304 data security jobs found

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for supervising member service call center and ensuring timely, professional, and courteous responses to all customer inquiries and complaints, appropriately referring inquiries to other areas as necessary for resolution. Investigate escalated member inquiries. The incumbent may be required to make routine medical approval decisions. ESSENTIAL RESPONSIBILITIES Manage the departmental operations and day-to-day functions. Handle escalated calls from members, state agencies, providers and vendors. Coach and counsel employees. Prepare reports for various internal and external areas for trends and statistics. Create and maintain quality and training programs for department. Responsible for on-call emergency contact for nights and weekend support. Other duties as assigned or requested. QUALIFICATIONS Minimum High School Education or...

Company : enGen Job Description : JOB SUMMARY This role will specifically guide the definition and delivery of capabilities related to the Epic Payer Platform and other EHR vendor interoperability solutions, focusing on enabling efficient payer-provider and payer-payer healthcare data exchange. The role will be part of the enGen data organization. The Senior Product Owner is responsible for leading and guiding a cross-functional team in the development and delivery of high-quality technology products. The ideal candidate will have a strong understanding of technology concepts and practices, agile methodology, product development, and the healthcare industry. They will be responsible for defining product vision, strategy, and roadmap, managing the product backlog, and ensuring successful product launches. They will also mentor other Product Owners, collaborate with stakeholders, and communicate product updates to leadership. This is a highly collaborative role...

Company : Highmark Health Job Description : JOB SUMMARY The Senior Strategy Partner plays a critical role in driving the evolution and optimization of Highmark's Living Health Acceleration operating model. This individual will be instrumental in continuously enhancing the product operating model within PHE and with critical partners, ensuring it aligns with strategic goals and market demands. The Senior Strategy Partner will bring an external perspective on operating model and workforce optimization for the Product organization, collating and subsequently leveraging data to inform decision-making to enhance operating model performance and maturity. This role also encompasses leading strategic communications, managing leadership meetings, and spearheading special projects on behalf of the Product organization and leadership team, to advance the organization's goals and priorities. This role can be hybrid or remote - if you are within 50 miles of an office you are...

Company : Highmark Inc. Job Description : JOB SUMMARY This job plans, develops, and maintains operational processes and reporting related to group/provider facility and professional reimbursement configurations and other operational processes. Acts as the primary liaison between provider contracting, provider reimbursement, and claims experience. Collaborates with the pricing team to troubleshoot reimbursement issues and works with the Reimbursement Policy and Compliance team team to develop and maintain effective reimbursement quality programs and reporting. ESSENTIAL RESPONSIBILITIES Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have...

Company : Highmark Health Job Description : JOB SUMMARY The job is an integral member of an agile software engineer team responsible for building scalable software applications across all digital channels to serve our customers. The position will be responsible for taking an enterprise-wide, architectural view of the solutions and the technical execution of products using the technical stack that best meets the needs of the platform. The position will collaborate with the internal/external clients and be involved in every aspect at part of the software application build process from ideation, business analysis, technical design and software development using the latest technologies and design patterns. A principal engineer may be accountable for a team of software engineers to drive and develop products meeting the needs of our clients and product roadmaps. ESSENTIAL RESPONSIBILITIES Lead the resolution of a variety of technical and business problems...

Company : Highmark Health Job Description : JOB SUMMARY The job is an integral member of an agile software engineer team responsible for building scalable software applications across all digital channels to serve our customers. The position will be responsible for taking an enterprise-wide, architectural view of the solutions and the technical execution of products using the technical stack that best meets the needs of the platform. The position will collaborate with the internal/external clients and be involved in every aspect at part of the software application build process from ideation, business analysis, technical design and software development using the latest technologies and design patterns. A principal engineer may be accountable for a team of software engineers to drive and develop products meeting the needs of our clients and product roadmaps. ESSENTIAL RESPONSIBILITIES Lead the resolution of a variety of technical and business problems...

Company : Highmark Health Job Description : JOB SUMMARY This role is responsible for supporting the execution of member activation and engagement initiatives across products and solutions, with a particular focus on the clinical side of the business. As part of the Customer Relationship Management (CRM) team, this individual will contribute to developing a center of excellence for creating and managing profitable customer relationships and experiences. Key responsibilities include developing end-to-end strategies that will help with managing relationships with clinical partners, identifying C2V savings, overseeing wellness programs, addressing diagnosis and care gaps, and promoting member health through education and preventative steps. Preferred experience as a clinician or in a clinical setting. This role can be hybrid or remote. If you live with 50 miles of an office you are required to be onsite 3 days a week (T,W,Th). Outside of 50 miles will be remote....

Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations. ESSENTIAL RESPONSIBILITIES Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid. Conduct research beyond medical policy review to make decisions on medication coverage requests. Other duties as assigned. EDUCATION...

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides expertise for moderately to very complex problem solving and complete understanding of system functionality. The incumbent reviews significant amounts of data and analyzes processes to support business unit needs. Troubleshoots errors, conducts impact analyses, and/or solves data rejection. Performs business analyses in one or more operational areas. Identifies process gaps and recommends process improvements for efficiencies. Provides guidance and education to Associate and Intermediate level employees. ESSENTIAL RESPONSIBILITIES Intake operational objectives and gather information. Define, understand, and manage project scope. Perform moderate/complex research to support evaluation of complex output requirements and formats. May translate more complex business initiatives to less experienced employees. Present project deliverables to appropriate audiences. Create reports on...

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides personalized support and guidance to customers through an omni-channel experience, leveraging knowledge of healthcare administration and integrated partnerships to proactively resolve inquiries, ensuring a positive and seamless experience and ultimately driving positive member behavior and cost-effective business outcomes. ESSENTIAL RESPONSIBILITIES Serve as the primary point of contact for customers seeking information and assistance regarding their health benefits, claims, and online healthcare tools. Resolves standard and frequently non-routine, customer inquiries, comments, and concerns with the most limited escalation consistent with company policies and processes. Engage and guide members through clinical model complexities; connect members with appropriate clinical and non-clinical resources and redirect member site of care as defined by model and client requirements....

Company : Highmark Inc. Job Description : JOB SUMMARY This position coordinates member and provider outreach activities. The role focuses on completing non-clinical tasks, including prescriber office outreach, benefits investigations, and formulary research to ensure timely, accurate information gathering and communication. ESSENTIAL RESPONSIBILITIES Conducts member outreach in a professional, courteous, and service-focused manner, gathers and verifies, patient information prior to transferring cases to a pharmacist, ensuring completeness and accuracy. Supports timely processing of requests by following established workflows, turnaround time expectations, and regulatory requirements. Performs prescriber office outreach to initiate changes, obtain documentation, clarify medication information, and resolve non-clinical case needs. Completes benefits investigations, including eligibility verification, formulary coverage clarification, and...

Company : Highmark Inc. Job Description : JOB SUMMARY The job is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. This incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/ savings of money related to fraud, waste and abuse. The incumbent must be able to testify in a court of law, prepare cases for referral to...

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. ESSENTIAL RESPONSIBILITIES Communicate effectively with physician and pharmacy network providers to ensure that the needs of the...

Company : enGen Job Description : JOB SUMMARY This pivotal role will lead the strategic transformation and optimization of workforce operations across enGen, encompassing both internal resources and external vendors. The Senior Director will be a key driver in establishing robust frameworks for tracking hours, managing financial allocations, and ensuring highly efficient resource deployment. This individual will possess a deep understanding of transformational initiatives, serving as a change expert who can intelligently engage with vendors, internal stakeholders, and senior leadership to align business operations with strategic objectives and deliver significant value. This leadership role is responsible for influencing, shaping, and executing high-impact strategies and initiatives delivering significant enterprise-level value. The Senior Director level demands a high degree of strategic leadership, independent decision-making, and accountability for fostering...

Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews inquiries to determine if they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals; initiates a case file for each grievance and appeal; ensures compliance with organizational and regulatory requirements for member or provider issues; independently coordinates the resolution with internal/external parties as required; and documents and summarizes to all parties involved in the case the investigation results. ESSENTIAL RESPONSIBILITIES Review inquiries to determine if they meet definition of appeal/grievance. Request and review all related relevant documentation and assemble case file. Coordinate resolution results and relay investigative results with all involved parties. Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross...

Company : Highmark Inc. Job Description : JOB SUMMARY This job resolves standard and occasional non-standard customer inquiries, comments, and concerns by applying a seamless and positive customer experience gained through many recurring cycles of on the job work engagement. ESSENTIAL RESPONSIBILITIES Engages with customers in a confident and compelling manner, performing the full range of customer service duties and responsibilities, as assigned. Strives to resolve customer concerns in a single interaction via telephone, written, or face to face communication. Responds to a diverse set of customers with an equal level of confidence regardless of the issue at hand. Works independently of support from a senior customer service representative, frequently utilizing the knowledge center, answering customer inquiries. Routinely responds to customers with an in-depth product knowledge achieved through a continuously improving set of...

Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations. ESSENTIAL RESPONSIBILITIES Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid. Conduct research beyond medical policy review to make decisions on medication coverage requests. Other duties as assigned. EDUCATION...

