Insurance Payor Issues Jobs

The Director of Human Resources role at Great Wolf Lodge leads strategy and execution for HR policies within the hospitality sector. Key responsibilities include partnering with lodge leadership to drive talent acquisition, performance management, and workforce planning while resolving complex employee relations issues and ensuring regulatory compliance. The position offers a dynamic environment with opportunities for career advancement through cross-training and leadership development programs. The role appeals to professionals seeking a culture that prioritizes diversity, well-being, and work-life balance through flexible scheduling and comprehensive wellness support. This position involves managing the local HR team and supporting international visa matters, operating within a collaborative resort setting.

The Behavioral Health Case Manager role at Bell Hospital involves providing comprehensive care coordination for patients of all ages within the behavioral health department. Key responsibilities include conducting psychosocial assessments, developing discharge plans, and connecting patients with community resources such as housing, therapy, and financial assistance programs. The position requires collaboration with interdisciplinary teams to ensure safe transitions from inpatient care to community settings. This full-time night shift opportunity appeals to licensed professionals seeking to make a direct impact on patient recovery and community reintegration. The role offers a supportive environment focused on patient-centered advocacy and professional growth within a large health system.

This full-time Principal Software Engineer role operates within Humana's healthcare technology team, focusing on the Appian low-code platform. The position serves as a hands-on technical authority responsible for designing, developing, and enhancing complex enterprise solutions, including workflow and case management applications. Key duties involve configuring platform security, optimizing performance for high-volume data, integrating RESTful APIs, and implementing AI capabilities within a HIPAA-regulated environment. The role appeals to candidates seeking to make a significant impact in the healthcare sector while working remotely from California with occasional travel for meetings. The position offers a collaborative culture that values whole-person well-being and provides opportunities for professional growth through technical leadership and platform governance.

The Financial Planning & Analysis Lead role within Centerwell Pharmacy focuses on driving strategic decisions through comprehensive financial forecasting and analysis. Key responsibilities include managing the Specialty Pharmacy P&L, developing drug-level profitability models, and presenting complex financial data to senior leadership to guide operational strategies. This position offers the appeal of working within a supportive, mission-driven healthcare community while solving complex business problems. The role is structured as a hybrid position based in Louisville, Kentucky, requiring three days in the office, though nationwide remote options are considered. It provides an opportunity for professional growth through collaboration with cross-functional teams and exposure to a dynamic regulatory environment.

This full-time Principal Software Engineer role focuses on designing and enhancing enterprise software solutions within a HIPAA-regulated healthcare environment. The position serves as a hands-on technical authority for the Appian platform, providing strategic guidance to multiple functional teams while actively developing complex workflow and case management applications. Key responsibilities include building process models and SAIL interfaces, optimizing platform security and performance, and integrating enterprise data sources using RESTful APIs. The role appeals to candidates seeking to leverage deep Appian expertise in a mission-driven organization that supports whole-person well-being. The position offers remote flexibility with occasional travel for training, requiring a dedicated home office setup to ensure data security and compliance.

The Specialty Infusion Manager role drives chronic and IVIG patient referrals within a defined territory for KabaFusion, the nation's largest privately held home infusion company. Key responsibilities include cultivating relationships with clinics, physicians, and payors to expand market share, collaborating with cross-functional pharmacy and nursing teams to ensure seamless service delivery, and achieving net revenue and profit goals. The position appeals to professionals seeking a culture that celebrates diversity and recognizes hard work, offering immediate benefits including a 401k match, comprehensive health coverage, and robust learning and development programs. This position supports a national network across 40+ states and requires strong business development skills within the healthcare sector.

