Nextech Internet Jobs in Usa
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In this role, you will support Medicare Part D members and healthcare providers by reviewing pharmacy benefit requests, evaluating clinical documentation, and ensuring decisions comply with Medicare guidelines and timelines.
This is an excellent opportunity for pharmacists interested in managed care, pharmacy benefit management, and clinical review operations .
High-performing contractors may have the opportunity for full-time employment based on performance .
Key Responsibilities Review and process Medicare Part D pharmacy benefit requests and appeals Ensure accurate case setup by reviewing internal notes, documentation, and fax requests Evaluate clinical information and apply professional clinical judgment for decision-making Conduct provider outreach to obtain additional clinical details when necessary Document case activities clearly and accurately within internal systems Ensure compliance with CMS Medicare guidelines and timelines Meet departmental productivity and quality standards Utilize drug compendia resources and clinical references for appropriate decision-making Participate in feedback sessions and development discussions with supervisors Required Qualifications Bachelor’s Degree in Pharmacy or PharmD Active Pharmacist License in good standing in the state of residence Strong computer literacy including: Microsoft Excel Microsoft Word Data entry and multi-system navigation Ability to work independently in a productivity-driven environment Ability to sit and focus for extended periods during scheduled shifts Reliable wired internet connection Minimum 25 Mbps download / 5 Mbps upload Dedicated quiet workspace for remote work Verifiable High School Diploma or GED Preferred Qualifications Experience in Managed Care or PBM (Pharmacy Benefit Management) environments Knowledge of: Microsoft Access Microsoft PowerPoint Microsoft Visio Experience handling high-volume data entry and multi-screen workflows Work Environment Fully remote position Camera use required during training and meetings Data entry and navigating multiple systems across dual monitors Possible outbound provider calls for clinical information Important Training & Scheduling Requirements Attendance is critical during the first 8–10 weeks of training Training schedule is Monday–Friday, 9:00 AM – 5:30 PM EST After training, shifts may include one weekend day or rotating weekend coverage Assigned shifts will fall within 7 AM – 8 PM EST Hiring Process Requirements Candidates must provide the following with their resume: Internet speed test screenshot showing both download and upload speeds ( ) Must have 25 download and 5 upload.
MUST SHOW BOTH Screenshot of active pharmacist license showing: Name License number State Status Valid dates Interview Process Virtual interview via Microsoft Teams
Remote working/work at home options are available for this role.
As a Senior Outside Plant Construction Technician in Appleton, WI, you will oversee the construction and maintenance of PON/fiber network communications facilities in TDS Telecom serving areas. Performs advanced operation of construction equipment which includes, but is not limited to, trenchers, backhoes, end loaders, and plows. Manages the overall project while coordinating with internal and external resources. Ensures the entire team operates according to safety protocols.
This role includes a $5,000 sign on bonus (payout terms apply) and may qualify for relocation assistance.
Outside Plant Construction Technicians can also earn up to $75 per week in incentives when your team meets production targets.
Training:
As a Senior Outside Plant Construction Technician, you will have the opportunity to obtain a Class A CDL through our in-house training program. You will attend safety training at one of our new facilities where you will also be trained on Pole Climbing and Bucket Trucks. On-the-job training includes exposure to various construction equipment including Directional Drill Rigs, Mini Excavators, Trenchers, and Locators. Fiber optic training includes Fusion Splicing, Fault Detection, and exposure to OTDRs and other advanced testing equipment.
This position may be eligible for relocation assistance. For further information, please contact the Talent Acquisition team.
Responsibilities :
- Receives maps and staking sheets for the full construction project and ensures project is built, with limited guidance from supervisors.
- Communicates updates to the project team as required.
- Manages daily and weekly project work based on deadlines, material and equipment availability, weather, and other factors.
- Coordinates with supervisor to ensure continual supply of work and availability of materials.
- Drafts and submits redlines upon completion of project.
- Ensures locates are performed on time and prior to team and equipment arriving at the worksite.
- Regularly engages municipalities, utility companies, suppliers, contractors, and property owners in order to smoothly coordinate project tasks and avoid disputes.
- Reads construction plans and municipality permits, and determines approach for completing work.
- Maintains all project documentation and records costs of project materials and material transfers.
- Ensures DOT inspections are performed on equipment.
- Works with project managers to ensure projects remain on schedule and within budget.
- Performs general construction labor in various weather conditions while utilizing safety fundamentals.
- Advanced operation of trenchers, backhoes, end loaders, plows, and other excavating equipment to construct and maintain outside plant cable facilities.
