Services Specialist 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. 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

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 Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience. Additional Responsibilities - Reviews pre‑specified claims and those that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication. - Ensures compliance with all regulatory requirements and confirms that payments align with company policies and procedures. - Identifies and reports potential overpayments, underpayments, and other claim irregularities. - Performs claim rework calculations as needed. - Trains and mentors as needed to enhance team performance and technical proficiency. - Conducts outbound calls to obtain required information for claims or reconsideration requests. Required Qualifications - Minimum of 18 months of medical claim processing experience with a health insurance payor or third‑party administrator. - Proven

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 Purpose and Summary As an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly those with social determinants of health (SDoH) needs and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants to support the member in maintaining optimal health. This is achieved by evaluating the members’ needs through the completion of the annual Health Risk Assessment Survey, addressing SDoH needs, and closing gaps in preventative and health maintenance care. Key Responsibilities Telephonic Engagement: Dedicate 50-75% of the day to engaging with members and coordinating their care. Member Outreach: Utilize all available resources to connect with and engage “hard-to-reach” members. Care Planning: Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs. Documentation: Maintain meticulous documentation of care management activities in the member’s electronic health record. Collaboration: Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable h

Job Title Sales Support, Clinical Specialist - Image-Guided Therapy Devices, Coronary (West Virginia) Job Description Sales Support, Clinical Specialist – Image-Guided Therapy Devices, Coronary (West Virginia) We are the industry leader in image-guided therapy, helping to improve treatment for every patient. Working together to realize this vision, we can save and improve lives and reduce the total cost of care by making therapy more efficient, more appropriate, and more personalized! Your role: Supports Territory Manager(s) and the Regional Sales Manager with sales activities that include procedure coverage, uncovering new opportunities for IGTD product penetration into assigned territory, and maintaining existing customers. Works independently to achieve business objectives and sales metrics set forth by the Philips IGTD division. Builds solid customer relations by interfacing directly with customers including hospital physicians, catheter laboratory, operating room personnel and business office staff, training/education, research, and supporting equipment and software. Interfaces with Marketing, R&D and other internal groups to quantify needs and to provide intelligence to management on competitive products and company product enhancements Provides ongoing support for company-sponsored clinical/marketing trials and registries You're the right fit if: You’ve acquired 3+ years direct experience in a hospital/medical setting Your skills include a license as a Cardiovascular Radiologic Technologist (CRT), Cardiovascular Technologist (CVT), or Registered Nurse (RN) or CVIS, RCIS You have a High School diploma required; Bachelor’s degree is a plus You must be able to successfully perform the fol

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: 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. · An excellent retirement savings plan with a high employer contribution. · 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. Abbott's Cancer Diagnostics business was established through the acquisition of Exact Sciences, bringing Exact Sciences' full cancer screening and diagnostics portfolio, including Cologuard, Oncotype DX, Cancerguard, and Oncodete

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: Position Overview: Working on the Oncology Sales team, the Sr. Regional Oncology Specialist (Sr. ROS) will develop and implement a plan to maximize the utilization of Abbott Cancer Diagnostics products in targeted accounts, while staying within budget, and support the corporate objectives and highlight the delivery of key selling messages. Products may include OncoExTra, OncoDetect (MRD) and RiskGuard (Hereditary Cancer Testing). The Sr. ROS should incorporate a high level of service toward being the best-in-class for an assay provider. The Sr. ROS’s plans are used to solve challenging problems in a dynamic environment. The plans should emphasize developing customer relationships as well as leveraging strong clinical and scientific expertise, key stakeholder insight, and selling approach in highly competitive and complex market. To do this plan, the Lead ROS must have, or be able to quickly develop, a clear understanding of key territory-related clinical/political issues. The Sr. ROS will devote whatever time is necessary to complete objectives outlined in the sales plan. The Sr. ROS provides information critical to accomplishing our mission to all parties involved in the sales of products. The Sr. ROS will provide direct feedback to individuals so they can make accurate decisions at all levels of the company, such as national, regional, and area teams. The Sr. ROS will work with managed care, reimbursement, patients, to include patient support groups, Abbott Cancer Diagnostics advocacy group, and providers to

