Become a part of our caring community The Fraud Medical/Financial Risk Evaluation Professional 2 is responsible for supporting the development, implementation and monitoring of medical/financial risk. The Medical/Financial Risk Evaluation Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Fraud Evaluation Professional position is critical to ensuring compliance with Humana’s documented standards and procedures regarding fraud and abuse investigations and ensuring that Fraud Research and Analytics Department both continues and increases its early fraud detection capabilities. This position places a key role supporting our partner departments: Special Investigations Unit (SIU) and Risk Adjustment Integrity Unit (RAIU) which are responsible for documenting all case investigative activities, evidence, and findings to prove or disprove fraud and abuse allegations. This position is critical in maintaining Humana compliance standards, early fraud detection and analysis, and the ability to meet regulatory requirements. Use your skills to make an impact Required Qualifications - Minimum 2 years of Humana claims systems experience specifically CAS and MTV as well as understanding of medical claims terminology - Experience in data analytics, including the use of data analytic tools such as Power BI - Expertise in Microsoft Excel, including advanced skills in utilizing Pivot Tables for data summarization, analysis, and reporting Work-At-Home Requirements - 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 - Associates 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 associates 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 Preferred Qualifications - Undergraduate Degree - Advanced experience in Power BI - Experience with SQL or Python Additional Information - As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. - If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews. 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: 04-06-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ 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.

Overview The Medical Science Liaison (MSL) is a field-based representative of the Medical Affairs Organization that supports and represents Shionogi Inc and its products with, and to, key opinion leaders (KOLs), clinicians, institutions, and professional organizations. This includes relationship building and management of KOLs providing for meaningful scientific exchange at national, regional and local levels in both academic and clinical practice settings. The incumbent addresses the specific needs of healthcare professionals (HCPs) by responding to unsolicited requests for information about our marketed and developing products. As a clinical and scientific expert on the company and products, the MSL is responsible for building long-term relationships and establishing rapport with HCPs in hospitals, clinics, and academic centers through scientific disease state and product discussions that support current therapeutic concepts and ensure the safe and effective use of products. The incumbent is also a resource to company management regarding therapeutic area dynamics, business development, and KOL feedback. The MSL also works cross-functionally with internal departments and external resources on clinical and scientific matters. At all times, the MSL fully complies with all applicable federal, state, and local laws and regulations as well as Shionogi Inc. Code of Conduct. policies, standards, work instructions, privacy and data guidelines. Responsibilities - The following outlines the main duties of the role. This summary is not meant to be an exhaustive, but provides a high-level overview of the key activities of the role. - Establishes, manages, and maintains successful relationships with relevant healthcare entities including, but not limited to, KOLs, HCPs, academic institutions, payors, patient organizations, etc. to serve as the educational, research and clinical/scientific informational resource. - Designs and executes plans for the assigned MSL region with alignment to medical strategy and KOL priorities. - Identify relevant HCPs in context of medical strategy and patient needs. - Responds to and documents unsolicited medical and scientific requests for information; Liaises with investigators on unsolicited requests for investigator-initiated research submissions studies. - Delivers, and may develop/design, fair-balanced clinical and scientific presentations for HCPs, payors, and patient organizations in response to unsolicited requests for information on company products with with medical review committee approval. - Identifies and trains speakers for advisory boards, symposia, and educational programs with presentation materials, including approved slide sets, abstracts, posters, etc. - Attends national and regional medical/scientific meetings and symposia as a representative of the company and engages in discussions with attendees as appropriate; attends scientific sessions and poster presentations, gathers information, and summarizes findings; as appropriate, cultivates professional relationships from interactions at these meeting. - Evaluates competitor research and information relevant to company therapeutic areas, objectives, activities, and product priorities; stays current on therapeutic advances; analyzes and applies relevant intelligence findings and presents data/insight to appropriate internal stakeholders. - Collaborates and works effectively across multi-disciplinary internal groups (Clinical, Regulatory, Commercial (Sales and Marketing), Legal, Compliance, etc.) to support Shionogi medical/scientific and business objectives. This includes providing disease state, clinical and scientific training as requested across functional teams and providing input to management on therapeutic and research advances, business development opportunities/risks, and KOL