Benefits & Eligibility Specialist II Job at Wyoming Game and Fish Department (Cheyenne)

Medical Appeals/Grievance Specialist II - Registered Nurse

Responsible for utilizing clinical acumen and managed care expertise related to ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

1 year experience in clinical and health insurance or other healthcare related field
3 years experience in clinical and health insurance or other healthcare related field AND 1 year Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
5 years experience in clinical and health insurance or other healthcare related field AND 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
8 years experience in clinical and health insurance or other healthcare related field AND 3 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
Associate’s Degree in a healthcare field of study or Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN), a Physical Therapist (PT) or a Licensed Master Social Worker LMSW.
Intermediate PC proficiency
Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
Maintain complete and accurate records per department policy.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Attend staff and interdepartmental meetings.
Participate in continuing education and current developments in the fields of medicine and managed care.

Fulltime

New

Medicaid Enrollment and Outreach Specialist I

As a community, the University of Rochester is defined by a deep commitment to M...

Location

United States of America , Rochester

Salary:

23.51 - 30.16 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Bachelor's degree (preferred)
Limited experience with Medicaid programs
1-2 years of experience in case management or related field or equivalent combination of education and experience
Foundational knowledge of public benefit rules and regulations (preferred)
Demonstrates professionalism, motivation, and strong communication (written and verbal)
Possesses customer service skills and the ability to work independently and solve problems in an interdisciplinary team
NY State of Health Certified Application Counselor (preferred)
Must provide and maintain a valid NYS Class 5 driver’s License

Job Responsibility

Counsels, guides, advises and provides outreach services to patients requiring public benefits including Medicaid, Child Health Plus, NYS Marketplace Exchange or other public entitlements
Accountable for coordinating all activities and necessary documentation needed to secure appropriate benefits
Resolves complex problems related to this process
Shares expert public benefits knowledge by providing consultation to physicians, social workers and other Health System staff whose patients require benefit assistance for payment and discharge planning
Benefit Management: apply for benefits via computer systems and/or paper application and may accompany or represent the patient at eligibility interviews, case conferences or fair hearings
Provides application assistance to patients referred by University of Rochester Health System staff through face-to-face interaction, telephone contact and home visitation for patients requiring assistance
Referral Coordination: Responsible for assessing referrals to determine eligibility for potential benefits and develops a plan of action to secure each
Communicates, coordinates and develops professional relationships with internal departments and external agencies
Monitoring Caseload, Documentation, and Reports: monitor caseload and is responsible for accurate and timely documentation in requisite systems
Reviews productivity reports and prepares status updates as required by management

Fulltime

Care Management Specialist II, D-SNP Team

The Care Management Specialist II utilizes clinical skills and training to perfo...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

New

Assistant Manager

At Caffè Nero, it’s our people that make us different. If you pride yourself on ...

Location

United Kingdom , London

Salary:

12.51 - 12.66 GBP / Hour

Caffe Nero

Expiration Date

March 06, 2026

Requirements

Experience as a Supervisor or Assistant Manager in a busy, customer facing environment
Be people focused – really caring about the welfare and development of your team
Love the challenge of meeting business targets
Strive for excellence, always
Be passionate about the Caffè Nero brand
Have a great attitude, bags of energy and love interacting with customers
Must be over the age of 18
Must have the Right to Work in the UK
Must be able to commit to a permanent role
Must be able to travel easily to the location

Job Responsibility

Support in the running of the store
Providing great customer service
Maintaining the best standards of coffee and food

What we offer

Brilliant training – no experience required
Opportunity to grow career and develop personally and professionally
Unlimited free handmade drinks and up to 75% off food and packaged drinks when on shift
50% off all handmade drinks and 40% off everything else when off shift
Recommend A Friend Scheme, chance to earn up to £750 for referrals
Length of service recognition
Access to benefits platform with hundreds of discounts, rewards and offers
Potential for additional 30p per hour via 'Nero 90' incentive if store achieves Customer Satisfaction score

Fulltime

New

Senior Director of Data Engineering and Machine Learning

Lead the Data Revolution at Modus Create. At Modus Create, we empower the world’...

Location

United States of America

Salary:

200000.00 - 240000.00 USD / Year

Modus Create

Expiration Date

Until further notice

Requirements

15+ years in data or software engineering roles
7+ years leading Data Engineering/ML teams—ideally at scale or in global consulting contexts
Hands-on experience with cloud data platforms, big data toolchains (Spark, Kafka), data transformation tools (Airflow, dbt), and ML platforms
Success in pre-sales, solutioning, and growing data/ML engagements within enterprise or mid-market accounts
Demonstrated ability to create enablement programs, uplift team capabilities, and grow inclusive, high-performing engineering cultures
Deep empathy for client pain points and the ability to craft and deliver impactful, measurable solutions
Excellent across technical, executive, and cross-functional settings, with an ability to successfully navigate diverse cultural differences

