Entry Level CSR (Work From Home) American Income Life Insurance CompanyEntry Level CSR (Work From Home)Gresham, ORRemoteFull timeWe are expanding our remote team and looking for motivated individuals who enjoy working with people, communicating clearly, and building toward long-term career growth. Assist clients by explaining available benefit options and answering coverage-related questions.
Entry Level Customer Service - Work From Home American Income Life Insurance CompanyEntry Level Customer Service - Work From HomeEugene, ORRemoteFull timeWe’re currently looking for individuals with strong customer service skills to join a long-standing supplemental benefits organization that has supported working families for over 65 years. Assist clients by clearly explaining available products and services.
Shipping Container Sales Work From Home Fully Remote QUALITY CONTAINERS INCShipping Container Sales Work From Home Fully RemotePortland, ORRemoteJoin Quality Container Inc as a National Sales Manager and help customers find the perfect shipping container solutions from the comfort of your home! Quality Container Inc has been a leader in the shipping container industry for over a decade, providing top-notch solutions to customers across the nation.
Mortgage Protection-Life Insurance Agent-Work from Home Symmetry Financial GroupMortgage Protection-Life Insurance Agent-Work from HomePortland, OregonRemoteYou’ll have access to an exclusive CRM, a fully digital platform with up-to-date resources, and the ability to be contracted with multiple carriers, offering in-demand products like living benefits and more. This opportunity is perfect for career-driven professionals who want room to grow, sharpen leadership and business skills, and truly own their success.
NewRemote Data Entry / Online Research Panelist - Work From Home FocusGroupPanelRemote Data Entry / Online Research Panelist - Work From HomePortland, ORRemoteFocusGroupPanel invites adults to join optional online research panels and focus groups from home. You choose whether to respond to each invitation and can participate using a computer, tablet, or smartphone with a reliable internet connection.
Appointment Setter (Work From Home) American Income Life Insurance CompanyAppointment Setter (Work From Home)Gresham, ORRemoteFull timeSince 1951, the organization has focused on helping union members, association members, credit union members, and their families access protection through life, accident, and supplemental health programs. Our representatives work directly with clients to provide clear information, answer questions, and help families understand the options available to them.
Entry Level Customer Service (Work From Home) Spade RecruitingEntry Level Customer Service (Work From Home)Bend, ORRemoteFull timeWith over 60 years of experience, our organization partners with labor unions, credit unions, and associations across North America to provide access to supplemental benefit programs. This opportunity is ideal for those looking to build a long-term career while working in a structured, supportive environment from home.
Work From Home - Bilingual Client Services Representative AO Garcia AgencyWork From Home - Bilingual Client Services RepresentativeOregon City, OregonRemoteAll interviews will be conducted via Zoom video conferencing (Global Elite Empire Consultants is a third-party recruiter, not an insurance agency) We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. Preferred Qualifications: • Bilingual (Spanish and English) • Excellent communication skills• Leadership capabilities • Self-starter • Positive attitude • Growth mindset .
Make an Impact on Others with a Career From Home Global Elite Empire ConsultantsMake an Impact on Others with a Career From HomeSalem, OregonRemoteWe may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. This is a remote opportunity where you’ll work directly with individuals who have requested help understanding their financial protection options.
Burned Out from the 9-5? There's Another Way - Remote Role Global Elite Empire ConsultantsBurned Out from the 9-5? There's Another Way - Remote RoleBend, OregonRemoteAll interviews will be conducted via Zoom video conferencing (Global Elite Empire Consultants is a third-party recruiter, not an insurance agency) We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. Take advantage of this opportunity to work from home, enjoy a schedule that suits your lifestyle, and receive mentorship as you advance your career in client service leadership.
Burned Out from the 9-5? There's Another Way - Remote Role AO Garcia AgencyBurned Out from the 9-5? There's Another Way - Remote RoleHillsboro, OregonRemoteGlobal Elite Empire Consultants is a third-party recruiter, not an insurance agency) We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. 4. Help Others: Use your skills and expertise to assist families in securing their financial futures, providing them with the support and guidance they need to navigate life’s uncertainties with confidence.
Accounting Manager (Accounting Manager 2) - Hybrid Remote Work Opportunity State of OregonAccounting Manager (Accounting Manager 2) - Hybrid Remote Work OpportunitySalem, ORRemote$7,537–$11,657 / yearDemonstrated experience developing, implementing, evaluating, or improving internal control frameworks, accounting procedures, financial governance practices, or operational processes to safeguard public resources, strengthen compliance, and improve organizational effectiveness. The position provides strategic direction, financial governance, financial risk management, and fiscal advisement related to accounting operations, financial reporting, internal controls, compliance, and long-range financial planning.