feedback. - Maintains a thorough awareness of medical/clinical, regulatory, compliance, and quality issues and processes as they apply to the Company’s therapeutic areas and adheres to, and supports the standards established by the company. - Completes accurate and timely submission of administrative reports, projects, expense reports, training, KOL documentation, conference reports, and all other required documentation. - Analyzes operational data to identify trends, root causes, and opportunities for improvement. Develops and tracks key performance indicators (KPIs) and associated metrics as assignment by Medical Affairs leadership. - Designs and ensures delivery of training programs at high standards to build operational excellence capabilities within the team. - Works closely with cross-functional teams, including medical affairs, clinical operations, regulatory affairs, commercial and marketing, and quality assurance, to drive alignment and achieve operational goals. - Leads change management efforts to ensure successful implementation of process improvements and operational initiatives. - Regularly assesses industry best practices, internal needs, opportunities and challenges, and identify fit-for-purpose opportunities to adopt and enhance medical impact and create operational efficiencies. - Other duties as assigned. Minimum Job Requirements Qualifications - Doctoral level degree in life sciences program with strong scientific knowledge highly preferred. Post grad in virology, infectious disease, epidemiology or related fields considered. - Previous MSL experience in the pharmaceutical/biopharmaceutical industry required with previous respiratory infectious disease experience preferred; experience in COVID-19 preferred OR, previous MSL experience in the pharmaceutical/biopharmaceutical industry preferred with previous respiratory infectious disease experience required. - Experience in the outpatient medical community as well both pre- and post-launch product approval activities is preferred. - Demonstrates clinical, scientific, and technical knowledge within infectious diseases or respiratory diseases preferred but not required. - Understanding of the pharmaceutical industry and business strategies. - Knowledgeable with current regulatory guidelines to ensure corporate compliance in all activities, including those related to scientific interactions, unsolicited questions, clinical trials, and research. - Behaves in an ethical and professional manner, adhering to the company's guidelines and regulatory requirements. Competencies - Adept at building and maintaining relationships with key healthcare providers and other industry stakeholders. - Works collaboratively with internal colleagues within and across groups, as well as, external organizations across all levels and roles. - Communicates effectively and presents scientific and medical information to a wide range of audiences, including healthcare providers, researchers, industry, cross-functional colleagues, payors, and key opinion leaders. - Ability to manage multiple projects and initiatives simultaneously, and be able to organize, communicate, and prioritize work effectively. - Thinks strategically, identifies opportunities and finds innovative solutions to challenges to advance the interests of the company. - Demonstrated computer skills in MS Word, Excel, Outlook, PowerPoint, MS TEAMS, and video conferencing. - Demonstrated ability to be flexible and adapt to the changing healthcare environment, pharmaceutical industry conditions, healthcare professionals’ and organizational needs. Other Requirements - Ability and willingness to travel up to 75% of time by automobile, train, or air to accomplish MSL responsibilities. Typically, MSL travel consists of approximately 3 days a week in the designated MSL region and attending conferences and/or other meetings 6-10+ annually. - Must live within the boundaries of the assigned geographic territory and within a commutable distance to a large airport. - Driving in a safe manner to required meetings and appointments. - Valid driver’s license with a clean driving record and ability to pass a complete background check. - Must have valid licenses and credentialing required to conduct business in assigned territory. Additional Information The base salary range for this full-time, field-based position is $175,000-$210,000. Individual pay is determined by several factors, which include but are not limited to: job-related skills, experience, and relevant education or training. The range does not include the comprehensive benefits, vehicle allowance, bonus, long-term incentive, or any additional compensation that may be associated with this role. EEO Shionogi Inc. is an equal opportunity employer supporting individuals with disabilities and veterans. All qualified applicants will receive equal consideration for employment opportunities based on valid job requirements without regard to race, color, religion, sex (including pregnancy), marital status, national origin, age, ancestry, citizenship, disability, genetic information, status as a disabled veteran, a recently separated veteran, Active Duty Wartime or Campaign Badge Veterans, and Armed Forces Service Medal Veterans, or any other characteristic protected by applicable law. It is the policy of Shionogi Inc. to undertake affirmative action for protected veterans and individuals with disabilities in compliance with all federal, state, and local requirements to recruit a diverse pool of protected veteran and individuals with disabilities applicants and to ensure that our employment practices are, in fact, non-discriminatory. If you are qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to use or access this website to apply for a vacancy as a result of your disability. You can request accommodations by calling 973-307-3550 or by sending an email to ShionogiHR@shionogi.com.