Job Responsibility

Build Modern Data Platforms: Design and oversee architecture for cloud-native data platforms, pipelines, and streaming systems on AWS, Azure, or GCP
Ensure robust solutions using platforms such as Databricks, Snowflake, Redshift, BigQuery, Spark, Kafka, Airflow, dbt, and Kubernetes
Deliver Products that are Intelligent: Define and drive responsible ML strategy, from model development to integration, using platforms like SageMaker, Azure ML, or TensorFlow
Enable smarter client experiences by embedding ML into applications, automation, and analytics
Lead & Grow Teams: Foster a culture of trust, continuous learning, and experimentation by hiring, mentoring, and empowering distributed teams of data and ML engineers
Define career paths, feedback frameworks, and learning programs grounded in a culture of experimentation,continuous growth, and a sense of belonging at every level
Shape Technical Strategy & Best Practices: Develop modular runbooks, tooling standards, and engineering frameworks optimizing for scalability, observability, and security
Champion collaborative practices like Agile/Lean development, dataOps, MLOps, and CI/CD for data pipelines and models
Business Development & Sales Enablement: Partner with Sales, Partnerships, and Account Teams to find and co-create thoughtful, outcome-driven data & ML engagements
Translate client needs into solution designs, shareable collateral, and winning proposals and estimates that reflect both technical strength and business empathy

What we offer

Remote work with flexible working hours
Flexible Time Off/PTO
Premium Health Insurance (medical, vision, and dental)
Other benefits such as FSA and HSA
401 (k)
Modus Global Office Programme: for when you want to get out of your home, we offer on-demand access to private offices, meeting rooms, coworking spaces and business lounges in locations in over 120 countries
Employee Referral Program
Travel according to client or team needs
The chance to work side-by-side with thought leaders in emerging tech
Access to more than 12,000 courses with a licensed Coursera account

Fulltime

New

Territory manager

2020 Companies is hiring Territory Managers who are experts in brand advocacy an...

Location

United States , Cantonment

Salary:

21.00 USD / Hour

2020 Companies, Inc

Expiration Date

Until further notice

Requirements

High school diploma or equivalent experience required
Six (6) months prior sales, promotion, retail, or marketing experience
Demonstrated knowledge of products and services
Excellent communications, presentation, interpersonal and problem-solving skills
Impeccable integrity and commitment to customer satisfaction
Ability to lift and carry up to 15 lbs. at a time
Ability to multi-task in a fast-paced, team environment
Ability to maintain customer confidentiality
Reliable transportation within assigned territory

Job Responsibility

Meet and welcome new merchants accepting our client's credit services
Travel within assigned territory, stopping by up to 35 retailers per day
Demonstrate the value to the merchant of customers using the Client's line of credit services at their business
Capture and address any objections raised by reluctant merchants
Attempt to place Point of Purchase signage at each business
Partner with the client to train and advocate client products at the retailer
Drive merchant awareness within your assigned territory
Maintain professional interaction with both merchants and fellow employees
Advise merchants by providing information on products
Audit and record competitive products, promotions, merchandising, displays and merchant feedback

What we offer

Next-day pay on-demand with DailyPay
Earn a bonus, paid monthly
Paid training
Paid travel time
Mileage reimbursed
Cell phone provided
Apparel provided
Health/Dental/Vision Insurance
401K Program
Paid Time Off

Fulltime

New

Associate Counsel

GEICO is looking to hire an Associate Counsel to defend lawsuits filed in Texas ...

Location

United States , Katy, TX

Salary:

112750.00 - 175275.00 USD / Year

Geico

Expiration Date

Until further notice

Requirements

2-6+ years of experience in related field litigation experience on insurance/defense/and or personal injury
Juris Doctor degree REQUIRED
Admission to the Texas Bar REQUIRED
Must be licensed in good standing to practice law in Texas and meet and maintain licensing requirements including mandatory Continuing Legal Education (CLE) requirements where applicable
Must be able to travel as required, including but not limited, to attend trials, hearings, depositions, management meetings and conferences
Must be able to document files in a clear, concise, professional written manner, to be understood by customers, clients, co-workers and other employees of the organization
Must be able to follow complex instructions, resolve conflicts or facilitate conflict resolution, and have strong organization/priority setting and multi-tasking skills
Must be able to learn and apply large amounts of technical and procedural information

Job Responsibility

Researching laws and preparing legal briefs, opinions, and memoranda
Rendering opinions on liability, damages, and value as requested by the Claims Department
Preparing and handling pleadings, motions, and discovery, to include depositions/examinations before trial and examinations under oath, and defending by trial or dispositive hearing, all matters assigned, as applicable

What we offer

Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family’s overall well-being
Financial benefits including market-competitive compensation
a 401K savings plan vested from day one that offers a 6% match
performance and recognition-based incentives
and tuition assistance
Access to additional benefits like mental healthcare as well as fertility and adoption assistance
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year

Fulltime

New

Server

Serve food courses and alcoholic beverages to guests. Set tables according to ty...

Location

United States , St. Louis

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

High school diploma or G.E.D. equivalent
At least 1 year of related work experience
No supervisory experience
No license or certification required

Job Responsibility

Serve food courses and alcoholic beverages to guests
Set tables according to type of event and service standards
Answer questions on menu selections
Communicate with the kitchen regarding menu questions, the length of wait, re-cook orders, and product availability
Communicate additional meal requirements, allergies, dietary needs, and special requests to the kitchen
Record transaction in MICROS system at time of order
Check in with guests to ensure satisfaction with each food course and/or beverages
Maintain cleanliness of work areas, china, glass, etc., throughout the day
Complete closing duties, including restocking items, turning off lights, etc.
Present physical and accurate check to guest and process payment

Parttime

Benefits & Eligibility Specialist II

Wyoming Game and Fish Department

Location:
United States , Cheyenne

Category:
Public Sector

Contract Type:
Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
February 20, 2026

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