate Sign Handler files for Weekly Ad Signs for CVS retail stores. The Senior Print Production Assistant is essential to verifying the quality and accuracy of their work. Responsible for ensuring that 8,000 stores receive their weekly ads. Executing all assignments that may be communicated or specified by written work orders accurately Completing assignments within required timelines based on production standard Maintaining equipment by performing preventative maintenance on a daily basis Maintaining inventory of all operational supplies such as paper, toner, tabs and other related materials needed to perform duties on a daily basis undefined Overtime may be requested due to operational need Required Qualifications 3 years of related work experience within a print production setting Preferred Qualifications Computer basic knowledge Printing background with Xerox training Equipment maintenance Math Skills Education Verifiable High School Diploma or GED required. <p style="text-align:l
Senior Test & Evaluation Engineer (Test Program Req & Planning) Company: The Boeing Company Boeing Test & Evaluation (BT&E) organization is seeking a Senior Test & Evaluation Engineer (Test Program Req & Planning) to join our team in Oklahoma City, OK . This position supports a diverse portfolio of Boeing programs including the B-1, and B-52 sustainment and modernization programs. The Engineer is responsible for supporting the Test Program Manager (TPM) and other program leadership by leading the Ground Test/Flight Test (GT/FT) Integrated Product Teams (IPTs) and ensuring the integration of Boeing Test & Evaluation (BT&E) capabilities and resources to meet program commitments. This role requires close collaboration with program IPTs, Systems Engineering Integration & Test teams, Program Offices and external developmental test organizations Position Responsibilities: Develop, prepare, and coordinate comprehensive Program Integrated Test Plans (ITP), detailed Test & Evaluation (T&E) plans, and associated documentation including requirements traceability, verification metrics, and program requirements. Lead the development and standardization of test methods, procedures, and processes to ensure repeatability, productivity, and continuous improvement through lessons learned. Integrate BT&E capabilities and resources with other IPTs, Systems Engineering, government stakeholders, industry partners, suppliers, and customers to ensure seamless test execution and alignment with program objectives. Conduct testability assessments of engineering requirements and oversee disciplined cost, schedule, and configuration management to meet program baselines and commitment
Senior Manager Company: The Boeing Company Boeing’s Global Real Estate and Facilities (GREF) organization is currently seeking a Senior Manager to lead the Facilities Management Center of Excellence (FM CoE) team at our North Charleston, SC site. The Senior Manager - Facilities Management is accountable for end-to-end oversight of facilities operations at the North Charleston site. This senior leader leads both internal and supplier-based teams, owns financial accountability for the facilities maintenance budget and processes, and partners closely with the Integrated Facilities Management (IFM) supplier. The role requires strategic collaboration with executive leadership, COEs, business partners, engineering, project management, and other service groups to ensure enterprise standards, continuous improvement, and alignment to business objectives. Position Responsibilities: Lead and manage facilities maintenance team, both internal and supplier-based, at the Charleston site Oversee day-to-day maintenance operations, emergency responses, shutdowns, and asset renewal strategies Manage facilities budgets and ensure financial accountability Collaborate with business partners, engineering, project management teams, and other COEs to support facilities initiatives Drive and influence change through leadership and collaboration, fostering a culture of continuous improvement Lead, motivate, and develop teams and managers, including conflict management and talent development Build and maintain strong relationships across CoEs, with the BRM community, FM leaders, business partners, and suppliers Manage supplier contracts and performance, ensuring alignment with Boeing’s standa
Become a part of our caring community The Senior HR Business Partner will lead the people management agenda aligned to Medicaid RFP/RFI/RFA responses. Their work will align to standing up markets and supporting current markets in collaboration with the aligned HR Business Partner Lead (HRBPL) and act as a facilitator for the company's management team. They will need to apply broad experience in various Humana Resources (HR) areas of expertise. Work assignments will involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior HR Business Partner acts as a single point of contact for a broad range of business and HR partners across the Retail segment. Work will focus cyclically on the support of Medicaid RFA/RFI/RFP responses and the subsequent stand up or change of markets and work across partners in Medicaid, HR and other shared services to ensure the successful bid and stand up/operation of new and existing plans. In addition this work is closely