Customer Service Representative II MMC GroupCustomer Service Representative IIRemote, ReRemoteThroughout the past 35+ years, MMC, one of the most trusted names in workforce management services, has successfully delivered strategic solutions to large and small businesses in numerous industries. Before interviewing, applicants must provide a screenshot of an internet speed test from Speedtest.net showing: ✔ Minimum 100 Mbps Download .
Spanish Bilingual Remote Customer Service Representative Vimo, Inc.Spanish Bilingual Remote Customer Service RepresentativeSalem, ORRemoteVimo currently has the largest state-based marketplace footprint, and our consumer-friendly interface and decision support tools empower millions of consumers across the country to make better health plan decisions. In addition to eligibility determination, plan selection, and enrollment technology for state agencies, the company delivers innovative agent marketing and call center tools and services.
Call Center Remote Customer Service Representative Vimo, Inc.Call Center Remote Customer Service RepresentativeORRemoteVimo currently has the largest state-based marketplace footprint, and our consumer-friendly interface and decision support tools empower millions of consumers across the country to make better health plan decisions. In addition to eligibility determination, plan selection, and enrollment technology for state agencies, the company delivers innovative agent marketing and call center tools and services.
OR Call Center Remote Customer Service Representative Vimo, Inc.OR Call Center Remote Customer Service RepresentativePortland, ORRemoteVimo currently has the largest state-based marketplace footprint, and our consumer-friendly interface and decision support tools empower millions of consumers across the country to make better health plan decisions. In addition to eligibility determination, plan selection, and enrollment technology for state agencies, the company delivers innovative agent marketing and call center tools and services.
Customer Service Specialist (Remote) Spade RecruitingCustomer Service Specialist (Remote)PORTLAND, ORRemoteFull timeWe partner with thousands of unions, associations, and professional groups to provide long-term benefit solutions when traditional employer benefits change, reduce, or end due to retirement or career transitions. Built on integrity, transparency, and financial stability, we prioritize training, advancement, and leadership development—supporting team members in building sustainable, long-term careers.
NewCustomer Service Representative Remote All Springs Manufacturing.Customer Service Representative RemoteSalem, ORRemoteAs a key member of our customer service team, you will play a vital role in maintaining our reputation for reliability and responsiveness while working from the comfort of your home. This role offers the opportunity to engage directly with our valued customers, providing timely support and ensuring a positive experience with our products and services.
Sales Manager - Remote InsuraTecSales Manager - RemotePortland, ORRemoteAbout InsuraTec Services Group: At InsuraTec Services Group, we're redefining insurance sales with a customer-centric approach. As a Sales Manager, you'll be pivotal in connecting clients with the insurance coverage they require, all while enjoying the perks of remote work with flexible hours.
NewSocial Worker, Social Services Humana IncSocial Worker, Social ServicesORRemote$59,300–$80,900 / yearWork at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. The Social Worker, Social Services works in a telephonic environment, assessing and evaluating members'' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.
NewDistrict Parts & Service Manager (Level DOE) Doosan CorpDistrict Parts & Service Manager (Level DOE)Portland, ORRemoteBased in Seoul, South Korea, with its North America headquarters in West Fargo, North Dakota, Doosan Bobcat is a leading global manufacturer of construction, agriculture, landscaping and grounds maintenance equipment, attachments and services. By building and maintaining strong relationships with dealership personnel, the DPSM aims to ensure that operational goals are met while effectively addressing customer concerns and feedback.
Full-Time Remote Customer Retention Specialist (TX, AZ, NV, OR, FL) (LP-04362) LAMPS PLUS, INC.Full-Time Remote Customer Retention Specialist (TX, AZ, NV, OR, FL) (LP-04362)ORRemoteUnder the supervision of the Customer Retention Manager(s), the Remote Customer Retention Specialist acts as the primary point of contact for all inquiries and issues involving Internet Customer Service via phone acting as a liaison to the Processing Department team. Identifying trends on issues that may affect customer satisfaction levels and consistently communicates them to management in measurable terms including employee errors on orders, product misrepresentation, etc.