This full-time Pharmacy Technician - Billing Specialist role is based in Pink Hill, North Carolina, within Southern Pharmacy Services, a division of the Guardian family. The position focuses on delivering customized medication management solutions for long-term care facilities. Key responsibilities include processing insurance claims, verifying patient eligibility, resolving billing disputes, and managing patient files to ensure regulatory compliance. The role also involves providing guidance on Medicare plans and performing prescription claims adjudication. The position appeals to candidates seeking a collaborative, fast-paced environment with opportunities for career growth and professional development. The work arrangement requires an on-site presence with a rotating weekend schedule and flexible hours between 8 am and 6 pm.

The Scheduling Specialist role supports the Therapy Services team at The Arc of the Ozarks by managing appointment logistics for a diverse range of clinical services. Key responsibilities include coordinating schedules for twenty-four providers, confirming client appointments, maintaining accurate records within the Electronic Health Record system, and assisting with front desk duties such as processing payments and verifying insurance. This full-time, in-office position offers the opportunity to work within a mission-driven organization dedicated to person-centered care. The role is appealing for its supportive collaborative culture, comprehensive benefits including health insurance and retirement matching, and opportunities for professional growth while helping the community access essential therapy services.

The RN Admissions Coordinator - Utilization Management role operates within Carle Health's interdisciplinary team to manage patient admissions and care transitions across Eureka and BroMenn facilities. Key responsibilities include conducting clinical assessments, coordinating with payers for preauthorization and concurrent reviews, and facilitating safe transitions from acute care to appropriate levels of care such as swing beds or home. The position requires collaboration with physicians and families to optimize patient outcomes while ensuring compliance with Medicare and state regulations. This opportunity appeals to nurses seeking a purpose-driven career in a Magnet-designated organization that values professional growth, community impact, and a supportive culture. The work arrangement involves on-site presence at Eureka with occasional afternoons at BroMenn based on census needs.

This PRN Medical Social Worker role within CenterWell Home Health supports an interdisciplinary team in delivering personalized care to patients recovering from illness or injury. The position involves assessing patients' social and emotional needs, coordinating community resources, and supervising social work assistants to ensure compliance with healthcare standards. Key responsibilities include developing individualized care plans, facilitating discharge planning, and maintaining detailed documentation for case conferences. The role appeals to professionals seeking to make a direct impact on patient well-being within a collaborative, patient-centered culture. It offers the flexibility of a part-time schedule with local travel required to visit patients in their homes.

The Director of Capital Design and Construction leads the Utah Transit Authority's capital and State of Good Repair programs, overseeing the full lifecycle from design through commissioning. Key responsibilities include managing major rail and bus construction projects, developing strategic programs for mass transit, and coordinating with government agencies for permitting and funding. The role requires building strong stakeholder networks to secure resources and collaborating with executives to drive ridership and revenue. This position appeals to leaders seeking to shape regional transportation infrastructure within a supportive environment offering extensive benefits, including a pension plan, tuition reimbursement, and wellness programs. The role is based on-site at the Utah Transit Authority headquarters.

The RN Admissions Coordinator - Utilization Management role operates within Carle Health's interdisciplinary team to oversee patient admissions and care transitions across Eureka and BroMenn facilities. Key responsibilities include conducting clinical assessments, coordinating with payers for preauthorization and concurrent reviews, and managing the discharge planning process to ensure appropriate levels of care. The position requires collaboration with physicians and families to optimize patient outcomes while maintaining compliance with Medicare and state regulations. This opportunity appeals to experienced nurses seeking a position that combines clinical expertise with strategic case management in a supportive environment. The role offers a hybrid work arrangement with on-site requirements at Eureka and occasional shifts at BroMenn, providing a chance to contribute to a Magnet-designated organization dedicated to community health and professional growth.

The Home Healthcare Revenue Cycle EDI Systems Analyst role supports the Revenue Cycle Management team within CenterWell Home Health, a subsidiary of Humana. This position focuses on managing and optimizing billing systems to ensure accurate claims processing and timely reimbursements for home care patients. Key responsibilities include configuring revenue cycle applications, analyzing EDI transactions such as 837 and 835 files, monitoring denial rates, and ensuring compliance with HIPAA and CMS regulations. The role serves as a liaison between internal departments, IT, and external vendors to resolve system issues and drive process improvements. This position is appealing for its opportunity to impact patient care through efficient financial operations, offering a remote work arrangement with occasional travel for training. The role emphasizes a collaborative culture dedicated to whole-person wellness and professional growth in the healthcare technology sector.