- Advanced operation of all test equipment associated with outside plant facilities and construction duties.
- Installs, troubleshoots, tests, splices, repairs, and maintains fiber optic facilities.
- Identifies location of defective cable using various test equipment and repairs buried, aerial, underground, and/or customer cable.
- Locates cable and fiber in response to customer requests and/or construction needs.
- Performs cable fault acceptance tests on newly constructed facilities.
- Actively trains, monitors, and coaches team members while sharing construction knowledge and experience. Performs quality control inspections and makes training recommendations. Ensures safety protocols are enforced.
- Services, cleans, maintains, and repairs equipment.
- Completes all related paperwork in a timely manner.
- Provides assistance to field services technicians, as needed.
Qualifications : Required Qualifications
- 2+ years of construction equipment operation utilizing various underground and aerial construction equipment such as directional drills, trencher/plow/rock saw, backhoe, or bucket trucks -OR- current military service, or prior military service with honorable discharge.
- 1+ years of experience leading construction projects as a crew foreperson or project manager.
- Must follow the TDS attendance guidelines in order to meet TDS's business needs including but not limited to our obligations to our customers and to our customers' needs.
- Must have and maintain a valid driver's license and remain eligible for DOT requirements.
- Must have the ability to obtain a Class A CDL. A current CDL is preferred at hire, but TDS will train and certify eligible associates through its in-house CDL certification program after hire.
- Physical requirements may vary based on company needs: Ability to climb poles, ladders, towers, and other structures as needed. Ability to kneel, dig, lift, and pull.
- Upon hire, must successfully pass all components of the Safety Training course curriculum.
- Upon hire, must successfully complete customer-specific requirements, which may include a background check administered by the customer.
- Preferred 2+ years' experience in the construction of fiber optic cable outside plant networks -OR- 2+ years installation of any underground or overhead utilities will be considered.
- Understanding of telecommunication products and services.
- Proven organizational skills and ability to multi-task.
- May require occasional travel.
- Must be willing to work overtime as needed. May be required to work various/swing shifts as business needs dictate.
- Must be able to operate vehicles with manual transmissions.
Physical Demands and Work Environment
While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear. The employee is frequently required to stand; walk; and stoop, kneel, crouch or crawl. The employee must also be able to climb poles, ladders, towers or other structures. The employee is occasionally required to sit, reach with hands and arms, climb or balance, and taste or smell. The employee must regularly lift and/or move up to 50 pounds and occasionally lift and/or move more than 100 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
While performing the duties of this job, the employee is regularly exposed to outside weather conditions and may have to work in attics and crawl spaces, or high-risk areas such as high voltage electrical, trenches, and manholes. The employee is frequently exposed to moving mechanical parts and heavy equipment; high, precarious places; fumes or airborne particles; and vibration. The employee is occasionally exposed to wet and/or humid conditions, toxic or caustic chemicals, extreme cold, and extreme heat. The noise level in the work environment is at times loud.
Benefits
We believe in taking care of our team, which is why we offer comprehensive benefits to support your health, financial well-being, and overall happiness. Join us and experience a work environment where your well-being is a top priority!
Associates scheduled to work 20 or more hours per week have access to:
- Medical Coverage
- Dental Coverage
- Vision Coverage
- Life Insurance
- 401(k) Plan
- Generous Vacation & Paid Sick Leave
- Seven Paid National Holidays & One Floating Holiday
- Paid Parental Leave (6 weeks after 12 months of employment)
- Adoption & Surrogacy Assistance
- Employee Assistance & Wellness Programs
- Short-Term & Long-Term Disability
- TDS Service Discounts
- Education Assistance
- Paid Volunteer Time
Who is TDS Telecom?
TDS Telecom provides high-speed internet, TV entertainment, and phone services to a diverse range of communities, including small to mid-sized urban, suburban, and rural areas across the U.S . click apply for full job details
As a Senior Outside Plant Construction Technician in Madison, WI, you will oversee the construction and maintenance of PON/fiber network communications facilities in TDS Telecom serving areas. Performs advanced operation of construction equipment which includes, but is not limited to, trenchers, backhoes, end loaders, and plows. Manages the overall project while coordinating with internal and external resources. Ensures the entire team operates according to safety protocols.
This role includes a $5,000 sign on bonus (payout terms apply) and may qualify for relocation assistance.
Outside Plant Construction Technicians can also earn up to $75 per week in incentives when your team meets production targets.
