Role Description Employees are responsible for triaging, investigating, and resolving potential instances of healthcare fraud and/or abusive conduct by medical professionals or providers. Using information from tips, complaints, external intelligence or behavior data, the medical community and law enforcement, employees conduct confidential investigations and document relevant findings and report any illegal activities in accordance with all laws and regulations. Identify, communicate, and recover losses as deemed appropriate. These investigations may include participation in telephone calls or meetings with providers, members, clients, legal compliance, and other investigative areas and requires adherence to state and federal compliance policies, reimbursement policies, and contract compliance. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Gather and analyze data and information gathered to determine behavior and understand provider/scheme at issue - Utilize appropriate documentation and tracking controls in the case tracking system to ensure compliance and auditability requirements are met - Collaborate with SIU Lead Investigator to apply knowledge of coding guidelines to determine validity of aberrances - Collaborate with a variety of external sources to identify current and emerging patterns and schemes related to FWA - Perform member and provider interviews, and review medical documentation as needed - Communicate with legal, Law Enforcement, clients and business partners as needed - Perform all other duties as assigned Qualifications - High School Diploma/GED and 5+ years of experience working in a FWA / SIU or Fraud investigations role OR Associate’s degree in Criminal Justice or experience in a related field - Certified Professional Coder (CPC) - 2+ years of experience within the health insurance claims industry - 1+ years of knowledge and/or experience with medical/behavioral health codes and service delivery - Intermediate level of proficiency in Microsoft Excel (pivot tables and macros) and Word (creating, editing, and saving documents) Requirements - 2+ years of experience working with law enforcement or legal entities or 3+ years of investigative experience with fraud investigations - Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar - Familiar with CPT code terminology - Experience with computer research - Experience with regulatory compliance - Experience with data analysis as it relates to financial recovery/settlements Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) 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.

Role Description Onapsis is looking for a proactive and detail-oriented Legal Operations Analyst to join its legal department. The ideal candidate will contribute to the preparation and review of legal documents, provide insightful analysis to support legal decision-making, and optimize legal processes, data management, and reporting, ensuring accuracy and efficiency. Reporting to the Director Legal Operations & Corporate Counsel, the Sr. Legal Analyst will: - Draft, review and negotiate global supplier agreements, collaborating with internal stakeholders from different departments. - Support contract executions in a timely method with appropriate legal oversight to ensure compliance with company standards. - Draft, review and negotiate many types of commercial technology contracts with a diverse set of customers, following the company’s standards, such as NDA’s, SOW’s, Software Order Forms, Master Software License Agreements, Master Services Agreements for On-Prem or SaaS solutions, etc. - Draft, review and negotiate many types of commercial technology contracts with a diverse set of partners, such as Managed Services Security Agreements, Reseller Agreements, Subcontractor Agreements, etc. - Coordinate redlines and negotiation strategies with legal and other stakeholders. - Negotiate legal and business terms and collaborate, coordinate and explain risks and implications of contract terms to Legal, the business, and other stakeholders. - Complete gap analysis, review, redline and understand contract language, risks and implications of such language. - Defend legal terms on standard internal templates, agreements and third-party paper where necessary. - Collaborate with Onapsis Legal in the development, oversight and maintenance of relevant contract templates in our CLM Tool and legal database and fallback checklists. - Collaborate with internal stakeholders (e.g., HR, Finance, Product, Infosec) to ensure legal matters are aligned with the company’s objectives. - Maintain and optimize the contract database within the CLM tool and legal database, ensuring accurate storage and retrieval of all company commercial agreements electronically. - Maintain detailed logs of all commercial contracts and legal requests, generating weekly, monthly, and quarterly reports on contract status and key terms. - Conduct legal risk assessments of customer contracts, identifying potential compliance issues, liability risks, and deviations from company policy and submit them to internal decision-makers for discussion and resolution. - Track contract status