Process Claims jobs near me - 30 jobs

With supervisor approval, incumbents may be eligible for intermittent remote work; however, they must physically reside within the Sacramento region or have the ability to regularly report to a City of Sacramento physical worksite with little notice. To perform difficult and complex technical public contact and record keeping work related to billings, taxes, fees, and services; processes transactions and independently resolves problems related to complaints and inquiries according to established City standards and procedures. This is the advanced-journey level class in the Customer Service series. The Customer Service Specialist class works under minimal supervision, and is considered the technical expert of the series having the knowledge and authority to handle issues beyond the first attempts of lower-level Customer Service staff. The Customer Service Specialist level may be assigned to lead lower-level Customer Service staff. This class is distinguished from the Customer Service Supervisor class in that the latter is the full supervisory class, responsible for a customer service unit, operation, or special program. This class is distinguished from the Customer Service Representative class in that the latter is the journey-level class in the series where incumbents work under immediate supervision. General supervision is provided by a Customer Service Supervisor or higher-level management staff. The Customer Service Specialist may provide lead direction as assigned.- Provide lead supervision of staff, and adjust work schedules and assignments as needed to ensure adequate coverage of telephone and public counter operations; assist supervisor in overseeing the completion of daily assignments and special projects. * Represent the City and the department to the public, callers, and visitors in a professional and effective manner over the telephone and at a public counter; answer and respond to a high volume of phone calls; follow general customer service policy and procedure. * Interact with customers to respond to complaints and inquiries; contact customers as needed regarding service accounts, fees, licenses, permits, and service level; assist staff in the resolution of complex and difficult customer service problems; transfer call, and/or direct callers to department/unit as requested. * Calculate and collect payments for various City services, and ensure all requirements are met; initiate billing; collect opening, current, and closing payments and fees; perform collection efforts on delinquent accounts for City services; complete refund request; and calculate and process claims on bankrupt and deceased creditors; interface with department staff as needed. * Research and retrieve information, and analyze accounts to reconcile errors and modify account transactions; review and interpret billing statements; authorize the removal of penalties and issuance of credits or refunds; and recommend extensions on delinquent accounts; correct service records and repair orders received from field crews. * Make change and issue receipts; pro-rate accounts for established, changed or stopped service; prepare documents for recording and transmitting fees received; maintain daily balances; input debit applications and cancellation information to customer accounts. * Perform a variety of general accounting duties, including accounts receivable, accounts payable and bank deposits; verify accuracy of checks, payment cards and bank deposits; locate, gather and compile information regarding payments received without payment cards to identify account to be credited; maintain petty cash, daily cash and daily revenue records; and submit daily records; and maintain files and records. * Perform specialized work involving independent judgment, including database maintenance and customer information billing system activities, as required; update databases to reflect relevant legal information; research and compile information and data for statistical and financial reports/charts from oral direction, rough draft, forms, copy, or notes; maintain a variety of statistical records; and check and tabulate statistical data; perform notary services. * Calculate required fees in accordance with established policies; calculate, issue and collect payments for various service accounts; ensure accuracy, and all other requirements are met; issue licenses and other business related citations * Prepare and enter a variety of detailed commands into a computer in order to set parameters for a variety of billing services and reports; produce account statements; prepare backup files for protection of a department database; and update official City maps and records as required. * Utilize various systems to locate information, retrieve, research and review; determine the status of accounts and conditions; create or make adjustments to service requests; route work requests, follow-up and monitor posting of labor and materials billing; operate 2-way radio or other telecommunication device. * Create or make adjustments on property/parcels; research and verify correct lot splits, lot mergers, and lot line adjustments; update accounts to provide accurate billing information; update systems and run reports of various computer systems; research and establish correct ownership, change ownership information and deed date; generate inspections; process service records and repair orders received from field crews. * Confer with management staff regarding division and/or unit operations, procedures and regulations; provide responsible operational support to technical staff, unit supervisor, and lower-level staff; may assist higher level staff with development and revision of procedures; interpret City codes