Role Description This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. The Medical Health Questionnaire (MHQ) Specialist is responsible for conducting comprehensive telephone interviews with program members to complete detailed Medical Health Questionnaires, exposure assessments, and other required worksheets. This role ensures accurate documentation of member health histories and exposure information within internal systems to support the generation of monitoring exam summaries. The specialist also performs medical record review tasks in accordance with established program guidelines and work instructions. A strong commitment to confidentiality, adherence to HIPAA regulations, and reliable completion of daily departmental responsibilities are essential to success in this position. This position is full time (40 hours / week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am to 5:00 pm CST. It may be necessary, given the business need, to work occasional overtime. This will be on-the-job training. Training is not a set timeline and will be during normal work hours. Primary Responsibilities: - Conduct thorough telephone interviews to complete Medical Health Questionnaires (MHQs), exposure forms, and other program-specific worksheets - Accurately enter and submit interview data through internal database systems to support member monitoring exam summaries - Perform Medical Record Reviews following program requirements and documented work instructions - Always maintain strict confidentiality, uphold member rights, and ensure compliance with HIPAA guidelines and organizational standards - Complete daily operational tasks and assignments to support department workflow - Perform other duties as assigned Qualifications - High School Diploma / GED - Must be 18 years of age OR older - 2+ years of experience in a customer service environment - 2+ years of experience with medical terminology or completion of medical terminology course - 1+ years of basic level experience in Microsoft Excel (opening a workbook, inserting a row, selecting font style and size) - 1+ years of intermediate computer experience in Microsoft Outlook (creating and replying to emails) - Ability to work any of our 8-hour shift between 8:00 am - 5:00 pm CST Requirements - Knowledge and understanding of CPT and ICD coding - Vocational or Technical Training/Education (Medical Assistant, Nursing Assistant, etc.) or Clinical Upskilling course - National Career Readiness Certificate Benefits - Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays - Medical Plan options along with participation in a Health Spending Account or a Health Saving account - Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage - 401(k) Savings Plan, Employee Stock Purchase Plan - Education Reimbursement - Employee Discounts - Employee Assistance Program - Employee Referral Bonus Program - Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) More information can be downloaded at: http://uhg.hr/uhgbenefits Company Description At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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 Required - Bachelor's degree in Pharmacy Substitutions - None Preferred - Doctorate degree in Pharmacy EXPERIENCE Required - 1 - 3 years in Pharmacy Preferred - None LICENSES OR CERTIFICATIONS Required - Registered Pharmacist Preferred - None SKILLS - Oral & Written Communication Skills - General Computer Skills - Problem Solving & Decision Making - Compliance - Prioritizing Language Requirement (other than English) None Travel Required None PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $67,500.00 Pay Range Maximum: $126,000.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

• Responsible for performing precertification and prior approvals • Tasks are performed within the RN scope of practice, under the Medical Director's direction, using independent nursing judgement • Determines medical necessity and appropriateness of services using clinical review criteria • Accurately documents all review rationales and determinations • Collaborates with physicians and other providers to facilitate the provision of services throughout the health care continuum • Performs accurate data entry • Participates in continuing education initiatives

Role Description Seeking Dental Hygienist to review claims with the submitted diagnostic material to make proper benefit determinations based on group contracts and DeltaUSA and departmental established guidelines/policies. Responsible for clearing up queues on a daily basis and to pend appropriate claims for additional information. Refers claims to dental consultants for review. Location: Candidates located more than 1 hour outside of our corporate office in Roanoke, VA and residing in the following states may be considered for remote work: FL, GA, ID, MD, NC, NE, SC, TN, VA, WI, WV. Essential Functions - Reviews diagnostic material (i.e. x-rays, periodontal charting, etc.) to determine appropriate benefits. - Adjudicate claim benefit review requests in a timely manner. - Refers claims to dental consultant for review when diagnostic materials do not appear to support the procedure requested. - Follows DeltaUSA guidelines and departmental guidelines/policies for claims processing. - Works in team concept with the CCU and other departments within Delta Dental. - Maintain accuracy and production numbers to meet department expectations. - Audited to ensure KPI’s are met monthly. Qualifications - Dental Assistant or Dental office manager. - Knowledge interpreting dental x-rays. - The ability to follow established procedures with moderate decision-making. - Extensive computer knowledge/skills. - Strong interpersonal and communication skills. - The ability to focus for long periods of time. - A positive attitude with ability to adapt to change and learn new things. Physical Demands and Work Environment The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: - While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. - Use of hands is required for such technological devices such as a computer, telephone and others. - The employee must occasionally lift and/or move up to 15 pounds. - Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. - The employee will be required to travel (sometimes long distances) to attend required meetings. Work environment: - The work is limited to the office environment with occasional trips to other office facilities or locations necessitating walking outdoors or driving. - The noise level in the work environment is usually minimal.