aligned with the work of HRPBLs on this team and others to lead a strategy that ensures the successful growth and operation of our Medicaid line of business and facilitate superior member care delivery in all states. Responsibilities will include the identification, documentation, and implementation of best practices and support of the delivery of HR processes across Medicaid. This role will be accountable for identifying gaps, proposing and implementing changes necessary to cover risks and will act as a performance improvement driver and provoke positive changes in people management, lead change management projects and facilitate HR related internal and external communication. The successful candidate will influence our department’s strategy, make decisions on moderately complex to complex issues regarding technical approach for project com
Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: Job Title Senior Medical Writer / Senior Project Manager, Clinical Evaluation Working at Abbott At Abbott, you can do work that matters, grow, and learn, care for yourself and your family, be your true self, and live a full life. You’ll also have access to: Career development with an international company where you can grow the career you dream of. Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO medical plan in the next calendar year. An excellent retirement savings plan with a high employer contribution. Tuition reimbursement, the Freedom 2 Save student debt program, and FreeU education benefit - an affordable and convenient path to getting a bachelor’s degree. A company recognized as a great place to work in dozens of countries worldwide and named one of the most admired companies in the world by Fortune. A company that is recognized as one of the best big companies to work for as well as the best place to work for diversity, working mothers, female executives, and scientists. The Oppor
Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: This is a field-based position, supporting Abbott’s Vascular division. Abbott Vascular provides innovative, minimally invasive and cost-effective products for treatment of vascular disease. Our extensive portfolio includes drug-eluting stents, guide wires, balloon dilatation catheters, imaging catheters and software, vessel closure devices, peripheral stents, thrombectomy catheters and atherectomy devices. We currently have an opportunity for a Senior Clinical Specialist, Coronary, in Minneapolis, MN . The Senior Clinical Specialist will primarily be responsible for case planning, case support coverage, and product pull- through throughout the designated territory, and throughout the Region as needed. The Senior Clinical Specialist will promote Vascular products through education, service and training of customers in the hospital setting. The Senior Clinical Specialist will provide clinical education and sales support in order to assist in achieving projected sales goals, increasing sales revenues within assigned product lines, and increasing market share. This position will have a heavy focus on Vessel Closure. What You’ll Work On Serves as the technical procedure and product expert in support of case coverage in the hospital setting. Meet with existing and potential customers (e.g., physicians, physician office groups at hospitals) to identify their clinical needs, goals, and constraints related to patient care and to discuss and demonstrate how Vascular products can
$68.6K – $114.3K/yr
Why Patients Need You Pfizer’s purpose is to deliver breakthroughs that change patients’ lives. Research and Development is at the heart of fulfilling Pfizer’s purpose as we work to translate advanced science and technologies into the therapies and vaccines that matter most. Whether you are in the discovery sciences, ensuring drug safety and efficacy or supporting clinical trials, you will apply cutting edge design and process development capabilities to accelerate and bring the best-in-class medicines to patients around the world. What You Will Achieve As a Senior Associate Scientist, you will be at the center of our operations and you’ll find that everything we do, every day, is in line with an unwavering commitment to quality. You will be part of a team to support the preclinical evaluation and early clinical development of mRNA and protein based viral vaccines. You will be responsible for performing and developing immunoassays supporting various viral programs to monitor the immune responses elicited by vaccine candidates. You will be using your scientific knowledge to adapt and develop standard methods and techniques by applying prior work experience and consulting others. You should possess a strong work ethic and collaborative spirit and be adaptable to fast-paced environments. It is your innovative scientific temperament that will help in making Pfizer ready to achieve new milestones and help patients across the globe. How You Will Achieve It Perform assays to analyze immune responses to vaccine candidates that include (but are not limited to) cell culture, neutralization assays, other functional antibody assays, Luminex, and ELISAs in BSL-2 environments. Generate, characterize and tract critical reagents for preclinical bio-functional studies to support vaccine development. Assist with preclinical bio-functional assay development and t