and ordinances, policies, procedures and regulations. * Participate in the training of staff in various systems, procedures and operations; provide functional direction of lower-level personnel as assigned; participate in the evaluations of subordinate staff; attend meetings as directed. * Perform notary duties. * Provide exceptional customer service to those contacted in the course of work. * Other related duties may also be performed; not all duties listed are necessarily performed by each individual.Knowledge of: * English usage, spelling, grammar and punctuation. * Basic bookkeeping and record keeping methods. * Mathematical procedures and calculations, including percentages, calculations, and pro-rations. * Methods of researching and recording. * City codes and ordinances, policies, procedures, and regulations of assigned division/department. * Various rates and fees schedules. * Assessing maps, as assigned including geographic information system (GIS), parcel, subdivision, etc. * Methods and equipment used in processing payments. * Modern office methods, practices, procedures for billing purposes. * Computer operations, including computer software applications and other specialized business applications. * Principals of supervision and training. Skill in: * Computer keyboard, typewriter and 10-key calculator. * Working as part of a team. * Phone skills and diplomacy. * Computer and Internet searches. Ability to: * Exercise tact, judgment and patience in dealing with the public, staff and client departments. * Utilize specialized computer business applications and systems for account and billing purposes. * Analyze, read, and prepare schedules, maps, permits, reports, and statements regarding municipal operations. * Analyze and prepare schedules, reports and statements regarding municipal operations. * Interpret and apply City regulations and procedures as applicable to billing, fees and collections. * Work independently with minimal supervision. * Work any shift, including weekends and holidays is mandatory for some assignments. * Perform specialized technical work involving independent judgment. * Type at a speed of not less than 35 net words per minute. * Perform mathematic calculations. * Communicate clearly and concisely, both orally and in writing. * Establish and maintain effective working relationships with those contacted in the course of work. * Perform concurrently multiple complex customer service related duties. EXPERIENCE AND EDUCATION Any combination of experience and education that would provide the required knowledge and abilities is qualifying. A typical way to obtain the knowledge and abilities would be: Experience: Two (2) years of progressively responsible journey-level experience performing customer service work responding to customer complaints and inquiries in a public service operation. Education: Equivalent to the completion of the twelfth grade. PROOF OF EDUCATION Should education be used to qualify for this position, then proof of education such as, but not limited to, university/college transcripts and degrees should be submitted with your application and will be required at the time of appointment. Unofficial documents and/or copies are acceptable. An applicant with a college degree obtained outside the United States must have education records evaluated by a credentials evaluation service. Evaluation of education records will be due at time of appointment. PROBATIONARY PERIOD: Employees must complete twelve (12) months of probation at a satisfactory performance level prior to gaining permanent status. Please note, the City of Sacramento's preferred method of communication with applicants is via e-mail. As such, please ensure you verify the e-mail address on your application, and check your e-mail frequently, including your spam and junk folders. All e-mail notifications can also be accessed through the governmentjobs.com applicant inbox. 1. Application: (Pass/Fail) - All applicants must complete and submit online a City of Sacramento employment application by the final filing deadline; * Employment applications must be submitted online; paper applications will not be accepted. * Employment applications will be considered incomplete and will be disqualified: * If applicants do not list current and/or past job-related experience in the duties area of the "Work Experience" section. Note: Qualifying experience is based on full-time experience (40 hours per week). Qualifying experience is calculated to the full-time equivalent (pro-rated if less than 40 hours/week). * If "see resume" is noted in the "Work Experience" section; a resume will not substitute for the information required in the "Work Experience" section. * Proof of education such as, but not limited to, university/college transcripts and degrees should be submitted online with your application. Proof of education will be required at time of appointment. * Position/job titles will not be considered in determining eligibility for meeting the minimum qualifications for this position. * If you're requesting Veteran's credit, a copy of your DD214 must be submitted online with your application or emailed to the Employment Office by the final filing deadline. Information regarding the use of Veteran's credit can be found in the Civil Service Board rules under rule 4.9C. * Applicants are responsible for attaching a copy of their DD214 to each position for which they apply. 2. Training and Experience Exam: (Weighted 100%) - The questions located at the end of the application are the Training and Experience (T&E) Exam. Responses to the T&E questions will be rated and scored. This exam will evaluate the relevance, level, and progression of a candidate's education, training and experience. The exam score will determine your ranking on the eligible list for this job. When completing the T&E questions, please note: * Responses to the T&E questions must be submitted online; paper questionnaires will not be accepted. * A resume will not substitute for the information required in the T&E questions. 