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. Requirements - MD/DO - Experience with re-pricing and pre-payment review processes, including claim validation, reimbursement methodologies, and alignment with payer policies. - Proven experience in claims auditing or payment integrity within a health plan or TPA - Deep claims expertise with an understanding of provider billing and payer operations.billing, revenue cycle management, and payment integrity - Solid understanding of CPT, ICD-10, HCPCS codes, and reimbursement processes. - Strong analytical and communication skills; ability to translate medical concepts into structured business logic. - Experience in health-tech and data analytics environments, strong plus. BenefitsCompensation: $130-$150 per hour. Compensation finally awarded to the candidate will be commensurate with the candidate’s skills and experience.

Company Description It all started in sunny San Diego, California in 2004 when a visionary engineer, Fred Luddy, saw the potential to transform how we work. Fast forward to today - ServiceNow stands as a global market leader, bringing innovative AI-enhanced technology to over 8,100 customers, including 85% of the Fortune 500®. Our intelligent cloud-based platform seamlessly connects people, systems, and processes to empower organizations to find smarter, faster, and better ways to work. But this is just the beginning of our journey. Join us as we pursue our purpose to make the world work better for everyone. Job Description The Role The Sr.Technical Consultant, Expert Services is the functional and technical expert of a customer engagement team - consulting with customers and configuring the ServiceNow Platform products based on configuration best practices - all with the goal of accelerating and driving customer business outcomes. What you get to do in this role: - Creation and delivery of platform solutions that take in to account long term technical architecture, process design and ServiceNow technical standards - Support the engagement efforts related to platform wide process definition, re-engineering, improvement and gap analysis of current/future-state processes and functionality during workshops with key customer sponsors and stakeholders - Advise customers in their efforts to take advantage of the ServiceNow Platform capabilities in their efforts to improve their existing processes - Lead customer design workshops across multiple ServiceNow platform products and capabilities. - Guiding customers in completing required documentation such as business requirement workbooks for technical aspects of the solution - Drafting more technically-focused user stories, their acceptance criteria, testing strategy and knowledge transfer while supporting customers in reviewing and approving them - Guides and provides ad-hoc oversight/training for the customer's future system administrators throughout the engagement - Lead technical aspects of project delivery and solution delivery for engagements, sometimes providing oversight and unit testing of partner resources development - Be a lead member of an overall engagement project team focused on delivering successful and substantive customer outcomes - Develop required integration components (SSO, LDAP, etc.) with multiple systems - Prepare all customer-facing deliverables focused on the technology and responsible for quality of configured/developed solution - Juggle multiple and complex projects/initiatives - Promoting continuous improvement practices for delivery/engagement materials - Supporting specific sales activities when required - Providing training and mentoring to other members of the ServiceNow delivery team and partner ecosystem upon request Qualifications - Active TS/SCI Clearance with Full Scope Polygraph (FSP) Required - 3 years of experience working in US federal agencies and environment with ServiceNow Government Community Cloud (GCC). - Experience in leveraging or critically thinking about how to integrate AI into work processes, decision-making, or problem-solving. This may include using AI-powered tools, automating workflows, analyzing AI-driven insights, or exploring AI's potential impact on the function or industry. - ServiceNow security experience including Vault, Edge Encryption and Data Privacy - ServiceNow Domain Separation - At least 5 years of hands-on configuration/development experience for complex, highly-capable, technologies - inclusive of integrations and portals - Demonstrated ability to influence and consult (providing options with pros, cons and risks) in a complex and varied customer environments, while providing thought leadership to customer sponsors/stakeholders in solving business process and/or technical problems - Experience with Web Technologies (XML, HTML, JavaScript, Web Services, Bootstrap, CSS, middleware, LDAP, SSO, etc.) and working with SaaS technologies - Experience with data management, database design, and database concepts - Experience working with self-hosted installations of the ServiceNow platform - Knowledge of technical components such as LDAP, VPN, SSL, SAML/SSO and other widespread enterprise technologies - Strong interpersonal skills, customer-centric attitude, ability to deal with cultural diversity - ServiceNow certifications Certified System Administrator (CSA), Certified Application Developer (CAD) - Proven team player and team builder For positions in this location, we offer a base pay of $121,700- $213,000 plus equity (when applicable), variable/incentive compensation and benefits. Sales positions generally offer a competitive On Target Earnings (OTE) incentive compensation structure. Please note that the base pay shown is a guideline, and individual total compensation will vary based on factors such as qualifications, skill level, competencies, and work location. We also offer health plans, including flexible spending accounts, a 401(k) Plan with company match, ESPP, matching donations, a flexible time away plan and family leave programs. Compensation is based on the geographic location in which the role is located and is subject to change based on work location. Additional Information Work Personas We approach our distributed world of work with flexibility and trust. Work personas (flexible, remote, or required in office) are categories that are assigned to ServiceNow employees depending on the nature of their work. Learn more here . Equal Opportunity Employer ServiceNow is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex, sexual orientation, national origin or nationality, ancestry, age, disability, gender identity or expression, marital status, veteran status, or any other category protected by law. In addition, all qualified applicants with arrest or conviction records will be considered for employment in accordance with legal requirements. Accommodations We strive to create an accessible and inclusive experience for all candidates. If you require a reasonable accommodation to complete any part of the application process, or are unable to use this online application and need an alternative method to apply, please contact globaltalentss@servicenow.com for assistance. Export Control Regulations For positions requiring access to controlled technology subject to export control regulations, including the U.S. Export Administration Regulations (EAR), ServiceNow may be required to obtain export control approval from government authorities for certain individuals. All employment is contingent upon ServiceNow obtaining any export license or other approval that may be required by relevant export control authorities. From Fortune. ©2024 Fortune Media IP Limited. All rights reserved. Used under license.

