The Customer Care Advocate resolves member and provider inquiries regarding contract benefits, claim payments, and enrollment across multiple communication channels. They are responsible for documenting interactions and ensuring compliance with legislative requirements to enhance customer satisfaction.
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68 Remote Job Openings at company
Enterprise Regulatory Compliance Audit & Monitoring Program Admin I/II/III
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Full Time
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2 days ago
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Perform audits and monitoring to ensure organizational compliance with federal, state, and association regulatory requirements. Provide oversight, conduct root-cause analysis, and make recommendations for process improvements to mitigate risk.
Enterprise Regulatory Compliance Audit & Monitoring Program Admin I/II/III
company
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Full Time
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2 days ago
company
Perform audits and monitoring to ensure organizational compliance with federal, state, and association regulatory requirements. Provide collaborative oversight, conduct root-cause analysis, and recommend process improvements to mitigate risk.
The role serves as the primary representative for physician, ancillary, and facility reimbursement analysis, focusing on contracting strategies and rate testing. Responsibilities include monitoring provider billing trends, managing payment disputes, and designing alternative reimbursement methodologies to ensure cost and quality goals.
Develop new services using the Django framework and maintain APIs and systems for operational teams. Provide mentoring to teammates and improve existing internal tools.
Manage intellectual property rights, including trademark registration and fighting infringements across Ukraine, EU, and USA. Handle legal compliance for iGaming, Fintech, and eCommerce, while drafting key commercial agreements and managing non-resident corporate structures.
Develop new services using the Django framework and maintain APIs and systems for operational teams. Provide mentoring to teammates and improve existing internal tools.
Responsible for coordinating and monitoring the utilization of behavioral and physical health services to ensure compliance with regulatory standards. Performs clinical reviews to determine the appropriateness of services and collaborates with providers to eliminate gaps in care.
Develop, launch, and optimize omni-channel CRM communications including Email, SMS, Push, and In-App notifications. Build customer journeys and trigger scenarios while analyzing key metrics like OR, CTR, and LTV to improve retention.
Manage client-aligned relationships by resolving employee concerns, leading workplace investigations, and ensuring compliance with company policies and external regulations. Oversee employee leave management programs and implement proactive employee relations strategies to improve retention and morale.
The role involves analyzing requirements, creating test cases and checklists, and performing manual functional, regression, and acceptance testing. Additionally, the candidate will manage the STLC cycle, document defects, and conduct product demos.
Conduct quantitative and qualitative user research, including creating surveys, tests, and interviewing respondents. Analyze data from analytical tools to structure findings and maintain a user knowledge base to improve user experience.
Develop a Python service layer for LLM agents using schema validation and build a multi-agent architecture with request routing and Human-in-the-Loop processes. Implement server-side access control, integrate cloud data storage, and establish monitoring and observability for AI solutions.
Manage intellectual property rights, including trademark registration and fighting infringements via DMCA and UDRP. Draft key commercial agreements and ensure business compliance across iGaming, Fintech, and eCommerce sectors, including data protection laws.
Build and optimize user conversion funnels and landing pages for various products and traffic types. Manage partner integrations, track UTM parameters, and conduct competitor research to improve conversion rates.
Lead the enterprise strategy and delivery of customer-facing web and mobile platforms with a focus on AI-first transformation. Oversee cross-functional teams in product, engineering, and UX to drive operational efficiency and measurable business value within a healthcare environment.
The Actuarial Analyst establishes insurance rates, rating structures, and reserves to maintain the financial solvency of the health plan. Responsibilities range from basic data analysis and financial projections to leading complex organizational projects and interpreting regulatory changes.
Manage strategic and national accounts by acting as a strategic advisor on benefit design and financial impacts. Focus on account retention, prospecting new business, and maintaining strong relationships with clients and brokers.
Handle requests from VIP clients via chat and email, providing product information and resolving issues in collaboration with specialized teams. Monitor personal performance metrics and document user interactions while relaying client feedback to the company.
Provide high-quality support to the bronze VIP segment and convert them into higher VIP tiers. Promote activities like tournaments and quests while gathering user feedback to increase overall customer satisfaction.
Manage the VIP client base to maintain activity and recover inactive users through personalized support. Handle incoming and outgoing communications across emails, messengers, and calls to ensure a positive user experience.
Supervise the poker integrity team by managing case distribution, quality control, and developing investigation processes and sanction matrices. Monitor for fraudulent activities such as bots, RTA, and collusion while collaborating with Anti-Fraud teams and software providers.
The Purchasing Specialist manages automated and stand-alone procurement systems, processes purchase orders, and coordinates with suppliers to ensure timely delivery of products. The role also involves supporting strategic sourcing efforts, managing supplier contracts, and providing reporting and analytics for stakeholders.
