CorVel jobs - 227 jobs

The Utilization Review Case Manager gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay while supporting the goals of the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identifies the necessity of the review process and communicates issues of concern to the appropriate claims staff/customer Collects data and analyzes information to make decisions regarding certification or denial of treatment Documents all work in the appropriate manner Promotes utilization review services with stakeholders Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) Additional duties as assigned KNOWLEDGE & SKILLS: Must have thorough knowledge of both CPT and ICD coding Ability to interface with claims staff, attorneys, physicians and their representatives, as well as advisors/clients and coworkers Effective organization skills in a high-volume, fast-paced environment Strong time management skills with the ability to meet designated deadlines Excellent written and verbal communication skills Ability to work both independently and within a team environment Strong interpersonal skills Ability to utilize Microsoft Office including Excel spreadsheets Knowledge of the workers' compensation claims process preferred Knowledge of outpatient utilization review preferred EDUCATION & EXPERIENCE: Graduate of accredited school of nursing with an associate's degree, Bachelor of Science degree or Bachelor of Science in Nursing Current Nursing licensure in the state of operation required; RN is required unless local state regulations permit LVN/LPN 4 or more years of recent clinical experience Prospective, concurrent, and retrospective utilization review experience preferred Experience in the clinical areas of OR, ICU, CCU, ER and/or orthopedics preferred PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $29.95 - $44.77 per hour A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL: CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

PROVIDER AUDIT AND REIMBURSEMENT LEAD AUDITOR (CMS) - REMOTE ARC Group has an immediate opportunity for a Provider Audit and Reimbursement Lead Auditor (CMS)! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization offering tremendous career growth potential. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Job Description: The Provider Audit and Reimbursement Lead utilizes advanced knowledge of Medicare laws, regulations, instructions from the Centers for Medicare and Medicaid Services (CMS), and provider policies to perform desk reviews and audits of the annual Medicare cost reports, as well as interim rate review/reimbursement, and/or settlement acceptance/finalization for all provider types, including complex and organ transplant hospitals, as both a preparer and reviewer of work product based on established performance goals. The position will mentor and train Auditors and In-Charge Auditors and oversee daily workload of unit team. ESSENTIAL DUTIES & RESPONSIBILITIES Lead Accountabilities (60%): Coordinates with management by overseeing the unit's daily workload. Routinely uses independent judgment and discretion to make decisions for self and less experienced auditors with regard to additional time and procedures; identifies and raises errors to the attention of supervisor and/or provider and identifies and communicates actions to correct same. Prioritizes auditor work and ensures that audit work is completed on time. Recognizes data needs for self and other auditors; develops plan of work for less experienced auditors (10%) Analyzes working papers and cost reports for errors. (10%) Reviews workpapers of auditors for correctness, control and adherence to Generally Accepted Accounting Practices (GAAP), Generally Accepted Accounting Standards (GAAS) and Government Auditing Standards (GAS) as required. Examines and reviews workpapers upon completion of the audit to ensure compliance with CMS Uniform Desk Review (UDR), policy, or technical direction and reflects proper reference, clear and concise conclusion of the major audit categories and assembly of working papers into logical sequence. (10%) Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal and State Government regulations for each class/type of provider within area of responsibility. (5%) Develops technical competence and constructive work attitudes in self and less experienced auditors; strives to build an effective team and to develop the growth needs of individual members of his/her team. (10%) Coordinates the assignments and subsequent development of auditors based on their training needs; explains work to be performed and principle or objective of procedure; provides accurate and constructive coaching, mentoring, and training of team members. Identifies training needs within the team and/or department. (5%) Manages, implements and coordinates an internal quality control program in conjunction with the Internal Quality Control (IQC) department and provides reasonable assurance that the Provider Audit and Reimbursement Department has established, as well as is following, adequate policies, procedures, and is following applicable auditing standards. (5%) Facilitates the development of Quality Management System (QMS) policies and procedures. (5%) Auditor Accountabilities (40%) Performs audit functions including those which are non-routine; keeps track of instructions for many projects simultaneously. Presents and defends adjustments and workpapers to provider with minimal consultation from manager. (10%) Coordinates large audits and/ or diverse audits independently while seeking help on truly unusual or major items. (10%) Uses professional communication techniques in own and auditor's work and in conclusions drawn from the work. (5%) Establishes and maintains constructive provider relations by demonstrating a professional approach, expressing positive corporate image. Advises providers on Medicare policy questions and directs other questions to responsible departments or personnel. (5%) Conducts entrance and exit conferences and meetings away from office as needed. (5%) Perform other duties as the manager may deem necessary (5%) REQUIRED QUALIFICATIONS Bachelors' degree or a combination of education and experience in disciplines such as auditing, accounting, analytics, finance or similar experience in lieu of a degree In addition to having a thorough understanding of the Medicare cost report, including the step-down method, the candidate must possess the required work experience to independently