$68.6K – $114.3K/yr
What You Will Achieve A Senior Associate Scientist (R2) position is available in the Conjugation Process Development group of Bioprocess R&D in USA - WA - Bothell. We’re seeking a passionate and creative individual to join a dynamic team of scientists and engineers focused on developing robust, scalable, and high productivity conjugation processes for the manufacture of antibody-drug conjugates (ADCs) for early- and late-phase clinical programs. The work will also involve working with commercial and clinical production facilities to ensure accurate technology transfer and successful large-scale production. You may also be involved in cutting-edge technology development projects that seek to discover new innovations for ADC process development and/or manufacturing. How You Will Achieve It Design, plan, and execute milligram to gram-scale conjugation experiments in the development laboratory. Ensures timely, effective, and high-quality documentation in electronic laboratory notebooks and internal technical reports. Communicate results and findings to stakeholders on a regular basis; present data/strategy to colleagues and management in internal and external venues (technical meetings, project team meetings, and conferences, etc.) as appropriate. Assist in or lead the technology transfer of manufacturing processes to clinical and commercial manufacturing facilities. Provide support and troubleshoot during manufacturing campaigns as needed. Work collaboratively with colleagues both within the group and cross-functionally; contribute to maintaining and improving upon our safe, effective and efficient lab operations. Qualifications Must-Have BS/BA in Chemistry, Biochemistry, Chemical/Biochemical Engineering, or other related disciplines with 3-4 years of experience, or MS in the above fields with 0-2 years of experience.
Join a pioneering team at the forefront of financial technology innovation. We are building a cutting-edge, agentic AI platform designed to revolutionize the end-to-end credit risk model development lifecycle. By leveraging the power of Large Language Models (LLMs) and intelligent workflows, we aim to augment our quantitative modelers, dramatically increasing their productivity, enhancing model governance, and accelerating the delivery of critical risk models. We are seeking a senior, hands-on technology leader to drive this transformation. In this role, you will partner directly with quantitative analysts and key stakeholders to shape the most impactful use cases and then lead a team of talented developers to design, build, and deploy the generative AI platform that brings this vision to life. Key Responsibilities Strategic Vision & Stakeholder Partnership: Collaborate closely with quantitative model developers, Model Risk Management (MRM), and business leaders to deeply understand their pain points and translate them into a technical vision and product roadmap. Identify, scope, and prioritize use cases for the agentic workflow platform, ensuring they deliver measurable value and align with strategic objectives. Serve as the primary technical liaison between the engineering team and its users, ensuring a tight feedback loop and continuous alignment. Platform Design & Hands-On Development: Lead the architectural design of a scalable, robust, and secure agentic AI platform, including core components for orchestration, knowledge retrieval (e.g. RAG), and tool integration. Engage in hands-on software development to build foundational components, create proofs-of-concept, and tackle the most complex technical challenges. Design and implement secure integrations with internal data sources, external APIs, and various LLMs, ensuring compliance
Job Requisition ID # 26WD101304 L'affichage de poste en français suivra / The French job posting follows. 26WD101304, Senior Field Marketing Manager, Flow Position Overview Autodesk Flow is the connected platform behind how film and television get made — from the moment footage is captured on set, through review and approval, to final delivery. We are standing up a dedicated field marketing function for Flow, and this is one of its first two hires. You will build the engine that puts Flow in front of the people who choose production technology: post-production supervisors, producers, heads of production and production technology leaders. This is a builder's role. You will shape the field program from the ground up, working alongside a dedicated ABM Manager and a growing Flow sales team. You will spend real time with filmmakers and production professionals, and you will be measured on the pipeline and revenue your programs produce. Responsibilities Own the field marketing plan for Flow, translating sales and business priorities into a coherent program of events, partner activity and digital demand Design and run small, high-touch customer experiences — hands-on sessions, workshops and roundtables — alongside a selective presence at the industry moments that matter (NAB, IBC, HPA, festivals and markets) Run webinars and digital programs that generate and progress demand, including partner co-hosted formats Drive qualified traffic into trial and self-serve entry points Help our channel and referral partners ma
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