Job Summary: The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. Essential Functions: - Provide prior authorization medical reviews, consultation and clinical review services - Participate in peer-to-peer discussions - Provide provider education, training, data sharing, performance evaluations and orientation to the plan - Conduct clinical reviews for designated CareSource members as requested - Provide physician review for clinical appeals cases - Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns - Participate in development of policies and procedures - Participates in quality improvement initiatives, case management activities and member safety activities (i.e. incident management - Provide cross-coverage for other Medical Directors and/or markets, as needed - Oversight and quality improvement activities associated with case management activities - Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate - Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards - Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives - Collaborate with market/product leaders to help define market strategy - Community collaborative participation - Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs - Perform any other job related instructions, as requested Education and Experience: - Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required - Successful completion of a residency training program, preferably in primary care is required - Minimum of five (5) years of clinical practice experience is required - Managed care medical review/medical director experience is preferred - Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred Competencies, Knowledge and Skills: - Basic Microsoft Word skills - Excellent communication skills, both written and oral - Ability to work well independently and within a team environment - Ability to create strong relationships with Providers and Members - High ethical standards - Attention to detail - Critical listening and systematic thinking skills - Ability to maintain confidentiality and act in the company’s best interest - Ability to act with diplomacy and sensitivity to cultural diversity - Decision making/problem solving skills - Conflict resolution skills - Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served Licensure and Certification: - Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required - Board Certification, preferably in primary care specialty is required - Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer) - MCG Certification is required or must be obtained within six (6) months of hire Working Conditions: - General office environment; may be required to sit or stand for extended periods of time - May be required to work evenings/weekends - May be required to travel to fulfill duties of position Compensation Range: $195,200.00 - $341,600.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SW2

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at jnj.com As guided by Our Credo, Johnson & Johnson is responsible to our employees who work with us throughout the world. We provide an inclusive work environment where each person is considered as an individual. At Johnson & Johnson, we respect the diversity and dignity of our employees and recognize their merit. Job Function: Medical Affairs Group Job Sub Function: Medical Science Liaison Job Category: People Leader All Job Posting Locations: Irvine, California, United States of America Job Description: Johnson and Johnson is currently seeking an Associate Director, Medical Science Liaison, Cardiac Electrophysiology for the Texas Region. Candidate should be based in close proximity to Texas. At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at https://www.jnj.com/. We know that the success of our business – and our ability to deliver meaningful solutions – depends on how well we understand and meet the diverse needs of the communities we serve. Which is why we foster a culture of inclusion and belonging where all perspectives, abilities and experiences are valued and our people can reach their potential. At Johnson & Johnson, we all belong. We are looking for a highly motivated and knowledgeable Associate Director - Medical Science Liaison (MSL) who specializes in cardiovascular medicine, within Johnson & Johnson Medtech Electrophysiology. In this role you will be driving key initiatives in KOL engagement, advisory boards, research, publications, medical education, and field intelligence between our Scientific Affairs team and the academic/non-academic surgical community. This is a business-critical role that requires a combination of both commercial/field/business acumen and Med Affairs/Clinical Affairs background. Key responsibilities include developing and nurturing strong relationships with key option leaders (KOLs) and healthcare professionals, identifying unmet needs/scientific gaps in medical research/clinical practice paradigms and cross functional collaboration with internal partners to deliver field & medical insights. You will participate and/or drive special projects including: voice of customer events, physician initiated clinical study conversations, internal and external education, publication planning and execution. Your primary objective will be to bridge the gap between J&J and our electrophysiology customers by maintaining thorough knowledge of our product platforms, understanding business/strategy objectives and goals, and being updated on current literature and data in cardiac electrophysiology. Major Duties & Responsibilities - Support the development and implementation of strategic engagement plans to establish and maintain relationships with KOLs, surgeons, operating room staff, and relevant medical societies in the cardiac ablation field. - Act as a scientific authority in cardiac electrophysiology, providing medical and scientific education to internal and external stakeholders. - Collaborate with cross-functional teams, including Product