3. Eligibility: Candidates who pass the Training and Experience Test will be placed on the eligible list. The hiring department may contact candidates for interview at any time during the life of the one-year list. Candidate's eligibility expires one year from the date of notification of a passing score for the Customer Service Specialist examination. 4. Screening Committee: (Pass/Fail)- All candidates that pass the examination and are in one of the top three ranks will have their application forwarded to the hiring department for review. The hiring department will select the most competitive applications for further consideration. Human Resources will only evaluate employment applications for the minimum qualifications, as stated on the job announcement, for applications selected by the hiring department. 5. Conditional Hire: Upon receipt of a conditional offer, the selected candidate must complete and pass Live Scan/fingerprinting. If applicable, candidates may also need to pass a pre-employment medical exam, controlled substance and/or alcohol test, and possess any required licensure or certification prior to receiving a start date from the Department. Failure to meet these prerequisites will be grounds for withdrawal of your conditional offer of employment. QUESTIONS: For questions concerning this job announcement and the application process: * Please visit **************************************************** for a comprehensive, step-by-step guide to the application process. * For technical support between 6 AM - 5 PM PT, contact Live Applicant Support at **************. * Visit the City of Sacramento Human Resources Department website at *********************************************** * Send an email to *******************************; or * Call the Human Resources Department at **************

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance ADA Accommodation Coordinator **Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:** **Dubuque, IA** : 4141 Westmark Drive, Dubuque, IA 52002 **Cedar Rapids, IA** : 333 1st Street SE Ste. 200 Cedar Rapids IA 52401 **Coralville, IA:** 3273 Ridgeway Drive Coralville IA 52241 **Dublin, OH** : 5500 Glendon Court Dublin OH 43016 **New Albany, OH** : 7795 Walton Parkway New Albany, OH 43054 **Chicago, IL :** 175 W. Jackson Blvd. 12th Fl. Chicago IL 60604 **Indianapolis, IN:** 8909 Purdue Road Suite 501 Indianapolis, IN 46268 **Irving, TX** : 2201 W. Royal Lane Suite 125 Irving, TX 75063 **Memphis, TN :** 8125 Sedgwick Way, Memphis TN 38125 **Southfield, MI** : 300 Galleria Officentre Southfield MI 48034 **Orlando, FL :** 12650 Ingenuity Dr Orlando FL 32826 **Eden Prairie, MN** : 11000 Prairie Lakes Drive Eden Prairie, MN 55344 **PRIMARY PURPOSE** **:** To process claims and determine accommodation options following written guidelines and procedures pursuant to ADA, state and/or client requirements; to make timely referrals for appropriate disability and federal/state leave of absence eligibility review; and to ensure the ongoing processing of claims. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Informs claimants of documentation required to process claims, required time frames, and claims status either by phone, written correspondence and/or claims system. + Reviews medical information to determine if the claimant meets the requirements under ADA, state, and/or client requirements for a qualifying condition. + Makes claim determinations to approve non-complex ADA claims or makes a recommendation to team lead to deny claims based on the ADA, state, and/or client requirements. Processes ADA claims ensuring compliance with duration control guidelines, ADA and state regulations, and/or client-specific process provisions. + Determines accommodation options; makes timely claims referrals for appropriate disability or federal/state leave of absence eligibility reviews where applicable. + Conducts initial employee interview per process guidelines. + Utilizes the appropriate clinical and vocational resources in case assessment (i.e. duration guidelines, in-house clinicians, ADA job accommodation specialists). + Refers cases as appropriate to team lead. + Maintains professional client relationships. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** High school diploma or GED required. **Experience** Two (2) years of related experience or equivalent combination of education and experience required. One (1) year of benefits or claims management experience preferred. **Skills & Knowledge** + Excellent oral and written communication skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent interpersonal skills + Good negotiation skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Computer keyboarding, travel as required **Auditory/Visual** **:** Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $19.00 - $21.00 USD Hourly_ _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Job DescriptionCLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering). SUMMARY STATEMENT The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review. ESSENTIAL DUTIES & RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary. 90% of time will be spent on one or more of the following activities depending on assignments: Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization: Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations. Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care. Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns. May develop recommendations for further corrective action based on medical review findings. May refer for review, or implement, corrective action related to medical review activities. May process claims and complete project work in the appropriate computer system(s). The remaining 10% of time will be spent on the following activities depending on assignments: Identify providers needing education and individually educate providers who are subject to medical review processes: Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal. This may involve discussion with CMS leaders and leaders in the provider community. Participate in special projects as assigned. REQUIRED QUALIFICATIONS * Valid nursing degree * 2 years' clinical experience * Excellent written and oral communication skills * Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility) * Strong computer skills to include Microsoft Office proficiency * Valid unrestricted Registered Nurse (RN) license PREFERRED QUALIFICATIONS * Inpatient Rehabilitation Facility Experience * Bachelor of Science in Nursing (BSN) * Insurance industry experience * Certified Coder ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. Under the general direction of the Administrator and Business Service Manager the Patient Account Analyst is primarily responsible for verifying insurance benefits and eligibility as presented by the patient. This position also obtains and regulates all authorizations and ensures the patients are processed in a timely fashion to start course of treatment. This position is also responsible for patient account inquiries/requests and payment postings for payments made at the site under departmental protocols within business services, pre- AR, and financial assistance planning. Crucial communications with the patient (on the phone or at site), with clinical team members, and/or physicians are required with this position, collection of additional information on patient accounts may be required to process claims both internally and externally as needed to include coding and compliance according to CPC regulations. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * High School diploma or GED from an accredited program * 3+ years in similar field involving insurance verification, 3rd party payors, patient accounts and business office functions * Customer service experience * Windows computer skills * ICD 9- 10 and CPT minimum 1+ years of coding experience in global billing * Good knowledge of managed care contracts * Basic knowledge of health insurance * Type 30 wpm * Demonstrated clear communication skills * Demonstrated fast and accurate data entry skills Preferred Qualifications: * CPC * EPIC Experience preferred but not required, will train onsite * Knowledge of insurance, billing and collection concepts and theory * Insurance verification and business office functions preferred to be in the physician practice setting Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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. OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance. Representative must be able to work independently as well as work closely with management and team to take appropriate steps to resolve an account. Team member should possess the following: Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed. Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions Access payer websites and discern pertinent data to resolve accounts Utilize all available job aids provided for appropriateness in Patient Accounting processes Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities Provide support for team members that may be absent or backlogged ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards. Perform special projects and other duties as needed. Assists with special projects as assigned, documents, findings, and communicates results. Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor. Participate and attend meetings, training seminars and in-services to develop job knowledge. Respond timely to emails and telephone messages as appropriate. Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies Intermediate skill in Microsoft Office (Word, Excel) Ability to learn hospital systems - ACE, VI Web, IMaCS, OnDemand quickly and fluently Ability to communicate in a clear and professional manner Must have good oral and written skills Strong interpersonal skills Above average analytical and critical thinking skills Ability to make sound decisions Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims. Intermediate understanding of EOB. Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms. Ability to problem solve, prioritize duties and follow-through completely with assigned tasks. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. High School diploma or equivalent. Some college coursework in business administration or accounting preferred 1-4 years medical claims and/or hospital collections experience Minimum typing requirement of 45 wpm PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Office/Team Work Environment Ability to sit and work at a computer terminal for extended periods of time WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Call Center environment with multiple workstations in close proximity As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation Pay: $15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience. Position may be eligible for a signing bonus for qualified new hires, subject to employment status. Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: Medical, dental, vision, disability, and life insurance Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. 401k with up to 6% employer match 10 paid holidays per year Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.