Training:
As a Senior Outside Plant Construction Technician, you will have the opportunity to obtain a Class A CDL through our in-house training program. You will attend safety training at one of our new facilities where you will also be trained on Pole Climbing and Bucket Trucks. On-the-job training includes exposure to various construction equipment including Directional Drill Rigs, Mini Excavators, Trenchers, and Locators. Fiber optic training includes Fusion Splicing, Fault Detection, and exposure to OTDRs and other advanced testing equipment.
This position may be eligible for relocation assistance. For further information, please contact the Talent Acquisition team.
Responsibilities :
- Receives maps and staking sheets for the full construction project and ensures project is built, with limited guidance from supervisors.
- Communicates updates to the project team as required.
- Manages daily and weekly project work based on deadlines, material and equipment availability, weather, and other factors.
- Coordinates with supervisor to ensure continual supply of work and availability of materials.
- Drafts and submits redlines upon completion of project.
- Ensures locates are performed on time and prior to team and equipment arriving at the worksite.
- Regularly engages municipalities, utility companies, suppliers, contractors, and property owners in order to smoothly coordinate project tasks and avoid disputes.
- Reads construction plans and municipality permits, and determines approach for completing work.
- Maintains all project documentation and records costs of project materials and material transfers.
- Ensures DOT inspections are performed on equipment.
- Works with project managers to ensure projects remain on schedule and within budget.
- Performs general construction labor in various weather conditions while utilizing safety fundamentals.
- Advanced operation of trenchers, backhoes, end loaders, plows, and other excavating equipment to construct and maintain outside plant cable facilities.
- Advanced operation of all test equipment associated with outside plant facilities and construction duties.
- Installs, troubleshoots, tests, splices, repairs, and maintains fiber optic facilities.
- Identifies location of defective cable using various test equipment and repairs buried, aerial, underground, and/or customer cable.
- Locates cable and fiber in response to customer requests and/or construction needs.
- Performs cable fault acceptance tests on newly constructed facilities.
- Actively trains, monitors, and coaches team members while sharing construction knowledge and experience. Performs quality control inspections and makes training recommendations. Ensures safety protocols are enforced.
- Services, cleans, maintains, and repairs equipment.
- Completes all related paperwork in a timely manner.
- Provides assistance to field services technicians, as needed.
Qualifications : Required Qualifications
- 2+ years of construction equipment operation utilizing various underground and aerial construction equipment such as directional drills, trencher/plow/rock saw, backhoe, or bucket trucks -OR- current military service, or prior military service with honorable discharge.
- 1+ years of experience leading construction projects as a crew foreperson or project manager.
- Must follow the TDS attendance guidelines in order to meet TDS's business needs including but not limited to our obligations to our customers and to our customers' needs.
- Must have and maintain a valid driver's license and remain eligible for DOT requirements.
- Must have the ability to obtain a Class A CDL. A current CDL is preferred at hire, but TDS will train and certify eligible associates through its in-house CDL certification program after hire.
- Physical requirements may vary based on company needs: Ability to climb poles, ladders, towers, and other structures as needed. Ability to kneel, dig, lift, and pull.
- Upon hire, must successfully pass all components of the Safety Training course curriculum.
- Upon hire, must successfully complete customer-specific requirements, which may include a background check administered by the customer.
- Preferred 2+ years' experience in the construction of fiber optic cable outside plant networks -OR- 2+ years installation of any underground or overhead utilities will be considered.
- Understanding of telecommunication products and services.
- Proven organizational skills and ability to multi-task.
- May require occasional travel.
- Must be willing to work overtime as needed. May be required to work various/swing shifts as business needs dictate.
- Must be able to operate vehicles with manual transmissions.
Physical Demands and Work Environment
While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear. The employee is frequently required to stand; walk; and stoop, kneel, crouch or crawl. The employee must also be able to climb poles, ladders, towers or other structures. The employee is occasionally required to sit, reach with hands and arms, climb or balance, and taste or smell. The employee must regularly lift and/or move up to 50 pounds and occasionally lift and/or move more than 100 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
While performing the duties of this job, the employee is regularly exposed to outside weather conditions and may have to work in attics and crawl spaces, or high-risk areas such as high voltage electrical, trenches, and manholes. The employee is frequently exposed to moving mechanical parts and heavy equipment; high, precarious places; fumes or airborne particles; and vibration. The employee is occasionally exposed to wet and/or humid conditions, toxic or caustic chemicals, extreme cold, and extreme heat. The noise level in the work environment is at times loud.
Benefits
We believe in taking care of our team, which is why we offer comprehensive benefits to support your health, financial well-being, and overall happiness. Join us and experience a work environment where your well-being is a top priority!