ROLE SUMMARY Everything we do, every day, is in line with an unwavering commitment to the quality and the delivery of safe and effective products to patients. Our science and risk-based compliant quality culture is innovative and customer oriented. Whether you are involved in manufacturing, testing, or compliance, your contribution will directly impact patients. All over the world, Pfizer colleagues work together to positively impact health for everyone, everywhere. Our colleagues can grow and develop a career that offers both individual and company success; be part of an ownership culture that values diversity and where all colleagues are energized and engaged; and can impact the health and lives of millions of people. Pfizer, a global leader in the biopharmaceutical industry, is continuously seeking top talent who are inspired by our purpose to innovate to bring therapies to patients that significantly improve their lives. Pfizer has a deep heritage and leadership in cardiovascular disease, and we are committed to providing breakthroughs that change patients’ lives. An integral part of Internal Medicine, the Cardiology (CARD) Team’s mission is to promote a breakthrough therapy for patients suffering from NVAF or VTE. The CARD Health & Science Professional (HSP) is responsible for increasing territory sales and relationship development with assigned customers and accounts by engaging in product promotion and determining the best strategies to manage their business. A CARD HSP should possess customer, market, and business acumen, analytical skills, and strong product and disease state knowledge; demonstrate ability to drive sales, promotional and strategic business development and management skills, and in-depth customer engagement expertise both in-person and virtually; demonstrate outstanding communication and teamwork skills; be adept in the operation of digit

Role Summary Everything we do, every day, is in line with an unwavering commitment to the quality and the delivery of safe and effective products to patients. Our science and risk-based compliant quality culture is innovative and customer oriented. Whether you are involved in manufacturing, testing, or compliance, your contribution will directly impact patients. All over the world, Pfizer colleagues work together to positively impact health for everyone, everywhere. Our colleagues can grow and develop a career that offers both individual and company success; be part of an ownership culture that values diversity and where all colleagues are energized and engaged; and can impact the health and lives of millions of people. Pfizer, a global leader in the biopharmaceutical industry, is continuously seeking top talent who are inspired by our purpose to innovate to bring therapies to patients that significantly improve their lives. Pfizer is advancing in Neuroscience, and an integral part of the Migraine Team’s mission is to promote a breakthrough therapy for patients suffering from migraine. The Neuroscience Health & Science Professional (HSP) is responsible for increasing territory sales and relationship development with assigned customers and accounts by engaging in product promotion and determining the best strategies to manage their business. The HSP should possess customer, market, and business acumen, analytical skills, and strong product and disease state knowledge; demonstrate ability to drive sales, promotional and strategic business development and management skills, and in-depth customer engagement expertise both in-person and virtually; demonstrate outstanding communication and teamwork skills; be adept in the operation of digital and virtual tools; and be effective at working remotely in collaboration with cross-functional internal teams to address c

ROLE SUMMARY Everything we do, every day, is in line with an unwavering commitment to the quality and the delivery of safe and effective products to patients. Our science and risk-based compliant quality culture is innovative and customer oriented. Whether you are involved in manufacturing, testing, or compliance, your contribution will directly impact patients. All over the world, Pfizer colleagues work together to positively impact health for everyone, everywhere. Our colleagues can grow and develop a career that offers both individual and company success; be part of an ownership culture that values diversity and where all colleagues are energized and engaged; and can impact the health and lives of millions of people. Pfizer, a global leader in the biopharmaceutical industry, is continuously seeking top talent who are inspired by our purpose to innovate to bring therapies to patients that significantly improve their lives. Pfizer is advancing in Neuroscience, and an integral part of the Migraine Team’s mission is to promote a breakthrough therapy for patients suffering from migraine. The Neuroscience Health & Science Professional (HSP) is responsible for increasing territory sales and relationship development with assigned customers and accounts by engaging in product promotion and determining the best strategies to manage their business. The HSP should possess customer, market, and business acumen, analytical skills, and strong product and disease state knowledge; demonstrate ability to drive sales, promotional and strategic business development and management skills, and in-depth customer engagement expertise both in-person and virtually; demonstrate outstanding communication and teamwork skills; be adept in the operation of digital and virtual tools; and be effective at working remotely in collaboration with cross-functional internal teams to address customer needs