The Vice President of Sales - MI Clarity is a senior leadership role within Caris Life Sciences focused on driving adoption of precision oncology diagnostics for early-stage breast cancer providers and pathologists. The position involves developing and executing area sales strategies to meet revenue targets, building and mentoring a team of Regional Business Directors and Molecular Oncology Specialists, and cultivating executive-level relationships with healthcare system leaders. This role appeals to candidates passionate about transforming cancer care through meaningful work that improves the human condition. The position offers the opportunity to lead a high-impact team in a mission-driven culture while requiring regular field travel to engage directly with clients and prospects.

The Senior Manager, FOCUS role operates within Gilead's Legal, Compliance and Corporate Responsibility team to advance public health initiatives across Florida. The position focuses on partnering with healthcare institutions to standardize bloodborne virus screening, reduce late diagnoses, and improve linkage to care for HIV, HCV, and HBV. Key responsibilities include developing state action plans, monitoring partner data and implementation quality, engaging with policy makers, and collaborating cross-functionally with government and medical affairs teams. This field-based position offers the opportunity to drive meaningful health equity outcomes while working in a mission-driven culture that values inclusion and innovation. The role requires approximately 25% travel within the state and involves strategic leadership to scale evidence-based practices.

This Data Governance Analyst role supports enterprise data initiatives within a large-scale environment hosted on Google Cloud Platform. The position focuses on Master Data Management and data quality governance, requiring collaboration with business and technical teams to ensure data integrity and lineage visibility. Key responsibilities include managing data stewardship processes using Reltio MDM, writing SQL queries to validate data across systems like Postgres and Oracle, and supporting data integration architectures. The role appeals to candidates seeking a culture of ownership where individuals act as partners in shaping company strategy. It offers opportunities for professional growth through continuous learning and access to global capabilities. The position is based in Missouri, Minnesota, Kansas, Nebraska, or Iowa.

The Director of Science serves as a strategic leader for The Nature Conservancy's Nevada and Utah chapters, guiding the development and deployment of evidence-based conservation strategies. Key responsibilities include mentoring science teams, designing complex conservation projects, fostering multi-disciplinary partnerships, and integrating scientific insights into regional policy initiatives. This role appeals to candidates seeking to drive transformative environmental outcomes while working within a collaborative, mission-driven culture that values diversity and professional growth. The position offers a flexible work environment with up to 30% travel required between Salt Lake City and Reno to support on-the-ground conservation efforts.

The RN Case Manager role at Medical City Dallas involves coordinating patient care plans within a large tertiary care center to ensure high-quality, compassionate outcomes. Key responsibilities include conducting comprehensive patient assessments, managing length of stay, collaborating with multidisciplinary teams to develop safe discharge plans, and facilitating smooth transitions to post-acute care. The position appeals to nurses seeking professional growth through extensive education assistance, a supportive culture, and access to advanced medical technology. The role is full-time with day shift hours, typically Monday through Friday, and offers a comprehensive benefits package including retirement matching and health coverage.

The Senior Manager, Adult Tournaments & Masters Tour role serves as the national strategic lead for the USTA's adult competition portfolio and ITF Masters Tour. Key responsibilities include executing the Adult Competition Strategic Plan, managing the national tournament lifecycle from sanctioning to site selection, and overseeing the NTRP and Masters Championships. The position requires leading cross-functional teams, engaging with international governing bodies, and supervising tournament operations and staff. This opportunity appeals to candidates seeking to drive growth in the tennis industry within a mission-driven organization committed to accessibility. The role offers a hybrid work arrangement based in Orlando, combining remote flexibility with in-office collaboration, alongside a comprehensive benefits package focused on professional development and work-life balance.