Associates scheduled to work 20 or more hours per week have access to:
- Medical Coverage
- Dental Coverage
- Vision Coverage
- Life Insurance
- 401(k) Plan
- Generous Vacation & Paid Sick Leave
- Seven Paid National Holidays & One Floating Holiday
- Paid Parental Leave (6 weeks after 12 months of employment)
- Adoption & Surrogacy Assistance
- Employee Assistance & Wellness Programs
- Short-Term & Long-Term Disability
- TDS Service Discounts
- Education Assistance
- Paid Volunteer Time
Who is TDS Telecom?
TDS Telecom provides high-speed internet, TV entertainment, and phone services to a diverse range of communities, including small to mid-sized urban, suburban, and rural areas across the U.S . click apply for full job details
About the Role & Team
At Disney, we‘re storytellers. We make the impossible, possible. We do this through utilizing and developing cutting-edge technology and pushing the envelope to bring stories to life through our movies, direct-to-consumer streaming services, products, parks and experiences, and our television shows and networks. Now is your chance to join our talented team that delivers unparalleled creative content to audiences around the world.
The Distribution Legal group negotiates and provides legal counsel for the distribution of The Walt Disney Company’s world-class feature films, television content and online direct-to-consumer offerings. We represent Disney’s expansive portfolio of brands from the Walt Disney Studios (including Disney, Pixar, Marvel, Lucasfilm, Twentieth Century Studios and Searchlight) television entertainment, sports and news (including ABC Entertainment, ESPN, ABC News, Disney Channel/Disney Junior/Disney XD, FX Networks, National Geographic Channel and Freeform), and our innovative direct-to-consumer offerings (including Disney+, ESPN+, STAR+ and ABC News Live). The role is for the legal team supporting Disney Platform Distribution.
This team is the legal hub for Disney content distribution on a global scale, including theatrical distribution, television network distribution, over-the-top distribution of direct-to-consumer offerings via video streaming platforms, physical home video, electronic home video (“EHV”), transactional video-on-demand (“TVOD”), subscription video-on-demand (“SVOD”), ad-supported video-on-demand (“AVOD”) and linear television. The group also advises business executives on distribution technology matters, related legal and policy matters, and handles content protection.
The Distribution Legal group is seeking a Sr. Paralegal to work in a fast-paced environment on innovative, high-profile, industry-leading content distribution matters for Disney Platform Distribution, including Internet and television distribution of Disney’s portfolio of motion picture and television titles on a linear (free, basic, pay), SVOD, ADVOD and direct-to-consumer basis (e.g., Hulu, Star, and Disney+). We’re looking for a bright, energetic, self-motivated and reliable person who can work closely with attorneys, and with other internal groups, and will exercise the highest level of ethics and discretion.
What You Will Do:
Work closely with attorneys and directly with business units on drafting, negotiating and closing license agreements:
with distribution licensees in the U.S. and Canada for linear broadcast, basic cable and pay television with accompanying video-on-demand usage rights;
for the acquisition of motion picture and television content to support the strategic distribution activities of Disney Platform Distribution on a global basis;
for the acquisition and distribution of television formats with third parties and Disney business units worldwide; and
with Disney and third-party distribution licensees in the U.S. and Canada across a wide variety of traditional and new platforms and business models, including direct-to-consumer applications and paid subscription platforms such as SVOD and ADVOD.
Provide in a clear, concise manner, advice and counsel to business and legal personnel regarding distribution issues and analysis of contractual provisions, rights and restrictions, and where necessary, interface with and seek advice from lawyers and executives from relevant internal groups (network and studio legal and business affairs, sales, technology, regulatory, antitrust counsel, labor relations, privacy, music, affiliate relations, ad sales and operations, etc.).
Provide ongoing oversight of legacy agreements, including legal issues related to distribution relationships, e.g., MFN compliance.
Maintain various departmental charts and input information into databases on a regular basis.
Work independently and manage negotiations with minimal supervision while ensuring Company’s policies, procedures, intellectual property rights and other key concepts are properly addressed.