perform the duties of the position. To demonstrate the necessary experience, the candidate must have performed the following tasks at a sufficiently successful level to show understanding of the work, judgment, and the ability to perform these tasks independent of supervision, which is generally gained through 2.5 to 3 years of Medicare cost report auditing experience: A Uniform Desk Review (UDR) and an audit for a large or complex hospital, as the in-charge auditor A review of Medicare Bad Debts, inclusive of all relevant sample selection and testing according to CMS standards A review of DSH, inclusive of all relevant sample selection and testing according to CMS standards A review of IME/GME, inclusive of reviewing rotation schedules, bed count and all relevant testing according to CMS standards A review and appropriate approval of an audit's scope A supervisory review and approval of all work papers* Sample testing, transferring of testing to the audit adjustment report, and explaining the adjustments to a provider with the achievement of understanding by the provider* Assistance to audit management in the assignment and monitoring of workload, as well as leading junior team members Additionally: The auditor must display leadership skills by being integrally involved in junior auditor formal training or assisting on special projects, or have been a Subject Matter Expert (SME)* The auditor must be able to prepare workpapers according to CMS standards The auditor must have a good working knowledge of all applicable software applications The auditor must be able to serve as an effective mentor for less experienced staff The auditor must demonstrate engagement, commitment to departmental success, and professionalism by completing their work within prescribed deadlines, taking ownership of their work and setting an example for more junior auditors and staff by consistently and reliably working the time necessary to properly complete their duties, timely attending meetings, providing adequate notice to management and co-workers when unexpected issues arise, and ensuring work is properly covered in the auditor's absence. Demonstrated oral and written communications skills Demonstrated ability to exercise independent judgement and discretion Demonstrated attention to detail PREFERRED QUALIFICATIONS 3 to 4 years of Medicare cost report auditing experience Demonstrated work experience to independently perform: A review of Nursing & Allied Health Education (NAHE), inclusive of calculating the additional add-on payment and all relevant testing A review of Organ Acquisition costs, inclusive of all relevant testing Requirements This opportunity is open to remote work in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL and PA in-office and hybrid work may also be available. Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke ******************** or apply online while viewing all of our open positions at ******************* ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

Job DescriptionSr. Data Scientist (100% remote) ARC Group is currently seeking a Sr. Data Scientist to join a global leader in shipping and enterprise logistics services. The Data Scientist will be an integral part in helping the organization by working with numerous departments to develop solutions for customers, make sure products are as needed, and that quality and performance of products are met. This is NOT a junior position nor a developer role, it is a need for a Data Scientist that will look at arrays of capture points and customer data, model and analyze date to create better solutions and solve problems. This requires you to have permanent work authorization and not need sponsoring now or in the future. (No C2C, no brokering). Data Scientist Responsibilities: Align with SMEs to outline analytic requirements and devising the analytics that meet the requirements Develop data models top optimize and improve work of e-commerce functions Understand the flow of data in the domestic product portfolio and define new solutions to capture the right data to help measure performance Recognize emerging machine learning and pattern recognition algorithms and work with the team to integrate state-of-the-art algorithms into various solutions including product performance Become a SME for all domestic product portfolio data sources and help define interfaces across various data points to consolidate to produce required analytics Gain industry knowledge to understand and lead analyses of customer injection, market trends and competitive landscape Data Scientist Requirements: Bachelor's (master's is a plus) or higher from an accredited college or university in a quantitative discipline (e.g., statistics, mathematics, operations research, engineering, data science or computer science). Must have data modeling, predictive analytics and/or machine learning experience 5 years of related work experience in two or more of the following: designing/implementing machine learning, data mining, advanced analytical algorithms, advanced statistical analysis, artificial intelligence, or software engineering with data analysis software MUST HAVE experience in Azure and Azure Data Lake Storage / ADLS Hands-on work with Azure tools: Power BI, Azure Synapse and Azure Data Explorer, SQL. You should know how to build a report off Azure and link it to Power BI This is not a developer position, but you must possess strong SQL coding skills Experience in data mining and understanding of machine-learning and operations research is an advantage Analytical mind and business acumen with a problem-solving aptitude and the communication skills to utilize these skills Nice to have: Experience in data mining and understanding of machine-learning and operations research is an advantage Proficiency in Excel, PowerPoint, MS Access is a plus Knowledge of using machine learning workflow/toolkits i.e., Kubeflow and analytics engine i.e. Spark Any familiarity with other data analytics tools, data frameworks (e.g., Hadoop) is an asset Knowledge of Python will be a plus Would you like to know more about our new opportunity? For immediate consideration, please apply online while viewing all open jobs at ******************* . ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and clients' needs and goals and serving both with integrity and a shared desire to succeed. We are proud to be an equal-opportunity workplace dedicated to pursuing and hiring a diverse workforce.