This full-time remote role involves a Telephonic Nurse serving as a Care Manager within CenterWell Home Health, a division of Humana. The position focuses on ensuring continuity of care for patients transitioning between services, requiring the nurse to act as a clinical advocate and resource navigator. Key responsibilities include determining appropriate levels of care, facilitating referrals to home health, hospice, or palliative services, and providing education on Medicare coverage and available healthcare resources. The role appeals to experienced nurses seeking to make a meaningful impact on patient outcomes through empathetic, phone-based support. The position offers a flexible work-from-home arrangement with a standard weekday schedule and occasional weekend rotations, supported by a collaborative culture dedicated to whole-person wellness.

The Adjustments Transaction Processor is an entry-level, onsite role based in Milwaukee, WI, supporting business operations for major government and corporate clients. The position focuses on accurate data entry, account reconciliation, and processing financial transactions such as payments, adjustments, and stop payments. Key responsibilities include resolving payment discrepancies, maintaining databases, and ensuring strict adherence to established procedures and compliance standards. This opportunity appeals to detail-oriented individuals seeking a stable position within a culture that values individuality and offers structured training. The role requires a high school diploma, strong computer skills, and the ability to pass a typing assessment, with a standard Monday through Friday schedule.

This entry-level, onsite role at Conduent in Milwaukee supports Fortune 100 and government clients by managing critical financial transaction processing. The position involves posting payments, resolving account discrepancies, and performing high-accuracy data entry to maintain balanced records. Key duties include researching payment issues, reissuing checks, processing adjustments, and communicating with payors to obtain necessary information. The role appeals to detail-oriented individuals seeking to develop skills in accounting and data management within a structured environment that values individuality. Candidates must possess strong computer skills and pass a typing assessment. The schedule is Monday through Friday with potential overtime, and the position requires a high school diploma or GED.

This Principal Individual Contributor role within Humana's Supplemental Benefits Operations team focuses on the strategic execution and lifecycle management of the Spending Account Card. The position serves as a key thought partner to the Director, translating high-level strategy into actionable plans for benefit design, regulatory compliance, and operational optimization. Key responsibilities include leading cross-functional initiatives with technology and finance teams, managing vendor relationships, and ensuring adherence to CMS regulations while driving continuous improvement in member experience. The role offers the appeal of working for a leading healthcare organization with a mission to improve community well-being, providing significant autonomy to influence complex, high-visibility projects. While the position is primarily remote with a strong preference for Louisville, Kentucky, it includes occasional travel for meetings and training.

The Vice President of Financial Reporting & Regulatory Compliance leads the planning and execution of external financial reporting and regulatory adherence for a major California-based bank holding company. Key responsibilities include overseeing the preparation of critical regulatory filings such as Call Reports and FR Y-9C, managing relationships with auditors and regulators, and driving process optimization through automation. The role involves mentoring a high-performing team, ensuring SOX compliance, and advising senior leadership on emerging accounting standards. This position appeals to candidates seeking a leadership opportunity within a collaborative culture that values entrepreneurial thinking and operational excellence. The bank supports professional growth through robust development programs and offers a comprehensive benefits package including health insurance, retirement matching, and paid time off.

The Vice President of Financial Reporting & Regulatory Compliance leads the planning and execution of external financial reporting and regulatory adherence for a major California-based bank holding company. Key responsibilities include overseeing the preparation of critical regulatory filings such as Call Reports and FR Y-9C, managing relationships with external auditors and regulators, and driving process optimization through automation. The role involves mentoring a high-performing team, ensuring SOX compliance, and advising senior leadership on emerging accounting standards. This position offers the opportunity to work within a collaborative culture that values entrepreneurial thinking and operational excellence, supported by comprehensive benefits including tuition reimbursement, leadership development programs, and flexible family support initiatives.