Required Qualifications & Skills:
At least 3 years of paralegal experience
Outstanding drafting and legal writing skills
A deep interest in entertainment, media and technology industries, and willingness to learn about new areas
Ability to work independently or under limited supervision
Team-oriented and have the ability to take a solutions-oriented approach to legal issues
Ability to multi-task and work quickly and collaboratively under tight deadlines
Extreme attention to detail with accurate input and proofreading skills
Self-motivated, with outstanding interpersonal skills, and ability to communicate complex concepts and issues effectively with colleagues, counterparts and management
Proficient in Microsoft Word, Excel, Outlook and other office-related software
Preferred Qualifications:
Prior experience with entertainment, media and technology issues in television is preferred, but is not required
Some prior exposure to copyright law, intellectual property licenses and Internet and mobile platforms is preferred
Required Education:
A Bachelor’s Degree and/or qualifications to be a paralegal by certification or education and work experience as set forth by the American Bar Association and/or any applicable state codes. (JD’s will be considered)
#CORP_MEDIA
#twdcmedia
The hiring range for this position in Burbank, CA is $87,100.00 to $116,800.00 per year based on a 40- hour work week. The amount of hours scheduled per week may vary based on business needs. The base pay actually offered will take into account internal equity and also may vary depending on the candidate’s geographic region, job-related knowledge, skills, and experience among other factors. A bonus and/or long-term incentive units may be provided as part of the compensation package, in addition to the full range of medical, financial, and/or other benefits, dependent on the level and position offered.
It's fun to work in a company where people truly BELIEVE in what they are doing!
We're committed to bringing passion and customer focus to the business.
Spanish Bilingual Healthcare Call Center Representative
Location: Remote (Virtual Environment)
Company: Trusted Leader in Healthcare Services
Are you fluent in both Spanish and English? Do you have a passion for delivering exceptional customer service and helping others navigate their healthcare options? If so, we want to hear from you!
As a Spanish Bilingual Healthcare Call Center Representative, you will be the cornerstone of our commitment to customer satisfaction. In this role, you will provide comprehensive support and information to members, providers, and patients, ensuring they maximize the benefits of their healthcare plans and services. By adhering to compliance guidelines and embodying our company values, you will deliver extraordinary service while building trust and rapport with current and prospective members.
What You'll Be Doing:
- Customer Interactions:
- Manage inquiries in areas such as Member Services, Medicare, and Billing , assisting Spanish- and English-speaking customers.
- Represent our client professionally by addressing and documenting all incoming queries, including complex calls related to specialized product lines.
- Quality Service:
- Uphold the organization's philosophy of extraordinary customer relations.
- Proactively engage with Health Plan, medical group, and facility personnel to gather relevant information for resolving member inquiries.
- Problem Resolution:
- Analyze and evaluate customer issues to initiate and coordinate service recovery measures.
- Document all member interactions meticulously following established procedures.
- Healthcare Knowledge
- Demonstrate familiarity with health insurance terminology (copays, deductibles, claims, authorizations, etc.).
- Understand Medicare/Medicaid plans and regulations, and explain plan benefits, provider networks, and coverage policies.
- Operational Excellence
- Leverage a thorough understanding of company policies and processes to meet customer needs effectively.
- Contribute to departmental goals and objectives while maintaining proficiency through ongoing training and use of required tools.
- Performance Metrics:
- Monitor and achieve Contact Center KPIs, including call handling, first call resolution, and member retention.
- Compliance and Ethics:
- Consistently uphold company compliance standards and Code of Conduct, ensuring privacy and confidentiality of member information.
- Adhere to HIPAA regulations to protect personal health information (PHI) and maintain data security.
- Tools and Systems:
- Use multiple systems/screens while assisting callers effectively
- Navigate CRM, EMR/EHR, and ticketing platforms effectively
What You Bring:
- Experience:
- Fluency in both Spanish and English (spoken and written) is required.
- Minimum of two (2) years of customer service or healthcare member-interaction experience.
- Previous call center experience and/or prior experience in the health insurance industry (preferred).
- Education:
- High School Diploma or GED required.
- Skills:
- Outstanding written and verbal communication skills.
- Proven analytical and problem-solving abilities.
- Ability to respond concisely and clearly to customer queries.
- Strong critical thinking and problem-solving skills.
- Typing speed of at least 35 WPM with a 5% or lower error rate.
Success Factors for Working from Home
- To thrive in this remote role, you'll need:
- Private Workspace: A dedicated, quiet workspace with a door that closes, free from ambient noise.
- Ergonomics: A comfortable desk and chair setup that allows for the proper installation of necessary equipment.
- Reliable Internet Connection: Stable, high-speed internet with a minimum bandwidth of 20 Mbps downstream and 20 Mbps upstream.
- Quiet, Distraction-Free Workspace: A dedicated, quiet area where you can focus on delivering excellent customer service without interruptions.
- Tech-Savvy: Comfort with technology and ability to learn new systems quickly.
- Self-motivation & Independence: Ability to stay productive and manage your time effectively in a remote environment.