**Become a part of our caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **Use your skills to make an impact** + Additional Job Description **WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs. **Required Qualifications | What it takes to Succeed** - RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years) - MS-DRG coding/auditing experience - Experience reading and interpreting claims - Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings - Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel - Strong attention to detail - Can work independently and determine appropriate course of action - Ability to handle multiple priorities - Capacity to maintain confidentiality - Excellent communication skills both written and verbal **Preferred Qualifications** - Experience in APR DRG coding/auditing - Experience in Financial Recovery - Experience in a fast paced, metric driven operational setting **Additional Information** **Work at Home Requirements** - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested - Satellite, cellular and microwave connection can be used only if approved by leadership - Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-25-2040 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Become a part of our caring community and help us put health first The Pharmacy Stars Improvement Lead will be a part of a collaborative Pharmacy Stars team which is accountable for Humana's Stars patient safety measure performance. The Pharmacy Stars Improvement Lead will autonomously develops, implements, and manages clinical program strategies to improve Medicare members' medication adherence and appropriate medication use with specific focus on telehealth and in-home methods of care delivery. The Pharmacy Stars Improvement Lead exercises independent judgment and decision making on complex issues regarding job duties and related tasks, works under minimal supervision, and analyzes variable factors to determine the best course of action. Use your skills to make an impact Required Qualifications Bachelor's Degree in Business, Finance, Health Care or a related field 2 or more years of project leadership experience Prior Medicare/Medicaid experience Strategic thinking and planning capabilities; organized and detail-oriented Excellent communication skills Enthusiasm and motivation essential; a confident change-agent; strong presentation skills (oral and written) Ability to operate under tight deadlines Successful track record in facilitating and consulting across teams and managing projects Ability to learn quickly, work under pressure and timeline, work with ambiguity, and make complex decisions as necessary to meet business need Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint Preferred Qualifications Master's Degree in Business Administration, Health Administration or a related field Provider relations experience Prior managed care experience Understanding of metrics, trends and the ability to analyze and identify gaps in care Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus Understanding of CMS Stars and performance measure knowledge and experience a plus Background working in quality improvements Additional Information: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Work at home requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. SSN Alert: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $104,000 - $143,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 01-15-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care. Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Completely document work and final conclusions in designated computer program Adhere to regular and consistent work attendance Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) and other requirements as outlined in the Employee Handbook Responsive to additional Professional Review job duties as assigned by management or determined by legislative changes and/or market changes KNOWLEDGE & SKILLS: Must be able to communicate concisely and effectively in writing and verbally Must have the ability to interface with the claims adjusters, attorneys, physicians and their representatives, and advisors/clients, and co-workers Must have the ability to effectively promote all Professional Review products with attorneys, claims examiners, customers and management Must also have a strong ability to negotiate provider fees effectively Must be computer literate Knowledge of worker's compensation claims preferred EDUCATION & EXPERIENCE: Must maintain current licensure as a Registered Nurse in the state of employment with a minimum of 4 years clinical experience A minimum of an Associate Degree in Nursing as well as have a thorough knowledge of both C.P.T. and I.C.D.10 codes is preferred Medical bill auditing experience preferred Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., and orthopedics preferred Prospective, concurrent and retrospective utilization review experience preferred PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $47,061 - $70,236 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. About CERIS CERIS, a division of CorVel Corporation, a certified Great Place to Work Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

Researches utility termination warnings, potential missing bills, and late fees. Analyzes payment history, negotiates and arranges payment with utility vendors, or executes alternative solutions as deemed necessary to avoid client shut off of utility service. Responsible for the removal of client's late fees. Responds to calls received via the hotline. PRINCIPAL RESPONSIBILITIES AND DUTIES: Under direct supervision, researches utility termination warnings, potential missing bills, and late fees by reviewing payment history, account posting, and status of check clearing to determine whether further action is required on notices according to department procedures. Contacts utility vendors via telephone to determine reason and amount of balance due. Verifies address and that payment have been applied to proper account. With guidance, negotiates a date extension for receipt of payment or arranges alternative solutions to avoid a client shut off of utility service. In addition, negotiates with the vendor removal of late fees and penalties assessed to the account. Prepares and provides written correspondence via email or fax of copy of check remittance to vendors as deemed necessary to resolve shut off possibility. Request replacement bills from vendor as needed. Processes payment research items such as misapplied and stop payments, reissue checks, and pay now. Responsible for working closely with internal staff and vendors to minimize and correct errors, answers inquires, and resolves bill and account discrepancies. With some supervision, operates the termination research, missing bill, and late fee databases. Organizes daily work within the termination research, missing bill, and late fee databases utilizing department standards and procedures in prioritizing and identifying the most critical research items. Review and contact vendors listed on various