The Purchasing Specialist manages automated and stand-alone procurement systems, processes purchase orders, and coordinates with suppliers to resolve payment and delivery issues. The role also supports strategic sourcing efforts, manages supplier contracts, and provides reporting and analytics for stakeholders.
Community Connections Representative I/II (Central New York Region)
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Full Time
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13 days ago
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This role bridges the gap between health plan members and clinical operations through home visits and community outreach to address social determinants of health. It involves educating members on healthcare benefits and assisting with the enrollment and recertification process for various health insurance products.
Payment Integrity DRG Coding & Clinical Validation Analyst I/II/III (RHIA, RHIT, CCS, or CIC Certification Required)
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Full Time
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13 days ago
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Responsible for reviewing medical records to validate coding and DRG assignment accuracy for acute facility-based claims. The role involves auditing inpatient claims to ensure physician documentation supports the coded data and payment systems.
Design and implement backend features for a game provider, focusing on high-load scenarios and financial operation reliability. Collaborate on architectural decisions and develop APIs for frontend and partner integrations.
Build and maintain a data-driven decision-making system for marketing, including metric standards and reporting. Lead a team of marketing and web analysts while ensuring accurate attribution of marketing spend across various channels.
Build and manage a centralized Security Operations model, including SIEM implementation, log management, and detection rule creation. Develop incident response scenarios and automate routine SecOps processes while ensuring endpoint security and compliance.
Collaborates with stakeholders to elicit and document functional and non-functional IT system requirements. Serves as the primary interface between business units and IT teams to ensure solutions align with enterprise and data strategies.
Design and implement a centralized Access Management operational model, including RBAC, identity lifecycle automation, and access reviews. Establish policies and documentation to ensure compliance with regulatory audits and PCI DSS standards.
Establish the operational model for Application and Infrastructure Security, including vulnerability management and security controls integration into SDLC/CI/CD. Implement cloud and Kubernetes security baselines and collaborate with engineering teams to remediate findings and prepare for PCI DSS audits.
Launch, manage, and scale advertising campaigns on TikTok Ads while testing new hypotheses and creatives. Analyze key metrics such as ROI, CR, and EPC to optimize advertising links and manage large budgets across various GEOs.
Launch, manage, and scale advertising campaigns on TikTok Ads while testing creatives and new hypotheses. Analyze key metrics such as AR, CR, EPC, EPL, and ROI to optimize advertising links and manage large budgets across various GEOs.
Implement a comprehensive employer brand PR strategy and manage external communications across various platforms and media. Coordinate speaker development, professional conference participation, and cross-functional collaboration with SMM and design teams.
Develop and maintain the poker product roadmap and cross-conversion strategies between casino, betting, and poker. Responsible for financial modeling of tournaments, analyzing product metrics, and managing the full cycle from concept to technical specifications.
Provide high-quality support to the bronze VIP segment and convert them into higher VIP tiers. Promote activities like tournaments and quests while gathering user feedback to increase overall customer satisfaction.
The role involves analyzing technical specifications, creating test documentation, and performing functional, regression, and acceptance testing. The engineer will also manage the STLC cycle for features and bugs and conduct product demos.
Manage the VIP client base to maintain activity and recover inactive users through personalized support. Handle incoming and outgoing communications across emails, messengers, and phone calls to ensure a positive user experience.
Monitor and analyze marketing funnels and traffic efficiency using metrics like ROI, LTV, and ARPU to optimize budget distribution. Conduct user behavior analysis, competitor research, and product experiments to improve conversion rates and user flow.
The role involves analyzing technical requirements, creating test cases and checklists, and performing functional, regression, and acceptance testing. The engineer will also manage the STLC cycle for features and bugs, conduct demos, and collaborate with other departments to analyze issues.
Lead a frontend game development team by managing tasks, mentoring developers, and defining the technical strategy and architecture. Develop game processes using Pixi.js, including animations, UI/UX elements, and API integrations for iGaming projects.
Lead the product vision and roadmap prioritization while mentoring Product Owners and managing delivery across multiple product lines. Act as a Product Owner for one development team and optimize shared product processes and standards.
The role involves analyzing technical requirements, creating test cases and checklists, and performing functional, regression, and acceptance testing. Additionally, the candidate will manage feature releases across environments and support the SDLC cycle.
Integrate with internal services and optimize existing services using PHP and GoLang. Develop new services to support the company's iGaming B2B solutions.
Develop and maintain product functionality across multiple domains with a focus on SSR/SSG microservices and technical SEO. Optimize Core Web Vitals and implement performance monitoring using tools like Sentry and Grafana.