At Wipfli, people count. At Wipfli, our people are core to everything we do-the catalyst behind our ability to create exceptional impact and extraordinary results. We believe in flexibility. We focus on relationships. We encourage each individual to follow their own path. People truly matter and they feel it. For those looking to make a difference and find a professional home, Wipfli offers a career-defining opportunity. The Internal Audit Senior Consultant - Trust Focused position can work in person, remote, or in a hybrid environment in the Middlebury, CT area. About 10% travel to client locations in the U.S. is required. Responsibilities: - Complete trust audit procedures as assigned for clients in the financial services industry - Lead client engagements as the Engagement In-charge for client engagements: ensure proactive communication with the client and engagement team, manage project timelines and deliverables, cultivate strong client relationships, and oversee all aspects of project execution - Define, measure, and analyze client processes and procedures related to trust - Evaluate whether processes and procedures are designed appropriately and operate effectively; identify areas of improvement - Interview personnel at all levels within the client organization - Communicate trust audit findings clearly and proactively with and to clients; report audit plan status and issues to Engagement In-charge or Job Manager as applicable - Learn service offerings of the firm and recognize cross-selling opportunities as capacity allows Qualifications: - Bachelor's degree in finance, accounting, business, or related degree OR equivalent years of experience in addition to the base required years of experience - 5+ years of process and procedure-based trust audit or trust consulting experience at a professional services firm OR 6+ years of process and procedure-based trust experience at a financial services company - Experience within the financial services industry is preferred - Consulting experience is preferred - Knowledge of compliance or professional standards associated with audit is preferred - Ability to plan, prioritize, and organize projects under time deadlines - Strong analytical skills with high attention to detail and accuracy - Excellent written, verbal, and presentation communication skills - Proficient in Microsoft Word, Excel, Outlook, and Copilot - About 10% travel to client locations within the U.S. is required Carly Seidl, from our recruiting team, will be guiding you through this process. Visit her LinkedIn page to connect! #LI-hybrid #LI-CS1 Additional Details: Wipfli is an equal opportunity/affirmative action employer. All candidates will receive consideration for employment without regards to race, creed, color, religion, national origin, sex, age, marital status, sexual orientation, gender identify, veteran status, disability, or any other characteristics protected by federal, state, or local laws. Wipfli is committed to providing reasonable accommodations for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or participate in our recruiting process, please send us an email at hr@wipfli.com . Wipfli values fair, transparent, and competitive compensation, considering each candidate's unique skills and experiences. The estimated base pay range for this role is $88,000-118,000, with offers typically not made at the maximum, allowing for future salary increases. The actual salary at the time of offer depends on business related factors like location, skills, experience, training/education, licensure, certifications, business needs, current associate pay, and relevant employment laws. Individuals may be eligible for an annual discretionary bonus, subject to participation rules and based on a variety of factors including, but not limited to, individual and Firm performance. Wipfli cares about our associates and offers a variety of benefits to support their well-being. Highlights include 8 health plan options (both HMO & PPO plans), dental and vision coverage, opportunity to enroll in HSA with potential Firm contribution and an Employee Assistance Program. Other benefits include firm-sponsored basic life and short and long-term disability coverage, a 401(k) savings plan & profit share as well as Firm matching contribution, well-being incentive, education & certification assistance, flexible time off, family care leave, parental leave, family formation benefits, cell phone reimbursement, and travel rewards. Voluntary benefit offerings include critical illness & accident insurance, hospital indemnity insurance, legal, long-term care, pet insurance, ID theft protection, and supplemental life/AD&D. Eligibility for all benefits programs is dependent on annual hours expectation, position status/level and location. "Wipfli" is the brand name under which Wipfli LLP and Wipfli Advisory LLC and its respective subsidiary entities provide professional services. Wipfli LLP and Wipfli Advisory LLC (and its respective subsidiary entities) practice in an alternative practice structure in accordance with the AICPA Code of Professional Conduct and applicable law, regulations, and professional standards. Wipfli LLP is a licensed independent CPA firm that provides attest services to its clients, and Wipfli Advisory LLC provides tax and business consulting services to its clients. Wipfli Advisory LLC and its subsidiary entities are not licensed CPA firms.

Role Description Utilization Management Nurse - REMOTE - RN license number must be valid for Arkansas - Can work on holidays and during the weekend - Utilization Management: - Conducts and monitors clinical review cases to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-of-network services, and surgery. - Documents all relevant and specific information. - Screens, prioritizes, and organizes determination requests according to mandates and standards. - Promotes appropriate care and quality toward cost-effective and cost containment measures based on evidence. - Knowledge: - Remain current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery, and enterprise procedures, policies, and contracts. - Other duties as assigned. - Schedule Notes: Qualifications - Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook. - Ability to navigate multiple systems and keyboarding. - Experience in utilization management and/or medical review preferred. Requirements - Ability to prioritize and make sound nursing judgments through critical thinking. - Excellent verbal and written communication skills. - Ability to build collaborative relationships. - Attention to details. - Ability to interpret complex documentation.