- Communication Skills: Strong verbal and written communication skills, especially in a virtual setting.
- Adaptability: Ability to adapt to changing technologies and procedures while working remotely.
What You Will Get:
- Competitive Pay: Enjoy a competitive hourly rate with opportunities for performance-based increases.
- Comprehensive Benefits: Full health insurance coverage, including medical, dental, and vision plans.
- Work Environment: A supportive, engaging, and inclusive work environment with opportunities to grow and develop your skills.
- Career Growth: Abundant advancement opportunities within the organization.
- Inclusive Workplace: We are an Equal Opportunity Employer, welcoming individuals with disabilities and veterans.
- Unique Perks:
- Cell Phone Benefits: $25/month per line for unlimited phone, text, and data (restrictions may apply).
- Referral for Life Program™: Earn residual bonuses for referring employees who join the team and remain with the company.
Join Our Team:
If you are a motivated Spanish-English bilingual professional who wants to make a meaningful impact in the lives of others, we encourage you to apply! Start a rewarding career where your language skills, dedication, and customer service expertise will help shape the future of healthcare services.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
It's fun to work in a company where people truly BELIEVE in what they are doing!
We're committed to bringing passion and customer focus to the business.
Spanish Bilingual Healthcare Call Center Representative
Location: Remote (Virtual Environment)
Company: Trusted Leader in Healthcare Services
Are you fluent in both Spanish and English? Do you have a passion for delivering exceptional customer service and helping others navigate their healthcare options? If so, we want to hear from you!
As a Spanish Bilingual Healthcare Call Center Representative, you will be the cornerstone of our commitment to customer satisfaction. In this role, you will provide comprehensive support and information to members, providers, and patients, ensuring they maximize the benefits of their healthcare plans and services. By adhering to compliance guidelines and embodying our company values, you will deliver extraordinary service while building trust and rapport with current and prospective members.
What You'll Be Doing:
- Customer Interactions:
- Manage inquiries in areas such as Member Services, Medicare, and Billing , assisting Spanish- and English-speaking customers.
- Represent our client professionally by addressing and documenting all incoming queries, including complex calls related to specialized product lines.
- Quality Service:
- Uphold the organization's philosophy of extraordinary customer relations.
- Proactively engage with Health Plan, medical group, and facility personnel to gather relevant information for resolving member inquiries.
- Problem Resolution:
- Analyze and evaluate customer issues to initiate and coordinate service recovery measures.
- Document all member interactions meticulously following established procedures.
- Healthcare Knowledge
- Demonstrate familiarity with health insurance terminology (copays, deductibles, claims, authorizations, etc.).
- Understand Medicare/Medicaid plans and regulations, and explain plan benefits, provider networks, and coverage policies.
- Operational Excellence
- Leverage a thorough understanding of company policies and processes to meet customer needs effectively.
- Contribute to departmental goals and objectives while maintaining proficiency through ongoing training and use of required tools.
- Performance Metrics:
- Monitor and achieve Contact Center KPIs, including call handling, first call resolution, and member retention.
- Compliance and Ethics:
- Consistently uphold company compliance standards and Code of Conduct, ensuring privacy and confidentiality of member information.
- Adhere to HIPAA regulations to protect personal health information (PHI) and maintain data security.
- Tools and Systems:
- Use multiple systems/screens while assisting callers effectively
- Navigate CRM, EMR/EHR, and ticketing platforms effectively
What You Bring:
- Experience:
- Fluency in both Spanish and English (spoken and written) is required.
- Minimum of two (2) years of customer service or healthcare member-interaction experience.
- Previous call center experience and/or prior experience in the health insurance industry (preferred).
- Education:
- High School Diploma or GED required.
- Skills:
- Outstanding written and verbal communication skills.
- Proven analytical and problem-solving abilities.
- Ability to respond concisely and clearly to customer queries.
- Strong critical thinking and problem-solving skills.
- Typing speed of at least 35 WPM with a 5% or lower error rate.
Success Factors for Working from Home
- To thrive in this remote role, you'll need:
- Private Workspace: A dedicated, quiet workspace with a door that closes, free from ambient noise.
- Ergonomics: A comfortable desk and chair setup that allows for the proper installation of necessary equipment.
- Reliable Internet Connection: Stable, high-speed internet with a minimum bandwidth of 20 Mbps downstream and 20 Mbps upstream.
- Quiet, Distraction-Free Workspace: A dedicated, quiet area where you can focus on delivering excellent customer service without interruptions.
- Tech-Savvy: Comfort with technology and ability to learn new systems quickly.