late fee reports monthly. Determine which vendor's late fees should be targeted and contact vendor to request removal charges based on established departmental procedures. Document the results and status of the phone call in the late fee database. Answer vendor hotline and assist vendors with questions on a timely basis, within 2 hours of receipt of call or message. Contact vendors who bill summary and round up/donation invoices and have the clients removed from those specific billing formats. Follow up on outstanding requests to ensure they have been removed. Provides and maintains concise documentation of research, accurate production task time sheets, and updated departmental standards and procedures. Works overtime as required by management. Other duties as assigned by management. SKILLS AND ABILITIES REQUIRED: Ability to effectively communicate both verbally and written and maintain a positive composure. Possess good interpersonal skills. Possess organizational skills in order to handle multiple tasks simultaneously and prioritize work. Ability to operate standard office equipment including, but not limited to, computers, copiers, calculators, and facsimile machines. Ability to perform basic functions in the Microsoft Office suite. Good analytical and problem-solving skills. MINIMUM LEVEL OF PREPARATION AND TRAINING NORMALLY REQUIRED: High school diploma or equivalent required. 6 months of previous telephone experience normally acquired working in a customer service or collection position or equivalent work experience. General knowledge of the principles and practices of the utility billing process. APPLICATION PROCESS: You can directly apply through Cass's website at ********************************* Please apply directly to this position via the “Apply” button. You will be required to create an account and provide your resume, contact information and other pertinent employment information. This process typically takes 20 minutes or less. Should we find that you meet the minimum requirement of the position, a member of our recruiting team will be in touch to start the interview process. ABOUT OUR COMPANY: Cass Information Systems, Inc. (NASDAQ: CASS) is a leading provider of integrated information and payment management solutions. Cass enables enterprises to achieve visibility, control and efficiency in their supply chains, communication networks, facilities, and other operations. Disbursing over $94 billion annually on behalf of its clients, and with total assets of $2.4 billion, Cass is uniquely supported by Cass Commercial Bank. Founded in 1906 and a wholly-owned subsidiary, Cass Commercial Bank provides sophisticated financial exchange services to the parent organization and its clients. Cass was recently named as one of America's best midsize companies by a leading publication and is part of the Russell 2000 .

**Become a part of our caring community and help us put health first** The Senior Coding Educator identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes data and reporting and provides educational sessions with providers aimed at quality of care, documentation and coding improvements. + Collaboration with relationship owners and HQRI + Research data and workflow processes and arranges educational sessions with providers aimed at quality of care and documentation improvements. + Monitor and develops strategy with Coding educator and leader, tailor's provider group webinars and discussions based on various Risk Adjustment topics. **Use your skills to make an impact** **Required Qualifications** + AAPC CPC (Certified Professional Coder) Certification + 2 or more years of medical record review knowledge + 2 or more years of risk adjustment provider education + Familiar with coding guidelines (i.e. ICD-9/ICD-10) + Comprehensive knowledge of MS Word, Excel and PowerPoint + Analyzing Data to drive process improvement + Experience with public speaking and presentation skills **Preferred Qualifications** + Bachelor's degree + Certified Risk Coder (CRC) + Experience interacting with healthcare providers + Ability to work independently + Medicare Risk Adjustment knowledge + Analyzing data to build unique education strategies in PowerBi **Additional Information** **Department Hours: 7am to 5pm EST** Work at home - with ability to travel (up to 25% to surrounding provider offices) **Additional Information** As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. \#LI-BB1 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Job Description Construction Senior Project Manager ARC Group is looking for a Construction Senior Project Manager for a client based out in Cleveland, OH for a Full-Time direct hire with 5-7years of commercial Construction project management experience Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering). Job Type: Full-time Experience: Minimum 5-7 years in Construction Project Management Reports To: Director of Operations Job Summary We dont just build we rethink, reshape, and reimagine construction from the ground up. Were looking for a Senior Construction Project Manager who thrives on innovation, leads with confidence, and isnt afraid to break away from traditional processes. If you're ready to manage projects with creativity, accountability, and drive, this is the place for you. What Youll Do Lead end-to-end delivery of complex commercial construction projects. Create bold and effective strategies that challenge industry norms. Build, manage, and inspire high-performing teams under pressure. Maintain strict standards for safety, quality, and budget. Cultivate strong relationships with clients, partners, and stakeholders. Proactively identify issues and implement forward-thinking solutions. Who You Are A seasoned construction project manager with a strong track record. A natural leader with excellent communication and team-building skills. A creative problem-solver who thrives in fast-paced environments. Tech-savvy and well-versed in modern construction tools and software. Passionate about continuous learning, innovation, and accountability. Qualifications 57+ years of experience in commercial construction project management. Proven ability to lead and deliver projects successfully. Strong leadership and decision-making skills. Familiar with industry certifications and project management tools. Core Values Were looking for individuals who embody the following: In The Ditch: Action-oriented, self-reliant, and all about effort. In The Know: Solution-driven, always learning, with a growth mindset. In The Drivers Seat: Proactive, accountable, and ready to take chargenot just follow directions. Benefits Competitive salary 401(k) Health insurance Dental insurance Paid time off Opportunities for professional growth you like to know more about this role? For immediate consideration, please send your resume directly to Suresh Gaddala, *********************. You can also apply online and view all our open positions at ******************* ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. ARC Group is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse workforce.