Company : Highmark Health Job Description : JOB SUMMARY This job is a senior level actuarial analyst position. Participates in Highmark's Actuarial Executive Development Program and is expected to make continued progress towards actuarial credential. Utilizes experience and industry knowledge to define & diagnose a problem, outline data requirements for a study or analysis, and devise potential solutions. Guides and mentors less experienced staff and provides decision support to team members while initiating and leading the development of actuarial studies, analyses, and presentation materials needed to appropriately inform decision makers and making appropriate recommendations to management. Will work to develop efficient processes and will apply actuarial techniques and statistical analysis to several functions which may include insurance premium and pricing development, claim trend analysis, experience studies, medical economics, profitability analysis,...

Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) . Job Description : SUMMARY The Director Finance Central Region will provide financial leadership in Ryder’s Central Region FMS Business Unit. This Finance Director position will lead a team to support profitable growth and industry leading customer service by working directly with Operations, Sales and Product leadership. This position reports to the Group Director FMS Finance. * REMOTE work from HOME * ESSENTIAL FUNCTIONS Oversee the overall Financial Management of all activities withing the business unit and work with Group Finance Director to implement policies, procedures and controls. Oversee business plan and forecast to ensure accurate and timely reports for use by management throughout the organization. Provide leadership and capability to reduce costs, improve efficiency and ensure attainment of company business goals. Drive...

Job Description We are looking for an experienced solution consultant to help design, configure, activate and support the education, knowledge sharing, and product release communications for our internal solution consultants that support the Oracle Health Millennium solutions across Federal agencies including the Department of Defense, United States Coast Guard, Veterans Affairs and Indian Health Service. The Federal Consulting team is a group of hard-working, knowledgeable, passionate members who want to shape the electronic health records systems for active-duty service men and women, their beneficiaries, our Nation's Veteran's, American Indians, and Alaska Natives. A Sr. Knowledge Leader is an experienced solution consulting professional who has an understanding of solutions, industry best practices, multiple business processes or technology designs within a product/technology family. Operates independently to provide quality work products to multiple solutions and the...

Job Description We're on a journey to advance how health happens with technologies that support clinicians, inspire innovation, empower patients, and save lives. Our mission? To create a human-centric healthcare experience powered by unified global data. It's a big challenge, but big challenges are what we do best. We're already transforming some of the world's largest health systems-helping them turn data into lifesaving decisions and better patient care. We want people just as dedicated as we are making history with the advancement of Federal Healthcare systems. If you're excited about making healthcare more human, you've come to the right place. Oracle Health Government Services is seeking a skilled Compliance and Risk Specialist to join our mission-driven organization. In this role, you will be responsible for improving operational efficiency and consistency across the organization. This role focuses on developing business processes, managing internal audits of...

Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) . Job Description : Summary Responsible for design, development, and maintenance of dynamic eLearning, instructor led, blended or performance support training solutions and tools that enhance the capabilities and productivity of Ryder's employees. Essential Functions Creates learning content and testing to support major training and assessment initiatives, that aligns with Ryder’s goals, operating principles and competencies. Consults with subject matter experts, business owners to develop instructionally sound objectives, content, and implementation and evaluation learning strategies to deliver customized learning solutions. Organizes projects appropriately to accomplish deliverables while adhering to scope and timeline. Collaborate in the development and implementation of best practices in the use of instructional technologies, tools, and...

At Bayer we're visionaries, driven to solve the world's toughest challenges and striving for a world where 'Health for all Hunger for none' is no longer a dream, but a real possibility. We're doing it with energy, curiosity and sheer dedication, always learning from unique perspectives of those around us, expanding our thinking, growing our capabilities and redefining 'impossible'. There are so many reasons to join us. If you're hungry to build a varied and meaningful career in a community of brilliant and diverse minds to make a real difference, there's only one choice. Server Upgrade & Maintenance Support Specialist Server Upgrade and Maintenance Support Specialist - USA - Residence based Purpose: The purpose of this position is to execute software upgrades on servers, perform routine server and software related maintenance tasks, manage data migration projects and diagnose and resolve server related issues for multiple Bayer suite of products, current and future....

Overview At PNNL, our core capabilities are divided among major departments that we refer to as Directorates within the Lab, focused on a specific area of scientific research or other function, with its own leadership team and dedicated budget. Our Science & Technology directorates include National Security, Earth and Biological Sciences, Physical and Computational Sciences, and Energy and Environment. In addition, we have an Environmental Molecular Sciences Laboratory, a Department of Energy, Office of Science user facility housed on the PNNL campus. The Physical and Computational Sciences Directorate's (PCSD's) strengths in experimental, computational, and theoretical chemistry and materials science, together with our advanced computing, applied mathematics and data science capabilities, are central to the discovery mission we embrace at PNNL. But our most important resource is our people-experts across the range of scientific disciplines who team together to take...