Supervisor Appeals - Medicare (Remote) in PA or DE Highmark IncSupervisor Appeals - Medicare (Remote) in PA or DEPARemoteThe incumbent is responsible for the direct oversight and/or technical direction of non-clinical staff that make determinations to pay or deny services, identify provider education opportunities, and appropriate referrals to other contractors (Program Safeguard Contractor (PSC) for potential fraud and abuse activities, Qualified Independent Contractor (QIC) for second level appeals, etc…). In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Clinical Pharmacist - Remote (MTM) The Cigna GroupClinical Pharmacist - Remote (MTM)PARemote$54–$91 / hourPerformance Objectives and Responsibilities: Duties may include but are not limited to: Provide MTM services, including Comprehensive Medication Reviews (CMRs), Targeted Medication Reviews (TMRs), adherence interventions, cost-effective interventions, and other medication-related clinical interventions. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Remote Customer Support – Travel Industry DreamstravelcrRemote Customer Support – Travel IndustryPittsburgh, PennsylvaniaRemoteIn this role, you will help travelers plan unforgettable experiences by providing destination guidance, organizing travel details, and supporting clients throughout their entire planning process. As a Travel Experience Specialist, you will work remotely while helping clients transform their travel ideas into well-organized itineraries and memorable experiences.
Medicare Field Agent- Allegheny HumanaMedicare Field Agent- AlleghenyPittsburgh, PennsylvaniaRemoteWork 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. Comfortable with daily face-to-face interactions in prospective members' homes, at community-based events and engaging with the community through service, retail environment, organizations, volunteer work, or local events.
Medicare Field Agent- Butler HumanaMedicare Field Agent- ButlerCranberry Township, PennsylvaniaRemoteWork 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. Comfortable with daily face-to-face interactions in prospective members' homes, at community-based events and engaging with the community through service, retail environment, organizations, volunteer work, or local events.
Medicare Field Agent- Westmoreland HumanaMedicare Field Agent- WestmorelandGreensburg, PennsylvaniaRemoteWork 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. Comfortable with daily face-to-face interactions in prospective members' homes, at community-based events and engaging with the community through service, retail environment, organizations, volunteer work, or local events.
NewSpecialist Case Manager RN - (Remote) Highmark IncSpecialist Case Manager RN - (Remote)PARemoteMaintain oversight over specified panel of members by performing ongoing assessment of members" health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support. The Case Manager assesses member needs, develops and implements care plans, coordinates services, and monitors progress, while containing the cost of health care services.
NewTransformation Manager Highmark IncTransformation ManagerPARemoteThis job serves as the delivery leader responsible for defining, owning, and delivering mid-size engagements designed to meet/exceed key performance metrics (e.g., admin cost reduction, process improvement, automation, medical cost/value improvement, and enhanced customer/provider experience) for specific clients within the organization. Delivery Responsibilities: Lead individuals, teams or multiple groups and play an active role in analyzing project goals, creating a plan to achieve those goals, and helping to drive the consulting team members, client stakeholders/SMEs and potentially other third parties to achieve those goals while understanding the client environment and any limitations to execution.
Finance Technology Product and Portfolio Lead Highmark IncFinance Technology Product and Portfolio LeadPARemoteStakeholder Management & Communication: Exceptional ability to engage, influence, and communicate effectively with diverse stakeholders, including senior leadership, finance business partners, and technology teams. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
NewPharmacist - Case and Disease Management (CMDM) - Remote Highmark IncPharmacist - Case and Disease Management (CMDM) - RemotePARemoteIn connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Contact patients, care givers, physicians, pharmacists, etc. to intervene on identified gaps of care using a high level of clinical judgement and discretion.
Acquisitions Sales Representative - Pittsburgh, Pennsylvania Kendall Hunt PublishingAcquisitions Sales Representative - Pittsburgh, PennsylvaniaPittsburgh, PARemoteWe want to partner with talented educators in charge of lower-level, higher-enrollment courses to develop more interactive and engaging materials that solve the needs of their students and can make an impact in their college career and in the difference, they make in the world in the future. The ideal candidate will be located in Pennsylvania (Pittsburgh, Harrisburg, Lancaster, York, Reading, Allentown) or Maryland (Towson, Hunt Valley, Timonium, Owing Mills, Frederick).
Remote Customer Experience Coordinator Nexora TalentRemote Customer Experience CoordinatorPittsburgh, PARemoteAs a Customer Experience Coordinator, you will communicate with clients, assist with scheduling and service coordination, provide accurate information, and help create outstanding customer experiences. In this role, you will support clients by coordinating services, answering questions, and ensuring every interaction is smooth, organized, and positive from start to finish.
Remote Travel Customer Representative SawmilldcllcRemote Travel Customer RepresentativePittsburgh, PennsylvaniaRemoteIn this 100% work-from-home role, you will assist clients with travel-related questions, provide trip support, and ensure a smooth, stress-free experience from start to finish. This position is ideal for someone who enjoys helping people, is highly organized, and is excited about working remotely in the travel industry.
Remote Travel Customer Representative AlmaaventureraRemote Travel Customer RepresentativePittsburgh, PennsylvaniaRemoteIn this 100% work-from-home role, you will assist clients with travel-related questions, provide trip support, and ensure a smooth, stress-free experience from start to finish. This position is ideal for someone who enjoys helping people, is highly organized, and is excited about working remotely in the travel industry.
Sales Leader- Pittsburgh Northeast Sales Territory State FarmSales Leader- Pittsburgh Northeast Sales TerritoryPittsburgh, PennsylvaniaRemote$200,000–$310,000 / yearFull timeThis position requires you to obtain/maintain all applicable FINRA licensing exams (Securities Industry Essentials, Series 6, Series 63, and Series 65 or equivalent), sponsorship from State Farm VP Management Corp (SFVPMC) and State Farm Investment Management Corp. With the opportunity to initially earn up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service/education support days, there will be plenty of time for you!
Software Architect – Development WESCOSoftware Architect – DevelopmentPittsburgh, PARemoteGuiding development teams through all phases of software development life cycle (SDLC) and providing customer technical support solution analysis and design, and balancing technical and business aspects. Through comprehensive benefits (https://www.wesco.com/us/en/our-company/careers/work-at-wesco.html#benefits) and active community engagement, we create an environment where every team member has the opportunity to thrive.
VP Reserving Forecasting & Trend Analytics Highmark IncVP Reserving Forecasting & Trend AnalyticsPARemoteStrategic Actuarial & Financial Leadership: Serve as a trusted advisor to Senior Management and cross-functional teams, proactively identifying opportunities and advocating for strategic and tactical changes and best practices that align with Highmark"s enterprise-wide goals. Advanced Trend Analytics & Insights: Lead and empower the Trend Analytics team to identify, analyze, and interpret key trend drivers, developing early indicators that inform medical economics strategies and support proactive intervention.
NewMedical Case Manager - Remote (Pennsylvania) Highmark IncMedical Case Manager - Remote (Pennsylvania)PARemoteLicensed Social Worker (LSW)-Non-Specific - State (OR) Licensed Professional Counselor (LPC) - Non-Specific State (OR) Licensed Bachelors Social Worker (LBSW) (OR) Licensed Clinical Social Worker (LCSW) - Non-Specific (OR) Licensed Master Social Worker (LMSW) Non-Specific (OR) Licensed Graduate Social Worker (LGSW) (OR) Licensed Certified Social Worker (LCSW) (OR) Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). The Case Manager assesses member needs, develops and implements care plans, coordinates services, and monitors progress, while containing the cost of health care services.
Fluent Russian Speakers - US (Task-Based, Remote, Flexible) Prolific Academic LtdFluent Russian Speakers - US (Task-Based, Remote, Flexible)Pittsburgh, PARemoteYou'll join live video calls with other Russian-speaking participants, chatting naturally about everyday topics while your conversation is used to help AI models better understand how people actually speak. This is a genuinely interesting way to shape how AI understands human conversation, one call at a time - your natural way of speaking directly helps these models learn to communicate more like a real person.
Coder - Inpatient (CCS/CIC REQUIRED), Remote, Sign on Bonus Eligible Highmark IncCoder - Inpatient (CCS/CIC REQUIRED), Remote, Sign on Bonus EligiblePARemoteIn connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days.