SYSTEMS ENGINEER (NESSUS) - REMOTE ARC Group has an immediate opportunity for a Systems Engineer with strong experience working with vulnerability scanning tools! This position is 100% remote working eastern time zone business hours. This is starting out as a contract position running through January 2025 with strong potential to extend longer or convert to FTE. This is a fantastic opportunity to join a well-respected organization offering tremendous career growth potential. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering). Job Description: IT Systems Engineers are responsible for monitoring, installation, configuration, administration, troubleshooting and maintenance of technology solutions. IT Systems Engineers provide technical support, troubleshoot problem and perform scripting/programming to ensure stable and efficient operation of technology solutions. Essential functions: Performs installation, monitoring, testing, configuration, migration, maintenance and troubleshooting of assigned technology Manages system/application environment and ongoing operations Ensures that the technologies are updated with current, stable, and compliant architecture and applications that meet enterprise standards Researches, designs, implements and tests technology solutions Proactively monitors and reports performance and utilization of assigned technologies Troubleshoots software and/or hardware issues/failures Resolves alerts and performs remediation activities Manages problem or escalated tickets and tasks and out of cycle requests from systems/software owners Collects and presents data for reporting and planning Assists with developing tactical strategies, processes and procedures related to systems/application administration Determines migration and upgrade impacts and diagnose/resolve complex technology/application errors Collaborates with IT and business area partners on work groups and initiatives Determines best course of action for meeting business needs May provide input into infrastructure architecture designs Writes programming/scripting May participate in Disaster Recovery planning and exercises Ensures execution and alignment to architectural standards and blueprints. May contribute input to infrastructure architecture Performs on-call activities as needed for the environment and technologies Requirements: Extensive working knowledge of multiple technologies and their interfaces and integration Competent working in one or more environments highly integrated with an operating system. Extensive experience implementing and administering/managing technical solutions in major, large-scale system implementations Worked with Vulnerability tools but doing compliance with DISA STIGS or CIS Benchmark (Some examples of vulnerability tools are Eeye Retina, Tenable.SC, Tenable.io, Rapid 7, ACAS) Scripting experience with REGEX or Python Excel CISCO/Networking Experience or Unix/Linux Experience Required Experience: 3-5 years of related work experience or equivalent combination of transferable experience demonstrating proficiency and experience in design, implementation, monitoring and troubleshooting technology Musts: - Vulnerability tools (ex: Eeye Retina, Tenable.SC, Tenable.io, Rapid 7, ACAS) - Know compliance standards (STIGS or cis benchmarks) - Python/REGEX Required Education: Related Bachelor's degree in an IT related field or relevant work experience Security+ or Other Applicable Certs. Would you like to know more about our new opportunity? For immediate consideration, please apply online and view all our open positions at ******************* ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

Become a part of our caring community and help us put health first The Senior Program Delivery Professional strategically identifies, develops, and implements programs that influence providers, members or market leadership towards value-based relationships and/or improved quality metrics. The Senior Program Delivery Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Program Delivery Professional - IHWA Interoperability plays a key role in driving seamless data integration and collaboration within the In-Home Health and Wellbeing Assessment (IHWA) team and across interoperability initiatives. Serving as a business subject matter expert (SME), this individual partners closely with internal and external stakeholders, as well as the Interoperability team, to advance program objectives. Key responsibilities include collaborating with leaders on implementation planning, reviewing and communicating program results, and contributing to the ongoing improvement of processes and automation. The role also begins to influence departmental strategy and requires independent decision-making on moderately complex to complex technical matters related to project components. Work is performed without direct supervision, with considerable latitude in determining objectives and approaches to assignments. The ideal candidate demonstrates a collaborative approach, a strong interest in technology solutions, and a commitment to continuous process improvement. Use your skills to make an impact Required Qualifications Minimum three, (3) years of IT project management or business process automation, experience in technology solutions. Excellent communication skills, both oral and written Proven experience in interoperability or data integration within a healthcare or technology setting. Strong problem-solving skills with demonstrated success in process improvement initiatives and process