The Business Systems Analyst collaborates with stakeholders to elicit and document functional and non-functional IT system requirements. They serve as the primary interface between business units and IT teams to ensure solutions align with organizational objectives.
The Product Owner will define the long-term vision and roadmaps for services aligned with business goals while coordinating cross-functional teams. They are responsible for managing the full product delivery process, analyzing market trends, and maintaining high-quality documentation.
The role involves developing and implementing SEO strategies for iGaming projects, including the creation of PBNs, satellite sites, and parasite SEO. Responsibilities include conducting technical audits, managing link building, and optimizing content and structure to drive traffic and monetization.
Lead and mentor the DevOps/SRE team while developing technical strategies and engineering culture. Focus on scaling the gaming platform, improving observability, and automating infrastructure processes to ensure high availability.
Responsible for the accounting and financial reporting of company investments, including GAAP and statutory reporting and monthly close processes. Collaborates with internal finance teams and external custodians to ensure accuracy of financial data and resolve discrepancies.
The Medical Director oversees utilization and case management activities, including clinical reviews and the development of medical policies. They act as a liaison between the organization and the medical community while ensuring compliance with state and federal mandates.
Lead the development of high-quality game mathematics and mechanics for slots in collaboration with game designers. Perform simulations, competitive analysis, and rapid prototyping to ensure games meet target performance indicators.
The specialist will control payment reconciliation processes to ensure accuracy and timeliness while managing funds reporting and communication with payment providers. They will also optimize payment control processes and participate in the approval of provider contracts.
Provide analytic support for pharmacy and medical drug information to drive strategy, growth, and affordability. Collaborate with multidisciplinary teams to deliver actionable insights and ensure compliance with governmental and corporate guidelines.
Design, implement, and maintain distributed public and private cloud platforms to support business requirements and infrastructure deployment. Collaborate with IT teams to deliver secure, resilient, and cost-effective PaaS, SaaS, and on-premises solutions.
Resolves customer inquiries regarding contract benefits, claim payments, and enrollment via multiple communication channels. Ensures member and provider satisfaction by responding professionally and adhering to legislative and corporate requirements.
Develops and maintains code for electronic publishing and transactional statements using variable data composition systems. Analyzes system issues, creates workflows, and ensures compliance with design specifications through rigorous testing.
Provides administrative support and customer service for Utilization Management workflows, including handling inbound and outbound calls and creating authorizations. Acts as a primary contact for providers and members regarding regulatory requirements and authorization requests.
Conduct negotiations with streamers and bloggers to launch products and develop strategies for attracting new influencers. Analyze partner statistics against KPIs and optimize budgets to improve collaboration performance.
Drive traffic to projects with an ROI greater than 50% and monitor the effectiveness of advertising campaigns. Analyze profitable combinations, track KPIs, and collaborate with designers to create high-performing creatives.
Payment Integrity DRG Coding & Clinical Validation Analyst I/II/III (RHIA, RHIT, CCS, or CIC Certification Required)
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Full Time
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2 months ago
company
The analyst is responsible for auditing acute inpatient claims to ensure coding accuracy and clinical documentation compliance with MS-DRG and APR-DRG systems. They also manage case volumes, provide mentorship, and support departmental strategies through complex audits and data analysis.
The Software Engineer IV is responsible for directing software system validation, testing, and programming initiatives while assisting with system design and architecture. This role involves collaborating with cross-functional teams to communicate project statuses and implementing strategies to mitigate technical risks.
The specialist will be responsible for developing, launching, and optimizing Apple Search Ads campaigns to meet specific KPIs. They will also conduct market research, analyze competitor trends, and collaborate with ASO, design, and development teams.
This role provides medical leadership for utilization management, quality improvement, and cost containment activities within the behavioral health business unit. The director assists in establishing clinical policies, overseeing physician advisors, and ensuring compliance with regulatory and accreditation standards.
The Product Analyst will analyze key product metrics, user behavior, and sales funnels to generate actionable insights. They will also plan and evaluate A/B tests while maintaining analytical dashboards and supporting product decision-making.
The role involves developing and maintaining product functionality across multiple domains, focusing on SSR/SSG microservice development and implementing technical SEO tasks like indexing, canonicalization, and hreflang setup. Responsibilities also include performance optimization targeting Core Web Vitals and setting up performance and SEO monitoring.
The Software Engineer is responsible for working on projects currently being visualized or developed, involving the Software Development Life Cycle methodology, directing system validation/testing, and leading programming initiatives. This role requires close communication with clients and cross-functional departments regarding project statuses and proposals.