Management, Clinical Affairs, Marketing, Scientific Affairs, and Research & Development, to provide scientific input and insights. - Communicate & streamline complex scientific information effectively to healthcare professionals, ensuring a clear understanding of the benefits and clinical utility of our cardiac ablation and diagnostic platforms e.g., provide clinical support during voice of customers sessions. - Stay up to date with the latest scientific research, medical publications, and emerging trends in cardiac electrophysiology and appendage closure to provide up-to-date insights and guidance to internal and external stakeholders. - Lead the preparation of materials needed to deliver presentations on the science supporting the portfolio and participate in scientific symposia, conferences, and educational programs to enhance awareness and understanding of the platforms. - Support clinical studies and research initiatives by providing scientific and technical expertise and maintaining open lines of communication to the external KOLs and authors. - Provide training and education to internal teams, including Sales and Marketing, to ensure a deep understanding of scientific message. - Participate in internal trainings to ensure a deep and thorough understanding of our cardiac electrophysiology platforms. - Organize, analyze, and review/report on customer, scientific, and market information on pre-launch and marketed products. - Develop educational materials and support programs for personnel. - Discuss Investigator Initiated and Collaborative study concepts with clinicians. Qualifications: - Doctoral Degree is required (PhD, MD, DO etc.) is required. - A minimum of 5 years of experience working in the biotech/medtech industry is required; - Previous experience in cardiovascular medicine is highly desired and will be preferentially considered. - Minimum of 5 or more years of experience in a Medical Affairs/Clinical Sciences/Medical Science liaison is highly preferred. - Strong knowledge of cardiovascular medicine, ideally electrophysiology is heavily preferred. - Insights within the interventional cardiology and/or electrophysiology space is strongly preferred. - Strong understanding of clinical research methodologies, regulatory guidelines, and medical terminology is required. - Proven ability to establish and maintain relationships with KOLs, and other healthcare professionals is required. - Ability to analyze and interpret scientific data quickly and accurately is essential. - Excellent interpersonal, communication and presentation skills, with the ability to effectively communicate complex scientific concepts to both scientific and non-scientific audience. are essential. - Highly self-motivated, independent, and adaptable to changing priorities and environments. - Given focus of role for US market, candidate must have work authorization in USA. - Excellent computer skills, especially with the use of Microsoft Office is required. - The ability and willingness to travel up to 60% domestic is required. The anticipated base pay range for this position is 137,000 - 237,750. Relocation not offered. At Johnson & Johnson, we’re on a mission to change the trajectory of health for humanity. That starts by creating the world’s healthiest workforce. Through innovative programs and policies, we empower the physical, mental, emotional and financial health of our employees and the ones they love! At Johnson & Johnson, we offer a variety of outstanding health and financial benefits, including competitive compensation, 401k, pension, medical, dental, and vision insurance, exercise reimbursement, flexible time off, paid volunteer and parental leave, and more! Subject to the terms of their respective plans, employees are eligible to participate in the Company’s consolidated retirement plan (pension) and savings plan (401(k)). This position is eligible to participate in the Company’s long-term incentive program. Subject to the terms of their respective policies and date of hire, employees are eligible for the following time off benefits: - Vacation –120 hours per calendar year - Sick time - 40 hours per calendar year; for employees who reside in the State of Colorado –48 hours per calendar year; for employees who reside in the State of Washington –56 hours per calendar year - Holiday pay, including Floating Holidays –13 days per calendar year - Work, Personal and Family Time - up to 40 hours per calendar year - Parental Leave – 480 hours within one year of the birth/adoption/foster care of a child - Bereavement Leave – 240 hours for an immediate family member: 40 hours for an extended family member per calendar year - Caregiver Leave – 80 hours in a 52-week rolling period10 days - Volunteer Leave – 32 hours per calendar year - Military Spouse Time-Off – 80 hours per calendar year For more information on how we support the whole health of our employees throughout their wellness, career and life journey, please visit www.careers.jnj.com. Johnson & Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act. Johnson & Johnson is committed to providing an interview process that is inclusive of our applicants’ needs. If you are an individual with a disability and would like to request an accommodation, external applicants please contact us via https://www.jnj.com/contact-us/careers . internal employees contact AskGS to be directed to your accommodation resource. Required Skills: Preferred Skills: Clinical Research and Regulations, Clinical Trials, Customer Centricity, Data-Driven Decision Making, Developing Others, Digital Culture, Digital Literacy, Inclusive Leadership, Leadership, Medical Affairs, Medical Communications, Medical Compliance, Performance Measurement, Product Knowledge, Relationship Building, Research and Development, Scientific Communications, Strategic Thinking, Team Management The anticipated base pay range for this position is : $137,000.00 - $235,750.00 Additional Description for Pay Transparency: