This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Office of Risk Management, within the Division of Business Services, has responsibility for assisting campus in preserving the human and physical assets of the university. This involves identifying, evaluating and controlling loss exposures to minimize the adverse effects of unpredictable events impacting the University. - Assist departments in their recovery efforts - Provide a variety of risk management services to campus, including: - Driver authorization program oversight - Certificate of insurance program administration - Automobile, liability, property and other claims handling services - Coordinate Worker’s Compensation claims in partnership with Divisional Human Resources Representatives - Assist employees who have sustained work-related injury or illness Qualifications - Experience or interest in risk management and/or occupational injury prevention - Risk Management, Business, Information Systems majors preferred - Ability to utilize database applications with attention to detail and accuracy - Strong interpersonal and communication skills, including the ability to develop and maintain effective working relationships with campus and Universities of Wisconsin System personnel - Ability to problem solve and/or refer inquiries to the proper individual - Ability to work independently and effectively under general supervision - Proficiency in MS Word and Excel and Adobe Acrobat - A passing score on a criminal background check (CBC) must be attained prior to hire Requirements - Excellent oral and written communication skills - Strong organizational skills, attention to detail and accuracy - Ability to work during Winter Break - Ability to utilize database applications Benefits - Fully remote position with very limited occasional onsite work for meetings or special project needs - Flexible scheduling with summer hours up to 30 hours per week and minimum 10 hours per week during semesters - Salary range: Minimum $14.00 - Maximum $20.00 Institutional Statements UW-Madison is an Equal Employment, Equal Access Employer committed to increasing the diversity of our workforce. Diversity is a source of strength, creativity, and innovation for UW-Madison. We value the contributions of each person and respect the profound ways their identity, culture, background, experience, status, abilities, and opinion enrich the university community. The University of Wisconsin-Madison fulfills its public mission by creating a welcoming and inclusive community for people from every background-people who as students, faculty, and staff serve Wisconsin and the world. For more information on diversity and inclusion on campus, please visit: diversity.wisc.edu If you need to request an accommodation because of a disability, you can find information about how to make a request at the following website: Disability Accommodation Information for Applicants

Summary Performs medical/pharmacy reviews using established criteria sets and/or performs utilization management of services within the LPN/LBSW scope of practice to include but not limited to professional, durable medical equipment, home health services, and/or pharmacy requests covered under the medical plan. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Assists with discharge planning as appropriate. Serves as a resource, mentor, and preceptor as needed. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Performs medical/pharmacy reviews using established criteria sets and/or performs utilization management of services within the LPN/LBSW scope of practice to include but not limited to professional, durable medical equipment, home health services, and/or pharmacy requests covered under the medical plan. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Assists with discharge planning as appropriate. Serves as a resource, mentor, and preceptor as needed. Location: This is a remote position, but local candidates a preferred. The team works from 8:30am - 5pm. What You’ll Do: - May provide any of the following in support of utilization review practices: Performs authorization process, ensuring benefit coverage for appropriate medical/pharmacy services based on established Utilization Management guidelines and criteria. Utilizes allocated resources to back up review determination. Reviews interdepartmental requests and medical information in a timely/effective manner in order to complete utilization process. Reviews/determines eligibility, level of benefits, and medical necessity of services and/or reasonableness and necessity of services. Provides education to members and their families/caregivers. Conducts research necessary to make thorough/accurate basis for each determination made. Supports the discharge planning process by assisting and collaborating with Managed Care Coordinators as appropriate. - Educates internal/external customers regarding medical reviews, medical terminology, coverage determinations, coding procedures, and UM processes, etc. in accordance with contractor guidelines. Responds accurately and timely with appropriate documentation to members and providers on all rendered determinations. Identifies and makes referrals to appropriate area/staff (Medical Director, Subrogation, Quality of Care, Case Management, etc.). Maintains current knowledge of contracts and network status of all service providers and applies appropriately. - Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. Completes all Required Licenses and Certificates and attends mandatory meetings. Participates in division or departmental projects and/or serves on special workgroups/committees. To Qualify For This Position, You'll Need The Following: - Required Education: Bachelor's in a job related field - Degree Equivalency: Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing - Required Work Experience: 2 years working experience as LPN or LBSW and 1 year working experience of utilization management and/or medical/pharmacy reviews. - Required Skills and Abilities: Working knowledge of word processing software. Good judgment skills. Demonstrates effective customer service, organizational, and presentation skills. Analytical and critical thinking skills. Ability to handle confidential or sensitive information with discretion. Ability to operate a computer with proficient typing skills. Strong oral and written communication skills. Accurate application of medical policy/guideline criteria. Extensive knowledge of benefits and contracts. Ability to work independently, prioritize effectively, and make sound decisions. Persuasive, motivational, and influential. Demonstrates flexibility in handling multiple tasks. Utilizes available resources effectively and appropriately. - Required Software and Tools: Microsoft Office. - Required Licenses and Certificates: Active, unrestricted LPN/LVN licensure from the United States and in the state of hired, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC), OR active LBSW (licensed Bachelor of Social Work) in state hired. We Prefer That You Have The Following: - Preferred Education: Associate Degree- Nursing. - Preferred Work Experience: 2 plus years working with maternity patients - Preferred Skills and Abilities: Experience educating, training, and/or mentoring new employees. Understanding of claims analysis and processes. Seeks innovative and creative solutions. Participation in quality or process improvement projects or special committees/workgroups. - Preferred Software and Tools: Knowledge of Microsoft Excel, Access, or other database software. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. - Subsidized health plans, dental and vision coverage - 401k retirement savings plan with company match - Life Insurance - Paid Time Off (PTO) - On-site cafeterias and fitness centers in major locations - Education Assistance - Service Recognition - National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Become a part of our caring community and help us put health first The Policy Governance Professional policy Governance is the combination of Compliance processes established and executed that are reflected in the organization's structure and how it is managed and led toward achieving goals. The Policy Governance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Policy Governance Professional supports the ongoing development, review, and management of Utilization Management (UM) policies and procedures. This role works closely with UM governance and relevant committees, ensuring documentation and reporting align with regulatory standards and organizational objectives. The position also assists with monitoring and reporting quality metrics, and is responsible for preparing clear, accurate written materials to support compliance and continuous improvement initiatives. Responsibilities: - Assist with the development, review, and maintenance of UM policy and procedure documentation, ensuring compliance with regulatory requirements and enterprise standards. - Support UM governance activities and provide committee support by preparing meeting materials, documenting meeting minutes, and tracking action items. - Collect, analyze, and report on UM quality metrics to inform decision-making and support continuous improvement efforts. - Prepare clear, concise, and accurate written communications, summaries, and reports related to UM governance, quality metrics, and policy activities. - Facilitate communication and training related to UM policy requirements, reporting resources, and compliance protocols. - Assist with the escalation and documentation of suspected policy violations in accordance with established Humana procedures Use your skills to make an impact Required Qualifications - Bachelor's degree - Less than 5 years of technical experience - Experience with UM operations, policy governance, committee support, and/or quality reporting in a healthcare environment. - Strong written communication and documentation skills. - Familiarity with regulatory standards (e.g., HIPAA, HITRUST, NIST) and compliance practices. - Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications - Graduate or advanced degree - Background in policy or compliance Additional Information 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 recommended; 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. Benefits Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including: - Health benefits effective day 1 - Paid time off, holidays, volunteer time and jury duty pay - Recognition pay - 401(k) retirement savings plan with employer match - Tuition assistance - Scholarships for eligible dependents - Parental and caregiver leave - Employee charity matching program - Network Resource Groups (NRGs) - Career development opportunities 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. SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website. 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. $65,000 - $88,600 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. Application Deadline: 03-09-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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.

External candidates: In order for your application to be correctly processed please sign-in before you apply Internal candidates: Please go to Workday and click "Find Jobs" link under Career Thank you for considering opportunities with us! Job Title Information Architecture Governance Advisor - Remote Requisition Number R7581 Information Architecture Governance Advisor - Remote (Open) Location Arizona - Home Teleworkers Additional Locations Alabama - Home Teleworkers, Alabama - Home Teleworkers, Arkansas - Home Teleworkers, California - Home Teleworkers, Colorado - Home Teleworkers, Connecticut - Home Teleworkers, Delaware - Home Teleworker, District of Columbia - Home Teleworkers, Florida - Home Teleworkers, Georgia - Home Teleworkers, Idaho - Home Teleworkers, Illinois - Home Teleworkers, Indiana - Home Teleworkers, Iowa - Home Teleworkers, Kansas - Home Teleworker, Kentucky - Home Teleworkers, Louisiana - Home Teleworkers, Maine Home Teleworkers, Maryland - Home Teleworkers, Massachusetts - Home Teleworkers, Michigan - Home Teleworkers, Minnesota - Home Teleworkers, Mississippi - Home Teleworker, Missouri - Home Teleworker, Montana - Home Teleworkers {+ 21 more} Job Information CSAA Insurance Group (CSAA IG), a AAA insurer, is one of the leading personal lines property and casualty insurance groups in the United States. Here, every employee shapes our mission. We build innovative, human-centered solutions that help AAA members prevent, prepare for, and recover from life's uncertainties. You will join a collaborative, inclusive culture where your strengths have room to grow and your ideas can drive real impact. Step into a role where you can contribute to our shared success through meaningful work. We are actively hiring for an Information Architecture Governance Advisor - Remote! Your Role: The Information Architecture Governance Advisor owns the design and implementation of an enterprise information model. Establishes and carries out enterprise data and information architecture policies, standards, and processes according to guidelines. Is responsible for structuring, organizing, and communicating information in a way that makes it easy for business users to find, navigate, and understand. Champions and facilitates the review of data-related changes across the organization. Works with business partners and Information Technology (IT) partners to drive consensus around how data should be structured. This business-focused role will reside on the Enterprise Data Governance team but will be expected to closely interact with other architects and data modelers within the IT division. Your Work: · - Define criteria and controls for an authoritative data source (ADS) - Lead the design and implementation of information modeling practices for the enterprise - Define data and information architecture related standards and guidelines - Coordinate and facilitate the review of data-related changes from an enterprise perspective - Organize data within domains and sub-domains to enhance the ability to find, govern, and utilize data across the enterprise - Enhance the company’s data governance platform to include data and information architecture components, definitions, and relationships - Support enterprise data strategy and data governance programs by providing a structured approach to architectural decision-making, ensuring changes are evaluated based on their impact across the enterprise - Identify and mitigate risks associated with architectural decisions and implementations - Establish guidelines and standards to minimize risks while ensuring compliance with regulations and policies - Act as liaison between business and IT to translate business data requirements into logical data architecture design - Engage in the development of policies, standards and procedures and coordinate with stakeholders through the approval process - Ensure compliance with established standards for development and management of data - Ensure compliance to data-related regulatory rules - Perform regular peer review of information models used across the enterprise Required Experience, Education and Skills - Bachelor of Arts (B.A.) or Bachelor of Science (B.S.) or in the absence of 4-year degree, an additional 4 years of experience in addition to the minimum experience will be considered - 6 years of related professional experience with transferable skills with a focus on using data modeling tools to implement and support information architecture / data governance capabilities - Strong data analytical skills - Defining high-level application and data-related requirements - Experience in the insurance domain - Experience creating conceptual or information models - Familiarity with logical and physical data modeling - Experience with defining data domains, data dictionaries, and business glossaries - Experience with data modeling methods such as UML - Familiarity with business architecture frameworks such as Zachman and TOGAF - Experience with one or more data and/or information modeling tools - Ability to communicate to senior and executive level management - Ability to successfully collaborate and influence stakeholders at all levels cross-functionally - Familiarity with enterprise data governance concepts - Experience making recommendations for information and data architecture solutions - Actively shapes our company culture (e.g., participating in employee resource groups, volunteering, etc.) - Lives into cultural norms (e.g., willing to have cameras when it matters: helping onboard new team members, building relationships, etc.) - Travels as needed for role, including divisional / team meetings and other in-person meetings - Fulfills business needs, which may include investing extra time, helping other teams, etc Please note we are hiring for this role remote anywhere in the United States with the following exceptions: Hawaii and Alaska. Why Choose a Career at CSAA IG? At CSAA IG, we are a mission-driven organization proudly committed to empowering our members, our employees, and our communities to thrive. Recognition: We offer a total compensation package, annual bonus eligibility for most roles, 401(k) with a company match, and so much more! Read more about what we offer and what it is like to be a part of our dynamic team at https://careers.csaainsurance.aaa.com/us/en/benefits. Career Growth: We believe in growth for everyone. Here at CSAA IG, leaders and mentors partner with employees to align interests, unlock development opportunities, and support long‑term success. Flexible Workplace: We embrace a remote-first culture through our Flexible Workplace. Most employees hold Home-Flex roles, working primarily from home, often with the flexibility to work from various locations including CSAA offices. Our flexible workplace empowers you to balance remote work with intentional in‑person moments that deepen connection and collaboration. Inclusion and Belonging: An inclusive and welcoming workplace is the cornerstone of our success. By fostering an environment where people feel valued and heard, we deepen our ability to understand and meet the unique needs of our members. This strengthens innovation and enhances our products and services, giving us a competitive edge in the market. Sustainability: As climate change leads to more frequent and severe weather events, we are taking bold action to build more resilient communities and reduce our environmental impact. Submit your application to be considered. We communicate via email, so check your inbox and/or your spam folder to ensure you don’t miss important updates from us. CSAA is committed to providing reasonable accommodations to qualified applicants and employees with disabilities or other limitations. If you would like to request an accommodation to participate in the job application or interview process, please contact TalentAcquistion@csaa.com If you apply and are selected to continue in the recruiting process, we will schedule a preliminary call with you to discuss the role and will disclose during that call the available salary/hourly rate range based on your location. Factors used to determine the actual salary offered may include location, experience, or education. CSAA does not provide visa sponsorship for this role. Applicants must have authorization to work indefinitely in the US. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). CSAA Insurance Group is an equal opportunity employer. #LI-JR1 .