automation. Familiarity with various technology solutions and interest in exploring new innovations. Excellent collaboration, and stakeholder management abilities. Experience with managing and monitoring successful and impactful projects. Self-starter with the ability to work independently and as part of a team. Futuristic and broad thinker with attention to detail and downstream impacts. Preferred Qualifications Bachelor's degree in Information Technology, Computer Science, Information Systems, or a related field. Experience with EHR integration or usage. Experience with AI integration. Experience automating business processes. PMP certification a plus Knowledge and experience in health care environment/managed care Strong analytical skills Workstyle: Open for Hybrid or Remote Work at Home Location: U.S. Schedule: 8:00 AM - 5:00 PM Eastern Time Monday through Friday Travel: occasional onsite as business needs require. Work at Home Guidance To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 01-08-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Job Description Corporate Tax Manager Tax Provision Cincinnati, OH 45209 | Hybrid (Minimum 2 days/week in-office) About the Firm: We are partnering with a prestigious CPA firm recognized among the top 15 accounting firms in recent years. The firm offers a collaborative, high-performance environment and is committed to professional growth and development. Position Overview: The Corporate Tax Manager will play a key role in managing tax provisions and related reporting for the firm's clients. This position requires hands-on experience with tax provisions, strong technical expertise, and leadership capabilities to oversee and guide tax-related projects and processes. Key Responsibilities: Prepare and review corporate tax provisions in compliance with U.S. GAAP. Lead and manage complex tax provision engagements for corporate clients. Coordinate with external auditors and internal teams to ensure accurate and timely reporting. Provide guidance on tax accounting and provision-related issues. Utilize tax software (experience with ONESOURCE is preferred) to manage and streamline processes. Mentor and support junior staff in technical tax matters. Stay current on federal, state, and local tax regulations and industry trends. Qualifications: CPA license is required. Minimum of 5 or more years of experience in public accounting, preferably with a top 15 CPA firm. Hands-on experience with tax provisions is required. Bachelor's degree in Accounting, Finance, or related field; Master's degree is a plus. Experience with ONESOURCE tax software is a plus. Strong technical knowledge of U.S. GAAP and corporate taxation. Excellent communication, leadership, and problem-solving skills. Must be located in Cincinnati, OH, or willing to relocate. Ability to work in a hybrid environment, in-office minimum 2 days per week. Why Join: Work with a top-tier CPA firm and highly skilled professionals. Opportunity for growth and career advancement. Hybrid work flexibility with collaborative in-office culture.

Job Description Join Our Team: Experienced Commercial General Liability Claims Specialists Wanted! CorVel is actively seeking a Commercial General Liability Claims Specialist to join our growing team. In this role, you will manage mid to complex Commercial Auto and General Liability claims - including bodily injury and property damage - with a focus on achieving optimal outcomes for both CorVel and our clients. This includes handling litigated files within company best practices and delegated authority. Commercial General Liability experience is required. This is a remote position based on the East Coast, offering flexibility while working in a dynamic and collaborative environment. If you're a seasoned claims professional looking to make an impact, we'd love to hear from you! ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time liability claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Requires regular and consistent attendance Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”) Additional projects and duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to learn rapidly to develop knowledge and understanding of claims practice Ability to identify, analyze and solve problems Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to meet or exceed performance competencies Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor's degree or a combination of education and related experience Minimum of 1 year of industry experience and claims management preferred State Certification as an Experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL: CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publically traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

