Hi, we’re Healthee. We’re on a mission to make healthcare easy for everyone. Our AI-powered platform helps employees understand, navigate, and optimize their healthcare benefits — transforming how people access and manage care. We’re looking for a Physician Advisor with a strong background in managed care claims, medical billing, and payer-side processes (TPA, insurance companies, etc.). In this role, you’ll bridge the clinical and financial aspects of healthcare — ensuring accurate mapping of medical services, claims, and billing logic, as well as supporting re-pricing and pre-payment processes. You’ll report directly to our Chief Medical & Data Officer, working closely with the Growth and Data Science teams. You’ll play a key role in validating and refining Healthee’s AI-driven claims fraud, waste, and abuse detection, as well as re-pricing and pre-payment processes, ensuring our algorithms and billing logic align with real-world clinical accuracy. We strive to be the best at what we do — and we’d love your help getting there. Key Responsibilities - Support re-pricing and pre-payment processes to ensure accurate claim valuation, validation, and alignment with payer rules and clinical standards. - Review, evaluate, and investigate claims data, medical billing logic, and CPT coding to ensure billing accurately reflects the patient’s care. - Identify and correct mismatches between clinical documentation and billing submissions to prevent denials, errors, compliance risks, and potential fraud or abuse. - Ensure all codes accurately represent the services provided, avoiding both under- and over-billing. - Fraud, Waste, and Abuse Detection (FWA): Identify and investigate potential FWA claims - Conduct detailed reviews of itemized bills, medical records, and other claims data to validate coding accuracy and appropriateness of charges - Work with insurance companies and TPAs to clarify medical necessity, address coverage discrepancies, and resolve claim disputes. - Serve as a subject-matter expert on clinical and billing topics during audits, product reviews, and client implementations. - Collaborate with Growth and Data Science teams to design and build scalable tools and solutions that support new growth opportunities in these areas.

Collaborating Physician Summary/Overview Healing Partners is a rapidly growing wound care management company based in the Mid-Atlantic region currently hiring a part-time collaborating physician. Reporting directly to the Vice President of Clinical Operations, the part-time collaborating physician will oversee all provider clinical operations and evaluate them according to established goals. The supervising collaborative physician will be consulting with Wound Care Nurse Practitioners. This position is a part-time role and is ideal for a Physician looking to make some additional income while performing limited administrative tasks. There is no call and no office hours. The physician is to be available if needed for questions or a virtual consult. Responsibilities - Supervising Nurse Practitioners - The Collaborating physician must be available for consultation by phone if needed. - Help define the scope of practice (Nurse Practitioners will have very limited prescriptive authority) - 2 In-person visits per year with the provider - 20 mandatory chart reviews per month Education & Experience - Doctorate Degree - Missouri Medical License - 2+ Years of experience as a practicing physician Knowledge, Skills, and Abilities - Wound care Experience (preferred) - Must reside in the State of Missouri

Become a part of our caring community and help us put health first As a RN Care Manager, you will enjoy a true work-life balance with no night or weekend shifts. Reporting to the Manager of Care Coaching, you will support members enrolled in the Wisconsin Family Care Program providing essential care coordination, support, and education. You will make a difference in the lives of those you serve and within your own community. You will: - Assess members, focusing on health and safety needs, to develop a comprehensive Member Care Plan (MCP). - Conduct regular health assessments - Coordinate with acute and primary care providers. - Educate members on disease processes and related risks, nutrition, exercise and lifestyle modifications to support informed decision-making while respecting each person's autonomy. - Document in member files within required DHS contract timeframes. - Participate in member monthly phone contacts and travel to attend in person visits in members setting. - Work remotely from your home and travel approximately 40% of the time to visit your members. Use your skills to make an impact Required Qualifications - Associate degree in nursing - Licensed Registered Nurse in the state of Wisconsin Preferred Qualifications - Previous Care Management experience. Additional Information - Location: Jefferson County, WI (Fort Atkinson, Whitewater, Jefferson, Watertown, etc) - Travel- up to 40% - Typical Work Days/Hours: Monday through Friday, 8:00 am – 4:30 pm CST. Driving This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. Mileage reimbursement is provided for work-related travel. Eligible mileage includes: - Travel from your home to your first work location of the day. - Travel between client or assignment locations during the workday. - Travel from your final work location back to your home. WAH Internet Statement To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. - Satellite, cellular and microwave connection can be used only if approved by leadership. - Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. HireVue As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum. About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Per Diem Physician to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: - Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes - Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs - Work with Signify Health as a clinician colleague, fulfilling the requirements of the specified role - Be flexible to travel locally and within licensed states, as needed - Conduct virtual visits as needed - Provide all Signify Health services as indicated including Diagnostic & Preventive Services products (i.e., spirometry, DEE, etc.) A Note on Our Work Environment: As an in-home clinician, your primary workplace is the private residence of health plan members. We are dedicated to meeting health plan members where they are, wherever they call home. These environments are diverse and may present a variety of conditions. Candidates must be able to comfortably and safely perform their duties in homes that may contain household pets, secondhand smoke and other potential airborne allergens or irritants. Why Clinicians Enjoy Working with Signify Health “Many of the people I see are shocked that a physician is coming to their home to visit with them one-on-one. When you sit down and have an unhurried conversation about their health, they are impressed, happy, and understand that their health plan and care team cares about them.” - M.L., MD “The primary care physician gets a snapshot of a person in an office setting, but with Signify Health, we see things like the number of steps to enter their home, the state of disrepair those steps may be in, and the person’s ability to function comfortably and with ease in their own home. We can make referrals to the individual’s health plan, encourage the participation of their loved ones, and ensure their PCPs are aware of their health and overall quality of life.” - C.H., MD Per diem employees qualify for: - Hourly base rate, plus additional incentive structure (i.e., per visit completed, other incentives may apply) - Malpractice insurance coverage (during Signify Health-related activities) - Supplies and other perks Required & Preferred Qualifications (MDs and DOs) - Active, unrestricted license(s) in coverage area(s) - Multi-state licenses (preferred) - Able to cover the following primary locations: Bradford and surrounding area. Anticipated Weekly Hours 12 Time Type Part time Pay Range The typical pay range for this role is: $83.69 - $180.25 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 12/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.