NewTEMPORARY HRSN Benefit Specialist - REMOTE! Advanced HealthTEMPORARY HRSN Benefit Specialist - REMOTE!OregonRemoteSupport and contribute to effective safety, quality, and risk management efforts by adhering to established policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities. Awareness and understanding of equity, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices.
Remote CSR Agent Entry Level AILRemote CSR Agent Entry LevelPortland, ORRemoteFull timeAs a Remote Client Success Specialist , you’ll connect with both current and prospective clients daily, providing expert product knowledge and personalized support to meet their needs. As a Client Success Specialist, you’ll play a vital role in helping clients secure their futures while advancing your career in a supportive, high-performing environment.
Pharmacy Services Technician Cambia Health Solutions IncPharmacy Services TechnicianORRemote$20.50–$30.80 / hourAssist with auditing and investigations of medication-related claims, cases, and providers to identify misuse of medications, misuse of resources, substance abuse, and erroneous and fraudulent billing practices; investigate and organize workflow for claims referred to Pharmacy Services for review and allowable determination including miscellaneous J codes, providers on review, and reconsiderations. Support wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement; contribute to and support the corporation's quality initiatives through process improvement teams and by encouraging team and individual contributions toward quality improvement efforts.
Sales Design Consultant Closets By Design PortlandSales Design ConsultantBeaverton, OregonRemoteWe design, manufacture, and install a complete line of custom closets, home office furniture, media systems, wall beds, garage cabinetry, and more. From our no obligation in-home consultation, custom tailored designs and the highest quality product construction, our products simply offer the best value in the industry.
Licensed Medicare Benefit Advisor- Remote Allstate Insurance CompanyLicensed Medicare Benefit Advisor- RemoteORRemote$55,000–$100,000 / yearAs a Medicare Benefit Advisor, you'll utilize your in-depth Medicare knowledge and sales skills to consult retired seniors on the most beneficial Medicare Life and Health Plans that best suit their specific needs. Essential Duties as a full-time Medicare Benefit Advisor: Consult and educate seniors 65 years of age and older on the best Medicare Life and Health Plans that would best suit their needs.
NewInformatics Lead HumanaInformatics LeadSalem, ORRemote$117,600–$161,700 / yearWork at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. Advanced experience using SQL to analyze complex and diverse datasets, can identify analytics needs and own complex data analysis and transformation processes without oversight.
Temporary Customer Service Professional I Cambia Health Solutions IncTemporary Customer Service Professional IORRemote$19–$22.25 / hour6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience. As the face of Cambia, our CSPs play multiple roles - listener, problem-solver, investigator and advocate - all in service of making our members' health journeys easier and days brighter.
Remote Care Management Nurse Cambia Health Solutions IncRemote Care Management NurseMedford, ORRemote$36.80–$49.80 / hourAs a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts.
Bilingual Community Engagement Specialist Remote, Full Time - Weekends Arc Care IncBilingual Community Engagement Specialist Remote, Full Time - WeekendsORRemoteOur work is powered by a deeply collaborative team of nurses, social workers, community health workers, and medical professionals working alongside product, technology, and operations to close care gaps and improve outcomes for high-need patients. We seek a full-time Community Engagement Specialist to play a critical role on our team by directly engaging with and enrolling individuals living with Serious Mental Illness/ Substance Use Disorder, experiencing homelessness, and/or those who have high medical needs.
Licensed Crisis Counselor - Fully Remote in Beaverton, OR Protocall Services IncLicensed Crisis Counselor - Fully Remote in Beaverton, ORBeaverton, ORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
Licensed Crisis Counselor - Fully Remote in Salem, OR Protocall Services IncLicensed Crisis Counselor - Fully Remote in Salem, ORSalem, ORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
Licensed Crisis Counselor - Fully Remote in Portland, OR Protocall Services IncLicensed Crisis Counselor - Fully Remote in Portland, ORPortland, ORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
Licensed Crisis Counselor - Fully Remote in Eugene, OR Protocall Services IncLicensed Crisis Counselor - Fully Remote in Eugene, OREugene, ORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
Fully Remote - License Master Social Worker (LMSW) in Portland, OR Protocall Services IncFully Remote - License Master Social Worker (LMSW) in Portland, ORPortland, ORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
Licensed Crisis Counselor - Fully Remote in Bend, OR Protocall Services IncLicensed Crisis Counselor - Fully Remote in Bend, ORBend, ORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
NewCrisis Counselor - Fully Remote in Salem, OR Protocall Services IncCrisis Counselor - Fully Remote in Salem, ORSalem, ORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
NewCrisis Counselor - Fully Remote in Beaverton, OR Protocall Services IncCrisis Counselor - Fully Remote in Beaverton, ORBeaverton, ORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
NewCrisis Counselor - Fully Remote in Bend, OR Protocall Services IncCrisis Counselor - Fully Remote in Bend, ORBend, ORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
NewCrisis Counselor - Fully Remote in Portland, OR Protocall Services IncCrisis Counselor - Fully Remote in Portland, ORPortland, ORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
Licensed Crisis Counselor - Fully Remote in Oregon Protocall Services IncLicensed Crisis Counselor - Fully Remote in OregonORRemoteWe serve a wide range of nearly 700 different organizations nationwide, including Community Mental Health Centers, Certified Community Behavioral Health Clinics, Managed Behavioral Healthcare Organizations, University counseling centers, and Employee Assistance Programs following our brief immediate support model. Along with hard-wired broadband or fiber internet with speeds of at least 10 Mbps that is not susceptible to frequent outages; satellite and cellular-based services (including Starlink, Viasat, Verizon 5G Cellular, T-Mobile 5G Cellular, etc.) are not permitted.
Entry Level Remote Service Agent Globe Life AIL - Lisa RusselEntry Level Remote Service AgentGresham, ORRemoteFull timeThis fully remote opportunity allows you to take control of your schedule while building a rewarding career focused on delivering exceptional client support. In this position, you’ll work directly with clients—answering questions, providing guidance, and ensuring a high level of service.
NewNon-Clinical Care Coach Humana IncNon-Clinical Care CoachORRemote$53,700–$72,600 / yearWork at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. Minimum 2 years of experience in any direct adult patient care such as, but not limited to: long-term care, home and community-based services, hospital/facility setting, case management, managed care organizations.
NewBenefits Representative (Remote) OR 97230 Globe Life AIL - McQuade OrganizationBenefits Representative (Remote) OR 97230Portland, ORRemoteFull timeHas been respected and appreciated by more than 20,000 different groups, representing members of labor unions, credit unions, associations, fraternal organizations, sporting groups, licensed professionals, and nonprofit organizations. Assist existing clients through phone and/or in person about account management, billing issues, content and basic product application while building scalable customer-facing resources for common questions and issues.
Associate Veterinarian - Valley Animal Hospital - Grants Pass, OR Wellhaven Pet HealthAssociate Veterinarian - Valley Animal Hospital - Grants Pass, ORGrants Pass, ORRemote$120,000–$170,000 / yearWelcome to Valley Animal Hospital in scenic Grants Pass, Oregon-where compassionate care, strong team culture, and Southern Oregon adventure come together. May routinely be exposed to pets that may bite or scratch, biological hazards, anesthesia medications (smells), radiation if near an Xray machine, prescription medications, including controlled substances.
Senior Informaticist Humana IncSenior InformaticistORRemote$97,900–$133,500 / yearWork at Home Requirements 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 required; wireless, wired cable or DSL connection is suggested. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients.
Regional Service Sales Account Manager - Fire Protection ORR CorporationRegional Service Sales Account Manager - Fire ProtectionORRemoteThe Account Manager is responsible for increasing the recurring inspection service and monitoring sales for electronic and mechanical life safety systems including fire alarms, fire suppression systems, special hazards, etc. If you have experience in the fire protection industry, strong prospecting and networking skills, proven ability to close, along with excellent communication and interpersonal skills, let's talk!
NewNurse Case Manager II Apidel TechnologiesNurse Case Manager IIRemoteRemoteContractorThrough the use of clinical tools and information/data review, conducts comprehensive assessments of referred member\'s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member\'s benefit plan and available internal and external programs/services. The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
NewTEMPORARY Grievance System Specialist - REMOTE! Advanced HealthTEMPORARY Grievance System Specialist - REMOTE!OregonRemoteThis position processes member grievances and appeals from the initial receipt to resolution or denial within the required timelines, and federal, and state guidelines, while maintaining clear and timely communication to members, providers, CCO employees, and other stakeholders. Utilize internal and external systems to conduct comprehensive investigations, including collecting and reviewing information from members, providers, and delegates, verification of eligibility, authorizations, claims processing, plan coverage information, and any other information relevant to issues raised in the grievance/appeal; prepare cases for physician review.