The Provider Data Specialist is responsible for maintaining the accuracy of data in CorVel's national provider database (NDB). This database contains provider demographic information that drives the National PPO lookup and plays a crucial role in the bill review process. The is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provider Requests - Responsible for researching credentialing, NPI, specialty, licenses and certifications required prior to adding providers and contracts, as requested through the Provider Request Manager housed within MedCheck (provider add and network review requests). It is essential that the Provider Requests be processed within 24 hours for live bills Responsible for notifying PPO staff via email when items need to be escalated due to being beyond the limitations of the Provider Data Specialists knowledge, skills, ability or authority Responsible for adding and terminating providers to the PPO within 5 days of receiving via SharePoint and/or group mailbox Responsible for updating and maintaining PPO Roster, performing all necessary changes within 30 days of receiving via SharePoint Responsible for updating Provider Portal within 30 days of receipt via the Provider Request manager housed within MedCheck Correct historical errors, or errors made in day-to-day NPDB, in manual reports as requested by manager Ensure data integrity by merging or removing duplicate records created by the PPO loading process Requires regular and consistent attendance Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”) Additional projects and duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to identify, analyze and solve problems Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: High school diploma or equivalent Minimum 1 year experience in a professional office environment PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $16.36 - $26.31 per hour A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management ABOUT CORVEL: CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

TECHNICAL SOLUTIONS ARCHITECT (REMOTE US BASED) ARC Group has an immediate opportunity for a Technical Solutions Architect for a US-based remote position to help with the technical implementation of Ivalua, ensuring successful integration with existing systems, including ERP, 3rd Party Risk Management, and catalog systems. W2 Contract Only No 1099/No C2C 100% REMOTE! Reference # 16889-1 Candidates must have permanent work authorization and work for any employer without sponsorship now or in the future. Third party candidates are not eligible for this role. Job Description Lead the technical implementation of Ivalua, ensuring successful integration with existing systems, including ERP, 3rd Party Risk Management, and catalog systems. Collaborate with business stakeholders to gather requirements, design, and develop solutions that meet business needs. Collaborate with PM to develop and execute a detailed project plan, including timelines, milestones, and resource allocation. Manage a team of IT professionals, including developers, analysts, and testers, to ensure successful project delivery. Ensure data migration, data quality, and data governance are properly addressed during the implementation. Develop and maintain technical documentation, including system design, architecture, and configuration. Collaborate with the Ivalua vendor team to ensure successful implementation, including coordination of vendor resources, and resolution of technical issues. Develop and execute testing plans, including unit testing, integration testing, and user acceptance testing (UAT). Ensure compliance with enterprise IT standards, security policies, and regulatory requirements. Provide technical support and training to end-users, including procurement teams, and other stakeholders. Develop and manage project budgets, resource allocation, and vendor contracts. Communicate project status, risks, and issues to stakeholders, including project sponsors, business leaders, and IT management. **Requirements:** Bachelor's degree in Computer Science, Information Technology, or a related field. At least 8 years of experience in IT, with a minimum of 5 years in a leadership role, leading large-scale IT projects. Proven experience with implementing cloud-based procurement or spend management systems, preferably Ivalua. Strong technical knowledge of ERP systems (Peoplesoft, Oracle, and SAP), 3rd Party Risk Management systems (Archer), and catalog systems. Excellent project management skills, with experience in Agile methodologies and IT service management frameworks (e.g., ITIL). Strong leadership and team management skills, with experience in managing cross-functional teams. Excellent communication and interpersonal skills, with ability to communicate technical information to non-technical stakeholders. Strong analytical and problem-solving skills, with ability to troubleshoot complex technical issues. Experience with data migration, data quality, and data governance. Experience in analytics, including data visualization, reporting, and business intelligence, using Microsoft tools such as Power BI, SSRS, and SSAS. Experience in code development using Microsoft stack, including.NET, C#, ASP.NET, and SQL Server. **Nice to Have:** Experience with Ivalua implementation and configuration. Knowledge of procurement processes and spend management best practices. Experience with DevOps practices and tools (e.g., Jenkins, Docker). Certification in cloud security (e.g., CCSK) or compliance (e.g., CISA). Experience with Microsoft Azure, including Azure Functions, Azure Data Factory, and Azure Data Lake Required Experience: 5+ years of related work experience or equivalent combination of transferable experience in Technology application design and development 5-8 years of work experience designing systems/applications architecture on progressively complex IT projects. Required Education: Related Bachelor's degree in an IT related field or relevant work experience Would you like to know more about our new opportunity? For immediate consideration, please apply online and view all our open positions at ******************* ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. ARC Group is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse workforce. Position offered by No Fee agency.