Experienced Ordnance Specialist Company: Boeing Aerospace Operations The Boeing Company has an exciting opportunity for an Experienced Ordnance Specialist to join our team located in Hertford, NC . The ideal candidate will be upbeat and ready to react when given an unexpected time sensitive task. You will be asked to work alongside the client and other agency’s providing physical support along with scheduling range set up and cleanup operations with public works. This position will require you to work on outside ranges in all weather conditions. Position Responsibilities: Provide support to instructors prior to and during range activities Cleanup all buildings and work areas on range Maintain accurate levels of demolitions, chemicals and incendiary materials on range Keep inventory on all equipment, explosive and ordnance usage Receive explosives and incendiary material shipments Coordinate all demolition range work with public works Keep ranges supplied with safety and first aid supplies Keep electrical firing systems in repair and working order Fabricate targets and related training materials for use on ranges Maintain and stock storage areas Perform other duties assigned Knowledge of range regulations and safety procedures Maintains awareness of range schedule and provides status to management of any identified issues Responds to trouble calls and resolves a variety of complex problems Is able to use a wide variety of complex test equipment Provides technical expertise in the evaluation of products or equipment and makes recommendations Has specialized knowledge in the use of all hand

We anticipate the application window for this opening will close on - 27 Sep 2026 Careers that change lives start here. Medtronic is a global leader in healthcare technology with a Mission to alleviate pain, restore health, and extend life. Our 95,000 employees work across more than 150 countries to put patients first — developing innovative medical technologies that improve the lives of 72+ million patients each year. Your unique talents will help shape the future of healthcare while building a career grounded in purpose, growth, and impact. A Day in the Life We are seeking a committed professional to join our team. While this is a remote position not located at a physical Medtronic site, the candidate hired will be required to reside within the territory and drive to multiple accounts throughout the region. A valid driver's license is essential for this role. As one of three comprehensive portfolios at Medtronic, Neuroscience is dedicated to improving the lives of people living with neurological disorders, spine conditions, and chronic pain. Guided by our Mission—to alleviate pain, restore health, and extend life—we develop technologies and therapies that help people regain function, reduce pain, and return to the activities that matter most. Our Neuromodulation Operating Unit provides advanced therapies for chronic pain, movement disorders, and other neurological conditions. Through spinal cord stimulation, deep brain stimulation, and targeted drug delivery systems, we deliver personalized treatments that restore function, reduce symptoms, and improve quality of life worldwide. This role will be part of our Deep Brain Stimulation (DBS) Clinical team. Our DBS devices send electrical signals within the brain that can help reduce symptoms of certain disorders or disease. O

We anticipate the application window for this opening will close on - 30 Sep 2026 Careers that change lives start here. Medtronic is a global leader in healthcare technology with a Mission to alleviate pain, restore health, and extend life. Our 95,000 employees work across more than 150 countries to put patients first — developing innovative medical technologies that improve the lives of 72+ million patients each year. Your unique talents will help shape the future of healthcare while building a career grounded in purpose, growth, and impact. A Day in the Life The Cardiac Rhythm Management (CRM) portfolio delivers therapies designed to restore, support, and protect every heartbeat through advanced pacing, defibrillation, and remote monitoring solutions. CRM's unique ability to pair proven life-saving therapies with intelligent technology gives clinicians and patients greater confidence. Clinical impact and innovation come together to improve lives through meaningful patient outcomes. Provide technical, educational, operational and sales support to assist the district in meeting Cardiac Rhythm Management (CRM) sales and customer service objectives. CRM seeks collaborative candidates who will meet our customer expectations by striving without reserve for the greatest possible reliability and quality in our products, processes, and systems by being accountable, having a voice and acting promptly. This role supports the NYC territory and requires candidates to reside within the assigned area and travel regularly to customer accounts. Clinical Specialists must be available to support urgent customer needs and participate in weekend, holiday, and occasional after-hours coverage as bus

We anticipate the application window for this opening will close on - 30 Sep 2026 Careers that change lives start here. Medtronic is a global leader in healthcare technology with a Mission to alleviate pain, restore health, and extend life. Our 95,000 employees work across more than 150 countries to put patients first — developing innovative medical technologies that improve the lives of 72+ million patients each year. Your unique talents will help shape the future of healthcare while building a career grounded in purpose, growth, and impact. A Day in the Life We are seeking a committed professional to join our team. While this is a remote position not located at a physical Medtronic site, the candidate hired will be required to reside within the territory and drive to multiple accounts throughout the region. A valid driver's license is essential for this role. Our Neuromodulation Operating Unit provides advanced therapies for chronic pain, movement disorders, and other neurological conditions. Through spinal cord stimulation, deep brain stimulation, and targeted drug delivery systems, we deliver personalized treatments that restore function, reduce symptoms, and improve quality of life worldwide. Check us out on LinkedIn: Medtronic Brain Modulation and Pain Interventions At Medtronic, the Clinical Specialist, supports the Neuromodulation Pain and Target Drug Delivery Therapies in the areas of surgical coverage, follow-up support, troubleshooting, customer service and education. This person will be engaged in basic market de

We anticipate the application window for this opening will close on - 30 Sep 2026 Careers that change lives start here. Medtronic is a global leader in healthcare technology with a Mission to alleviate pain, restore health, and extend life. Our 95,000 employees work across more than 150 countries to put patients first — developing innovative medical technologies that improve the lives of 72+ million patients each year. Your unique talents will help shape the future of healthcare while building a career grounded in purpose, growth, and impact. A Day in the Life Job Specific Summary We are seeking a committed professional to join our team. While this is a remote position not located at a physical Medtronic site, the candidate hired will be required to reside within the territory and drive to multiple accounts throughout the region. A valid driver's license is essential for this role. Our Neuromodulation Operating Unit provides advanced therapies for chronic pain, movement disorders, and other neurological conditions. Through spinal cord stimulation, deep brain stimulation, and targeted drug delivery systems, we deliver personalized treatments that restore function, reduce symptoms, and improve quality of life worldwide. Check us out on LinkedIn: Medtronic Brain Modulation and Pain Interventions At Medtronic, the Clinical Specialist, supports the Neuromodulation Pain and Target Drug Delivery Therapies in the areas of surgical coverage, follow-up support, troubleshooting, customer service and education. This person will be en

We anticipate the application window for this opening will close on - 28 Sep 2026 Careers that change lives start here. Medtronic is a global leader in healthcare technology with a Mission to alleviate pain, restore health, and extend life. Our 95,000 employees work across more than 150 countries to put patients first — developing innovative medical technologies that improve the lives of 72+ million patients each year. Your unique talents will help shape the future of healthcare while building a career grounded in purpose, growth, and impact. A Day in the Life The Cardiac Rhythm Management (CRM) portfolio delivers therapies designed to restore, support, and protect every heartbeat through advanced pacing, defibrillation, and remote monitoring solutions. CRM's unique ability to pair proven life-saving therapies with intelligent technology gives clinicians and patients greater confidence. Clinical impact and innovation come together to improve lives through meaningful patient outcomes. Provide technical, educational, operational and sales support to assist the district in meeting Cardiac Rhythm Management (CRM) sales and customer service objectives . CR M seeks collaborative candidates who will meet our customer expectations by striving without reserve for the greatest possible reliability and quality in our products, processes, and systems by being accountable, having a voice and acting promptly . This role supports the Baltimore territory and requires candidates to