- Self-motivation & Independence: Ability to stay productive and manage your time effectively in a remote environment.
- Communication Skills: Strong verbal and written communication skills, especially in a virtual setting.
- Adaptability: Ability to adapt to changing technologies and procedures while working remotely.
What You Will Get:
- Competitive Pay: Enjoy a competitive hourly rate with opportunities for performance-based increases.
- Comprehensive Benefits: Full health insurance coverage, including medical, dental, and vision plans.
- Work Environment: A supportive, engaging, and inclusive work environment with opportunities to grow and develop your skills.
- Career Growth: Abundant advancement opportunities within the organization.
- Inclusive Workplace: We are an Equal Opportunity Employer, welcoming individuals with disabilities and veterans.
- Unique Perks:
- Cell Phone Benefits: $25/month per line for unlimited phone, text, and data (restrictions may apply).
- Referral for Life Program™: Earn residual bonuses for referring employees who join the team and remain with the company.
Join Our Team:
If you are a motivated Spanish-English bilingual professional who wants to make a meaningful impact in the lives of others, we encourage you to apply! Start a rewarding career where your language skills, dedication, and customer service expertise will help shape the future of healthcare services.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
Remote working/work at home options are available for this role.
It's fun to work in a company where people truly BELIEVE in what they are doing!
We're committed to bringing passion and customer focus to the business.
Join Us as a Technical Support Advisor!
Location: Remote Call Center
Join Us as a Technical Support Advisor!
Are you passionate about delivering exceptional customer experiences? Do you thrive in a fast-paced call center environment, solving technical problems and guiding customers through their challenges? If you have a love for customer service and a knack for technology, we want you on our team!
What You'll Be Doing:
Customer Service Excellence:
- Handle customer inquiries via phone, delivering tailored solutions to technical issues.
- Communicate clearly and effectively, both verbally and in writing, ensuring each interaction exceeds expectations.
Technical Support & Troubleshooting:
- Diagnose, troubleshoot, and resolve issues related to iOS, macOS, smartphones, tablets, or PCs.
- Use multiple systems to research and deliver efficient, real-time solutions.
Adaptability in Communication:
- Connect with a diverse range of customers by adjusting your communication style to meet their needs.
- Recognize and respond to verbal and non-verbal cues to provide an enhanced support experience.
Team Collaboration:
- Collaborate with fellow advisors to share expertise , solve problems, and achieve team goals.
What We're Looking For:
Customer Service Focus:
- Experience in customer-facing roles, such as in a call center or support environment (volunteer or academic experience counts too!).
Technical Enthusiasm:
- A solid understanding of iOS, macOS, smartphones, tablets, or PCs-and a passion for troubleshooting.
Resilience Under Pressure:
- Stay professional and composed in high-pressure situations, even when faced with criticism or setbacks.
Learning & Growth Mindset:
- Open to feedback and coaching, with a drive to continuously improve and excel.
What You Bring:
- Proven experience in customer support or technical assistance , ideally in a call center setting.
- Strong verbal and written communication skills.
- Problem-solving abilities with a flexible, adaptable approach to challenges.
- Confidence in navigating multiple software tools and systems to resolve issues.
- A self-motivated attitude with effective time management skills.
What You'll Get:
Competitive Pay:
- $17.31 per hour, with opportunities for performance-based incentives.
Comprehensive Benefits:
- Full health insurance package, including medical, dental, and vision coverage.
Cell Phone Perks:
- $25/month per line for unlimited phone, text, and data (restrictions may apply).
Training and Growth:
- Paid training to set you up for success.
- Career advancement opportunities with a globally renowned leader in technology innovation.
Referral Bonuses:
- Earn ongoing bonuses for referring new employees through our Referral for Life Program.
Supportive, Inclusive Environment:
- Thrive in a dynamic virtual work environment with a team that's dedicated to your success.
- Enjoy a culture that values diversity-we are an Equal Opportunity Employer, welcoming individuals with disabilities and veterans.
Remote Work Requirements
- Private Workspace: A quiet, dedicated workspace with no distractions.
- Ergonomics: A comfortable desk setup with all necessary equipment.
- Internet: A reliable internet connection with a minimum of 20 Mbps download and 10 Mbps upload speed.
- Ethernet Connection: Must be hardwired; Wi-Fi is not acceptable.
Why You'll Love Working Here:
At VXI, we value your contributions and commitment. Joining us means becoming part of a supportive, innovative team that champions continuous learning and career development. Whether you're driven by curiosity, passion, or technical expertise , you'll find the perfect space to grow and succeed with us.