Become a part of our caring community and help us put health first The Mail Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative, operational, and customer support assignments. Shift: 11:00AM-9:30PM Monday-Thursday Location: 9843 Windisch Rd. West Chester Township, OH 45069 Pay: $20.75/hr. Shift differential is available, 12% from 6:00PM-9:30PM Monday-Thursday. Earn a $1,500 hiring bonus! 50% of the hiring bonus is payable at hire and 50% is payable at 180 days of employment. The Mail Operations Pharmacy Technician 2: * Accurately fills and counts medications. * Ensures inventory levels are adequate for dispensing by working with the inventory supply team. * Works within defined parameters to identify work expectations and quality standards * Has some latitude over prioritization and timing, and works under minimal direction. * Follows standard policies/practices that allow for some opportunity for interpretation, deviation, and/or independent discretion. Use your skills to make an impact Required Qualifications * Must have an active Pharmacy Technician license in Ohio * Must have a National Pharmacy Technician certification, (PTCB or ExCPT) * Must be passionate about contributing to an organization focused on continuously improving consumer experiences * Must be able to stand 10 hours * ]Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications * High School Diploma or GED Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $40,000 - $52,300 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Become a part of our caring community and help us put health first Humana is looking for an experienced Healthcare Investigator to join its industry leading Special Investigations Unit. Do you enjoy speaking with members, providers, and other industry colleagues? Do you thrive on solving problems and thinking outside the box? Are you self-driven and enjoy being proactive? But, most of all do you have a passion for combating Fraud, Waste, and Abuse in the Health Care Industry? If this resonates with you, then you should strongly consider this amazing opportunity to join Humana's SIU. The Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Fraud and Waste Investigator collaborates in investigations with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares investigative and audit reports. Begins to influence department's strategy. Makes decisions on issues regarding technical approach for project components. Exercises good judgment with considerable latitude in determining objectives and approaches to assignments. In order to thrive in this role, the following attributes and experience would be helpful: o Self-starter and organized o Interview skills and able to conduct a thorough investigation to maintain compliance with Humana and governmental requirements o Able to collaborate with internal and external partners (Law Enforcement, Legal, Compliance). o Comfort with data analysis (Excel, Access, PowerBI), report writing, and creating/presenting via PPT or other platform o Performing Investigative research and medical record reviews o CPT code experience o Experience with testifying in Court This role will regularly engage with all of the following: o Local, State and Federal Law Enforcement o Humana Legal and Outside Counsel o Internal Compliance o Market Areas o Clinical Teams o Business areas for all product lines (Medicare, Medicaid, Commercial) o Industry Trend areas Use your skills to make an impact WORK STYLE: Work at Home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. WORK HOURS: Typical work hours are Monday-Friday, 8 hours/day, 5 days/week. EST/CST time zones Required Qualifications • Bachelor's degree • 2 years of healthcare fraud investigations and auditing experience • Knowledge of healthcare payment methodologies, claims, submissions, and payments • Strong organizational, interpersonal, and communication skills • Inquisitive nature with ability to analyze data to metrics • Proficiency with MS Word, Excel, Access • Strong personal and professional ethics • Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications • Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) • Experience testifying in court • Understanding of healthcare industry, claims processing, and investigative process development • Experience in a corporate environment and understanding of business operations Additional Information Work at Home Requirements • WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. • A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. • Satellite and Wireless Internet service is NOT allowed for this role. • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information How We Value You • Benefits starting day 1 of employment • Competitive 401k match • Generous Paid Time Off accrual • Tuition Reimbursement • Parent Leave • Go365 perks for well-being Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. #ThriveTogether #WorkAtHome Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $65,000 - $88,600 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 01-15-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Ohio. Work from home, and on the road. Monday - Friday, regular business hours. As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families. Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others. This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides in-person and telephonic Medical Case Management to individuals, involving the patient, physician, other health care providers, the employer, and the referral source Utilizes their medical and nursing knowledge to discuss the current treatment plan with the physician and discuss alternate treatment plans Provides assessment, planning, implementation, and evaluation of patient's progress Evaluates patient's treatment plan for appropriateness, medical necessity, and cost effectiveness Attends doctors, other providers, home and in some cases, attorney's visits Attends hospital and/or long-term facility discharge planning conferences, etc. for the purpose of determining appropriateness of care and developing an effective long-term care strategy Conducts home visit for initial evaluation Implements care such as negotiating the delivery of durable medical equipment and nursing services This role requires regular travel, dependent on the injured worker's injuries and needs. The employee must be available for local travel up to approximately 60% of the work week/month This role may require overnight travel Additional duties as required KNOWLEDGE & SKILLS: Effective communication and multi-tasking skills in a high-volume, fast-paced, team-oriented environment Ability to meet with the patient, their physicians, other healthcare providers, attorneys, advisors/clients, and coworkers A cost containment background, such as utilization review or managed care is helpful Strong interpersonal, time management, and organizational skills Computer proficiency and technical aptitude with the ability to utilize Microsoft Office, including Excel spreadsheets Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Experience as an RN Medical Case Manager is ideal, or a clinical background in orthopedics, neurology, or rehabilitation is preferred Graduate of accredited school of nursing Current RN Licensure in state of operation Certification as a CCM, CIRS, or other Case Management certifications preferred A valid driver's license, reliable transportation, and ability to travel to assigned locations is required PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $62,306 - $93,123 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL - Medical Case Managers: CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. In addition, Medical Case Managers are eligible for bonus and will be provided state-of-the-art technological devices to ensure ready access to CorVel's proprietary Case Management application, enabling staff to retrieve documents on the go and log activities as they occur. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote