Processing Management Representative III

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.  We are proud to say that for three years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.  What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/ How YOU will make a Difference: The Payment Integrity Analyst ensures assigned payment integrity programs are delivered efficiently and with high quality. Using claims expertise, program knowledge, and analytics capability, this person will provide the day-to-day management of assigned programs which may include, but aren’t limited to, our CMS Demand Case program and our Subrogation program. They will research case questions, resolve issues, identify process and program improvements, and ultimately contribute to the delivery of a strong portfolio of payment integrity programs. What YOU will do: Provide strong analytical, problem-solving and quality assurance skills to support efficient, accurate and timely execution of assigned payment integrity programs Combine healthcare knowledge and technical skills using programs including QicLink and Excel and reporting from vendor systems to gather, assess, and perform detailed evaluations of data to                 1) Identify issues, recommend solutions, and manage situations to resolution, and 2) identify, evaluate and deliver new program improvements that increase cost containment results for HMA and its clients Track, manage, and report on daily program inventory for short-term prioritization and long-term strategic planning Evaluate existing business processes and policies and develop sustainable, measurable improvements Produce clear written documentation to ensure consistent and accurate service provision, such as Procedural Work Instructions or Job Aids for core practices and business requirements for program changes Collaborate effectively with internal teams including Appeals, Claims, Client Success, and Stop Loss to deliver an informed, coordinated experience for clients and members Interact and communicate effectively with payment integrity program vendors and government agencies to meet program expectations Maintain current in knowledge of claims processing, job-related systems, and associated government regulations, and pursue education and training relevant to Payment Analyst role Requirements High School Diploma required ICD-10 & CPT experience required 3-5+ year of claims processing experience within the insurance industry 2+ year data entry experience Intermediate Excel skills with the ability to build effective spreadsheets and manipulate data Able to manage a complex daily queue and prioritize workload effectively Skilled in identifying root causes of issues through detailed investigation and inquiry Able to analyze impacts of potential actions or decisions to determine the optimal choice Benefits Compensation: The base salary range for this position in the greater Seattle area is $78,000-$93,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available. Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law. In addition, HMA provides a generous total rewards package for full-time employees that includes: Seventeen (IC) days paid time off (individual contributors) Eleven paid holidays Two paid personal and one paid volunteer day Company-subsidized medical, dental, vision, and prescription insurance Company-paid disability, life, and AD&D insurances Voluntary insurances HSA and FSA pre-tax programs 401(k)-retirement plan with company match Annual $500 wellness incentive and a $600 wellness reimbursement Remote work and continuing education reimbursements Discount program Parental leave Up to $1,000 annual charitable giving match How we Support your Work, Life, and Wellness Goals At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party. We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.)  HMA requires a background screen prior to employment. Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA’s standard policies and procedures. HMA is an Equal Opportunity Employer. For more information about HMA, visit www.accesshma.com.

At Tutor Me Education, we are revolutionizing the way students learn, and we're seeking passionate teachers and tutors with special education experience to provide 1:1 in-home tutoring in Daly City, CA! If you're committed to making a difference in the lives of students with special needs and helping them achieve academic success, we want to hear from you! About the Role: As an Academic Tutor with ASD Experience at Tutor Me Education, you’ll provide personalized, one-on-one tutoring to students with special needs in their homes. You will be responsible for helping students with daily activities, offering moral support, and delivering tailored instruction based on their Individualized Education Plan (IEP). We are currently hiring for multiple positions across all cities in Daly City, CA Details: In-Person Tutoring in Daly City, CA Schedule: Weekdays 3pm onwards Competitive hourly rate based on experience Ideal Candidate: Bubbly, warm, and encouraging demeanor, with the ability to maintain clear boundaries and consistency. Experience working with students with Autism, Intellectual Disabilities, or similar learning profiles. Skilled in foundational literacy and numeracy instruction, ideally with experience at the elementary level. Patient, empathetic, and able to de-escalate frustration or emotional moments calmly and positively. Creative and resourceful in finding ways to make learning enjoyable and relevant. Responsibilities: Deliver individualized, level-appropriate instruction based on the student’s academic needs. Use engaging and multisensory strategies to support literacy and math development. Incorporate the student’s interests to maintain motivation and attention. Provide emotional support and encouragement during moments of frustration or self-doubt. Maintain a consistent session structure to promote a sense of safety and predictability. Communicate regularly with the family and/or service providers to align on goals and progress. Reinforce IEP-aligned strategies and goals as appropriate. Why Tutor Me Education? At Tutor Me Education, we are dedicated to providing a nurturing, supportive environment where students can thrive. We pride ourselves on offering meaningful tutoring opportunities that make a lasting impact in the communities we serve. Whether you're looking for consistent hours or just want to make a difference, we have a place for you. Benefits: Performance-Based Pay Incentives Voluntary retirement program Referral program Flexible schedule Help students with special needs reach their full academic potential Equal Opportunity Employer: Tutor Me Education is proud to be an Equal Opportunity Employer, committed to diversity and inclusion. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, or veteran status. We encourage candidates from all backgrounds to apply. Diversity, Equity, and Inclusion: We are committed to fostering an inclusive workplace where every team member feels valued, respected, and empowered. Diversity drives innovation, and we believe it is essential for success.

Systems Security Administration (SSA) Management Team Lead (15.23) OCT Consulting is a business management and technology consulting firm that provides support to Federal Government clients. We provide consulting services in the areas of Strategy, Process Improvement, Change Management, Program and Project Management, Acquisition/Procurement, and Information Technology. Responsibilities and Duties OCT currently has an opening for a Systems Security Administration (SSA) Management Team Lead to work with a technology division within the Federal Bureau of Investigation (FBI). This role will require strong leadership and information system skills. The contractor shall oversee several Systems Security Administrators and advise on risk, compliance and security, as described below. Day to day responsibilities include: Support change management processes and ensure SSA controls are consistently implemented and applied Provide system security project management support. Provide status reporting of security activities to include risk posture and compliance. Identify Information System SSA gaps and offer mitigation strategies. Advise on new user account profiles and associated roles to preclude separation of duties conflicts and ensuring “need-to-know” and “least privileges" criteria are applied for access to applications. Manage annual user recertifications for the supported financial and facilities applications to ensure compliance with policy requirements. Collaborate / communicate with applicable parties to ensure appropriate approvals for requested user profiles and roles are obtained. Support the FSA-IS and A-123-IS Assessment audits for SSA functions and maintain appropriate artifacts. Leverage excellent verbal and written communication, analytical, critical thinking, and problem-solving skills. Lead and work in a team environment, remaining resilient and professional during highly sensitive and urgent situations. Ability to multi-task and prioritize competing tasks. Requirements Qualifications/Requirements Must be a US Citizen. Must hold an active DoD Top Secret (TS) clearance. Must have a Bachelor’s (BS/BA) in Information Technology, Computer Science, Math, or Science fields. (Master’s degree preferred.) Must have at least 7 years of InfoSec / IT Security related work experience. Must have 2 years of FISMA (Federal Information Security Management Act) related experience. Extensive knowledge and experience with information security standards, policies, and practices-NIST (800-53 rev), FISCAM, FISMA, DOD, DCID, FBI, etc. Experience analyzing information technology and system risk issues in complex environments. Experience in an IT customer support role, including working knowledge of account and access management. Experience managing a team of system security administrator personnel CISSP, PMP, and Comp TIA A+ certifications a plus. The primary place of performance will be at FBI facilities in the Washington Metropolitan Area (WMA)/ National Capital Region (NCR). Benefits Benefits OCT offers competitive compensation packages and a full suite of benefits which includes: Medical, Dental, and Vision insurance Retirement savings 401K plan provided by an industry leading provider with 3% employer contributions of the employee’s gross salary Paid Time Off and Standard Government Holidays Life Insurance, Short- and Long-Term disability benefits Training Benefits Salary Range: $150,000-$175,000 yearly commensurate with experience, education, etc. About OCT Consulting OCT Consulting LLC is a minority-owned, Small ​Disadvantaged Business (SDB) providing professional services and information technology solutions to the Federal government and commercial clients. Founded in 2013, we bring the advantage of agility in operations along with a management team with a track record of leading successful engagements at major Federal government agencies. At OCT, we are committed to ensuring equal opportunity for all individuals, recognizing that merit and qualifications are the foundation of our hiring, promotion, and development practices. We believe in creating a work environment where every employee can thrive based on their abilities, skills, and achievements. Our practices are designed to ensure fair treatment and equal access to opportunities for all, regardless of race, ethnicity, gender, sexual orientation, age, abilities, or other personal characteristics. We are dedicated to providing career growth and professional development based on individual merit and fostering a workplace where everyone’s contributions are valued and recognized.

Dane Street, a nationally recognized Independent Review Organization (IRO) and a leading provider of Utilization Review (UR) services, is expanding our panel of expert physicians. We are currently seeking Board-Certified Occupational Medicine Physicians with an active New York medical license to perform independent medical reviews on a flexible, remote basis. This non-clinical, contract-based role is ideal for physicians who wish to earn supplemental income while continuing their clinical practice. Position Details Specialty: Occupational Medicine License: Active, unrestricted New York medical license (Required) Work Location: Fully Remote / Telehealth Compensation: Paid per case (average case review takes 15–20 minutes) Scheduling: Set your own availability and volume Start Date: Onboarding and training completed in under 1 week Key Responsibilities Conduct evidence-based reviews of treatment requests for medical necessity Evaluate appealed cases and issue independent, guideline-based decisions Produce clear, concise written reports — no direct patient care involved Utilize Dane Street’s secure online portal for all case-related work Qualifications Board Certification in Occupational Medicine (or Preventive Medicine with Occupational focus) Active and unrestricted New York State Medical License Active engagement in clinical practice Strong analytical and written communication skills Experience applying clinical knowledge to evidence-based guidelines and utilization criteria (e.g., ODG, ACOEM) Why Partner with Dane Street? Flexible Workload: Review cases at your convenience—fully control your schedule Quick Reviews: Most reviews take just 15–20 minutes No Administrative Burden: We handle all medical record collection and preparation Comprehensive Training: Full onboarding and continuous team support Streamlined Tech: Access organized records and guidelines via our secure online platform Timely Turnarounds: Most cases are due within 1–5 business days Ready to Join a Leader in Medical Review Services? Make a meaningful impact—on your terms. Apply today to join Dane Street’s expert physician panel.

Knowledge Management & Data Analyst (0043) OCT Consulting is a business management and technology consulting firm that provides support to Federal Government clients. We provide consulting services in the areas of Strategy, Process Improvement, Change Management, Program and Project Management, Acquisition/Procurement, and Information Technology. Responsibilities and Duties OCT currently has an opening for a Knowledge Management (KM) & Data Analyst to work with a technology division within the Federal Bureau of Investigation (FBI). This role will require strong interpersonal skills and attention to detail. The contractor shall support various administrative functions for the Section Chief and Assistant Section Chief, as described below. Day to day responsibilities include: ·       Manage, and administer the SharePoint site(s) and MS Teams site(s); ·       Manage, create, and/or administer the Atlassian Confluence site(s) for some enterprise systems. ·       Leverage the capabilities offered by MS-Office applications (MS-Teams, MS-Access, MS-PowerPoint, MS-Project) and MS Power Platforms to promote and facilitate the effective and efficient conduct of actions and activities and support of facilities/finance systems. ·       Develop fully functional and adaptive applications using, for example, Power Apps/Power Platform to enhance data reporting and visualization. ·       Develop workflows with Power Automate, creating interactive dashboards and reports using Power BI. ·       Streamlining business processes through automation and developing user-friendly applications to support various departments using MS Power Platform tools. ·       Offer timely information dissemination to personnel (government and contractor); be prepared to provide expert advice and recommendations regarding website development. ·       Work towards and promote a strategy of centralization, standardization, and “best practice” stewardship of all owned documents and materials in conjunction with the Section Level Program Management Leadership. ·       Provide consulting services to Leadership in the creation, editing, review, and delivery of materials to support executive level presentations and briefings. ·       Support business process reviews and make recommendations for enhancements. This might include representing the Section at meetings outside of the FBI, documenting meeting minutes, supporting project timeline development, gathering requirements, or other relevant milestones. Requirements Qualifications/Requirements Must be a US Citizen. Must hold an active DoD Top Secret (TS) clearance. Must have a Bachelor’s degree and a minimum of 5 years of related work experience. Ability to assume the lead role in contributing to the development of standards and best practices surrounding the use of knowledge management techniques and applications to include website development. Must have strong working knowledge of SharePoint, Microsoft Office suite, including MS Power Apps and Power BI skills. Creative problem solver and strong general management consultant who is capable of executing various other duties as assigned. Must be able to work onsite: the primary place of performance will be at FBI facilities in the Washington Metropolitan Area (WMA)/ National Capital Region (NCR). Benefits Benefits OCT offers competitive compensation packages and a full suite of benefits which includes: Medical, Dental, and Vision insurance Retirement savings 401K plan provided by an industry leading provider with 3% employer contributions of the employee’s gross salary Paid Time Off and Standard Government Holidays Life Insurance, Short- and Long-Term disability benefits Training Benefits Salary Range: $100,000-$125,000 yearly commensurate with experience, education, etc. About OCT Consulting OCT Consulting LLC is a minority-owned, Small ​Disadvantaged Business (SDB) providing professional services and information technology solutions to the Federal government and commercial clients. Founded in 2013, we bring the advantage of agility in operations along with a management team with a track record of leading successful engagements at major Federal government agencies. At OCT, we are committed to ensuring equal opportunity for all individuals, recognizing that merit and qualifications are the foundation of our hiring, promotion, and development practices. We believe in creating a work environment where every employee can thrive based on their abilities, skills, and achievements. Our practices are designed to ensure fair treatment and equal access to opportunities for all, regardless of race, ethnicity, gender, sexual orientation, age, abilities, or other personal characteristics. We are dedicated to providing career growth and professional development based on individual merit and fostering a workplace where everyone’s contributions are valued and recognized.

Dane Street, a nationally recognized Independent Review Organization (IRO) and a leading provider of Utilization Review (UR) services, is expanding its panel of physician experts. We are actively seeking Board-Certified Neurological Surgeons with an active New York medical license to conduct independent medical reviews on a flexible, remote basis. This is a non-clinical, contract opportunity perfect for surgeons looking to earn supplemental income while maintaining their clinical practice. Position Details Specialty: Neurological Surgery License Requirement: Active, unrestricted New York medical license Employment Type: 1099 Independent Contractor Location: Fully Remote / Telework Compensation: Paid per case (average case takes 15–20 minutes) Schedule: Set your own availability and review volume Onboarding: Fast-track training; start reviewing in under 1 week Key Responsibilities Perform independent reviews of treatment requests for medical necessity Evaluate appealed cases and issue fair, evidence-based determinations Draft clear, comprehensive written reports — no direct patient care Access and manage casework through Dane Street’s secure online portal Candidate Requirements Board Certification in Neurological Surgery Active, unrestricted New York State Medical License Ongoing clinical practice required Excellent written communication and analytical skills Experience with evidence-based medicine and guideline-driven evaluations (e.g., ODG, AANS/CNS guidelines) Why Join Dane Street? True Flexibility: Work from anywhere, anytime—you control your schedule Minimal Time Commitment: Most reviews take only 15–20 minutes No Admin Overhead: We handle all record collection and formatting Dedicated Support: Full training provided with continuous assistance Efficient Technology: Secure platform with streamlined access to clinical records and guidelines Fast Turnarounds: Most cases are due within 1–5 business days Ready to Lend Your Expertise? Join a respected leader in medical review services and make a difference—on your terms. Apply today to become a part of Dane Street’s elite physician review panel.