Ready to Take the Next Step?
Apply today to become a Technical Support Advisor and help us create extraordinary customer experiences!
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
Remote working/work at home options are available for this role.
Summary:
- The Medical Director provides timely expert medical review of medical necessity requests for clinical services that do not meet utilization review criteria and renders a clinical opinion about the medical service under review while located in a state or territory of the United States.
Responsibilities include:
- Provide timely expert medical review of medical necessity requests for clinical services related to post-acute care and render a clinical opinion about the medical service under review, including post-decision reviews.
- Provide timely and collegial peer-to-peer discussions with treating physicians to clarify clinical information and to explain review outcome decisions.
- Participate in proactive peer to peers to assist with appropriate and timely discharge planning.
- Document all actions related to clinical review sessions and attest to review qualifications as required.
- Conduct weekly Case Conferences with nursing and social worker teams; discussing every assigned member receiving care in a post-acute care facility, focusing on discharge planning, complex medical care management, quality of care, appropriate level of care, and appropriate length of stay.
- Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications.
- Support the review of eviCore clinical guidelines.
- Support and communicate eviCore policies and procedures to the provider community.
- Testify at ALJ Hearings when your cases are being appealed
- Assist with staff educational training and in-service programs and serve as a clinical resource for eviCore staff.
- Serve as a Subject Matter Expert when Medical Directors and/or Senior Medical Directors are unavailable.
- Available for scheduled weekend call from home based on business needs.
- Participate in Joint Operating Committee (JOC) meetings, including the collection and review of data relevant to the client, and other virtual events with the provider engagement team in your specified territory.
- Participate in all required educational and quality improvement activities and maintain passing scores in all assessments.
- Assist in reviewing case determinations from clients responding to a provider or member complaint
- Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications
- Other duties as assigned
Minimum Education, Licensure and Professional Certification requirement:
- M.D or D.O with active board certification in primary care specialties (Family Medicine, Internal Medicine or Emergency Medicine) OR board certification in Physical Medicine and Rehabilitation required (recognized by the American Board of Medical Specialties or American Osteopathic Association) ?
- Three (3) or more years of relevant clinical practice post residency/fellowship required
- Active unrestricted license to practice medicine in a state or territory of the United States as a utilization review Doctor of Medicine or Doctor of Osteopathic Medicine.
- Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management
- Ability to commit to a set, weekly work schedule (Monday through Friday)
- Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems
- Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of the time
- In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That?s why you?ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you?ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Remote working/work at home options are available for this role.
Join Accredo Specialty Pharmacy, part of Evernorth Health Services, and bring your nursing expertise to patients where they feel most comfortable—their homes. As a Home Infusion Registered Nurse, you’ll deliver life-changing care while building meaningful relationships and driving positive health outcomes.
Responsibilities:
- Provide safe and effective administration of IV infusion medications in patients’ homes.
- Partner with pharmacists and care teams to ensure holistic patient well-being.
- Document assessments, treatments, and progress to maintain accurate patient records.
- Serve as the primary point of contact for patient updates and care coordination.
- Demonstrate autonomy in clinical decision-making to achieve optimal outcomes.
Required Qualifications:
- Active RN license in the state of practice.
- Minimum 2 years of RN experience.
- At least 1 year in critical care, acute care, or home healthcare.
- Proficiency in IV insertion and infusion techniques.
- Valid driver’s license and ability to travel within a large geographic region.
- Availability for a 32-hour workweek, including evenings and weekends as needed.
Preferred Qualifications:
- Bachelor of Science in Nursing (BSN).
- Experience with specialty pharmacy or infusion therapy programs.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Take your nursing skills to the next level by helping to improve lives with Accredo Specialty Pharmacy, a division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes.
As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it’s about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You’ll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team.
For more than 30 years, Accredo has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You’ll get the opportunity to make a lasting impact on the lives of others.
How you’ll make a difference and improve lives:
- Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients’ needs are met and to help them achieve their best health.
- Administer Medications: Take full responsibility for administering IV infusion medications in patients’ homes.
- Provide follow-up care and manage responses to ensure their well-being.
- Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey.
Requirements:
- Active RN license in the state where you’ll be working and living
- 2+ years of RN experience
- 1+ year of experience in critical care, acute care, or home healthcare
- Strong skills in IV insertion
- Valid driver’s license
- Willingness to travel to patients’ homes within a large geographic region
- Ability to do multiple patient visits per week (can include days, evenings, and weekends, per business need)
- Flexibility to work different shifts on short notice and be available for on-call visits as needed
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.