and lifecycle, working collaboratively with internal stakeholders to continuously improve company contract processes and reduce turnaround times. - Participate in continuous improvement projects to enhance the efficiency and effectiveness of Legal Operations, including the implementation of new workflows. - Assist in global corporate matters of the group, including subsidiary management and international regulatory compliance. - Assist in the administration of the global insurance program, including policy renewals, claims processing, and risk assessments. - Assist in the administration and development of the company’s patents and trademarks global portfolio. Qualifications - Bachelor’s degree in law. - 5-7 years of relevant work experience. - Business fluent in English with concise verbal and written communication skills is essential. - Prior experience drafting, reviewing, and negotiating IT, technology product and/or services agreements is a must. - Must be detail oriented and have strong organizational skills. - Ability to handle multiple tasks simultaneously. - Ability to prioritize; must be responsible and conscientious. - Ability to work under pressure to meet specific deadlines. - Ability to work independently and in a team environment. - Dedication to quality and reliability in all work tasks. - Demonstrate autonomy, take ownership, and drive tasks to closure. - Team player with a sense of humor. - Strong computer skills (e.g., Google Workspace, Microsoft Word/Excel, etc.). Experience with a CLM tool, Slack and Salesforce nice-to-have. Location - This is a remote role, candidates must be based in Buenos Aires, Argentina. Benefits - A unique culture of high achievement and teamwork. - Supportive and humble colleagues. - OSDE Medical Insurance. - Unlimited Paid Time Off. - Onaversary Holiday.

Title: Reimbursement Analyst Location: Fully Remote United States At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives. Position Summary A Reimbursement Analyst is responsible for being the primary point of contact in assisting patients or healthcare providers in obtaining access to therapy for the reimbursement hub program to which they are assigned. Primary activities may include researching and analyzing moderate to complex reimbursement policies, billing, benefit investigations, prior authorization, appeals and patient assistance support programs. Responsibilities, may include interactions with client contacts as well as handling of escalated cases/issues. Key Responsibilities - Assist patients and healthcare providers with moderate to complex billing and coding, insurance benefit investigations, prior authorization, appeals and patient assistance support programs inquiries. - May include acting as regional contact for senior level client contacts. - Manage patient cases and interact with external contacts like payers and other stakeholders. - Assist with coordination of relevant tasks/activities between Gifthealth and the client. - Review and resolve denied or underpaid insurance claims. - Identify and assess patient specific insurance coverage options for client specific products. - Reverify patient benefits at predetermined time frames - Document all activities in program database within required timelines. - Research payer medical policy - Monitor and update payer prior authorization requirements and coverage policies for specified client program. - Prepare and/or assist with preparation of reports as requested, including adverse event and product complaint reports. - Review and process documentation to determine patient specific eligibility for client patient support program(s), as appropriate. - Complete quality monitoring and quality assurance activities, as assigned. - Travel to and attend client meetings, off-site training, and/or conferences. Travel time estimate: 5%. Qualifications - Minimum four years recent healthcare experience (2 years’ direct industry preferred). - Exhibit proficiency in Microsoft Office products - Excellent customer service skills (call center experience preferred). - Advanced problem solving, research and analytical skills. - Advanced communication skills, both written and verbal. - Attention to detail, data entry accuracy required. - Ability to multi-task and manage time independently. - Client interaction experience preferred. - Advanced knowledge of medical insurance (public and commercial), billing and - coding and associated terminology. Work Environment - Location: Remote - Schedule: Full-time - May require availability or flexibility for escalations. - Regular meetings with teams, departments, or leadership to ensure alignment. Key Essential Functions - Ability to sit for extended periods of time while working at a computer and on the phone throughout the workday. - Ability to engage in continuous phone and computer use, including navigating multiple systems simultaneously, for the duration of the shift. - Ability to perform repetitive motions for an entire shift, including typing, mouse use, and phone handling. - Ability to view and read information on a computer screen for prolonged periods. - Ability to communicate clearly and professionally via phone, email, and internal systems. - Ability to manage a high volume of inbound and outbound calls while maintaining attention to detail and accuracy. - Ability to work in a remote environment with minimal distractions and maintain productivity and performance standards. - Ability to adapt to changing priorities, workflows, and processes in a fast-paced environment. - Ability to meet attendance, schedule adherence, and performance expectations, including flexibility for occasional extended hours or weekends as business needs require. Employment Classification Status: Full-time FLSA: Non-Exempt Equal Employment Opportunity (EEO) Statement Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status. Disclaimer This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time. Salary Description $24.81 - $29.18

Title: Lead Quality Assurance Analyst (Bilingual English-French) Location: Canada Requisition ID 56388 Canada - Remote Title: Lead Quality Assurance Analyst (Bilingual English-French) Location – Canada / Remote Sapiens is seeking a dynamic and experienced Lead Quality Assurance Analyst (Bilingual English-French) to oversee the quality assurance efforts for a complex, integrated platform comprising multiple modules. This role requires hands-on leadership, strategic planning, and technical expertise in both manual and automation testing. The Lead Quality Assurance Analyst will manage a hybrid QA team, drive platform-wide quality initiatives, and collaborate with cross-functional stakeholders to ensure seamless integration and high-quality delivery. This position will be part of Sapiens’ Life and Pension Insurance division, for more information about it, Click here. Responsibilities Test Strategy & Planning - Define and implement comprehensive test strategies for manual and automation testing across modules. - Translate business and technical requirements into test artifacts including test cases, automation scripts, and test plans. - Plan and estimate QA efforts during sprint planning and release cycles. - Ensure alignment with QA best practices, design patterns, and organizational standards. Test Execution & Platform Oversight - Oversee execution of manual and automated test cases across functional, regression, integration, and UAT phases. - Validate end-to-end workflows across integrated modules and shared services. - Coordinate system-level testing across environments (staging, pre-prod, production). - Monitor automation coverage and maintain regression suite health. Defect & Risk Management - Identify, document, and track defects; collaborate with development and BA teams for resolution. - Evaluate defect impact across modules and prioritize based on business and technical risk. - Proactively identify platform-level quality risks and implement mitigation strategies. Metrics & Compliance - Create and distribute QA reports covering test progress, defect metrics, risk mitigation plans, and platform KPIs. - Review and act on quality indicators such as defect leakage, test case effectiveness, and release confidence. - Ensure compliance with QA standards, audit requirements, and regulatory guidelines. Team Leadership & Development - Lead and mentor a team of manual and automation QA engineers. - Support onboarding, training, and continuous learning for team members. - Conduct performance reviews and foster a culture of accountability and excellence. Collaboration & Communication - Act as the primary QA contact for product, development, and delivery teams. - Collaborate with SMEs, architects, and module owners to ensure quality deliverables. - Facilitate cross-team defect triage and platform-level release readiness meetings. - Promote a culture of quality and continuous improvement across teams. Requirements Technical Skills - Strong understanding of QA methodologies, SDLC, and Agile/Scrum practices. - Experience with automation frameworks (e.g., Selenium frameworks). - Knowledge of REST/SOAP API testing and interface validation. - Ability to write SQL queries. - Familiarity with test management tools (e.g., Jira, Zephyr, QC). - Experience in life insurance domain (individual life and annuities) – Must Leadership & Communication - Proven experience managing hybrid QA teams and platform-level testing. - Excellent analytical, problem-solving, and communication skills. - Experience in client-facing roles (e.g., pre-sales, UAT coordination). - Ability to work independently and lead by example. Qualifications - Bachelor’s degree in Computer Science or related field (preferred). - ISTQB or equivalent certification - Advantage - 10+ years of QA experience, with at least 3 years in a lead role. - Bilingual English French - Must Added Advantage - Experience in cloud platforms (AWS, Azure). - Exposure to performance, accessibility, and cross-browser testing. - Experience in tool evaluation and selection for manual and automation testing. - Willingness to work in a fast-paced, high-ownership environment. Sapiens is an equal-opportunity employer. We value diversity and strive to create an inclusive work environment that embraces individuals from diverse backgrounds. #LI-Remote