BroadPath is hiring a detail-oriented **Senior Claims Examiner** to train and work from home! Join our team as a Senior Claims Examiner and play a crucial role in ensuring the financial health of our organization while supporting quality patient care. The Senior Claims Examiner's primary function is to ensure the accurate adjudication of all complex claims for SCCIPA contracted plans. Your expertise will be crucial in maintaining our high standards of accuracy and efficiency in claims processing. **Compensation Highlights:** + Base Pay: $18.00 per hour + Pay Frequency **:** Weekly **Schedule Highlights:** + Training Schedule: 5 days, Monday-Friday, 8:00 AM - 5:00 PM PST + Production Schedule: Monday-Friday, 8:00 AM - 5:00 PM PST, no weekends! **Responsibilities** + Adjudicate all types of claims, resolving system edits and audits for hardcopy and electronic submissions + Resolve provider and eligibility issues related to received claims + Generate emergency reports and authorizations for claims that lack prior authorization + Adjudicate third-party liability and coordination of benefit claims in line with policy + Review stop loss reports and identify members approaching reinsurance levels + Identify potential system programming issues and report them to the supervisor + Provide technical support and training for claims processors + Recognize and appropriately route claims for carved-out services based on plan contracts + Process claims using knowledge of plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans, and capitation arrangements + Ensure correct posting of claims information to the appropriate general ledger accounts + Collaborate with Customer Service and Provider Services on large claim projects and adjustments + Assist with benefit and plan interpretation via the cut-log system when necessary + Adjust complex claims and support other examiners with claim resolution + Perform additional duties as assigned **Qualifications** + High school diploma or equivalent required + Two years of experience processing both regular and complex claims + Proficiency in ICD-9, CPT, HCPC, and revenue coding required + Strong communication skills with the ability to collaborate effectively with supervisors, co-workers, and other departments + Ability to analyze and resolve claims issues, troubleshooting complex problems independently + Capable of working in a high-volume, production-oriented environment + Detail-oriented with the ability to maintain focus during extended periods of time + Strong performance under demanding production and quality standards + Technical proficiency with claims processing software + In-depth understanding of complex claims procedures and medical terminology + Knowledge of HEDIS, DOC, HCFA, and NCQA requirements + Ability to act as a resource and trainer for claims processors **Diversity Statement** _At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!_ _Equal Employment Opportunity/Disability/Veterans_ _If you need accommodation due to a disability, please email us at_ _*****************_ _. This information will be held in confidence and used only to determine an appropriate accommodation for the application process._ _BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law._ _Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location._

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Disability Representative Sr. **PRIMARY PURPOSE** : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan. + Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan. + Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines. + Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), as needed. + Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. + Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system. + Communicates with the claimants' providers to set expectations regarding return to work. + Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions. + Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims. + Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities. + Negotiates return to work with or without job accommodations via the claimant's physician and employer. + Refers cases to team lead and clinical case management for additional review when appropriate. + Maintains professional client relationships and provides excellent customer service. + Meets the organization's quality program(s) minimum requirements. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. **QUALIFICATIONS** **Education & Licensing** High School diploma or GED required. Bachelor's degree from an accredited university or college preferred. State certification or licensing in statutory leaves is preferred or may be required based on state regulations. **Experience** Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred. **Skills & Knowledge** + Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures + Knowledge of state and federal FMLA regulations + Working knowledge of medical terminology and duration management + Excellent oral and written communication, including presentation skills + Proficient computer skills including working knowledge of Microsoft Office + Analytical, interpretive, and critical thinking skills + Ability to manage ambiguity + Strong organizational and multitasking skills + Ability to work in a team environment + Ability to meet or exceed performance competencies as required by program + Effective decision-making and negotiation skills + Ability to exercise judgement autonomously within established procedures **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required. **Auditory/Visual** **:** Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

MCI is one of the fastest-growing tech-enabled business services companies in the USA, with a strong call center footprint and operations that extend across multiple countries. We deliver Customer Experience (CX), Business Process Outsourcing (BPO), and Anything-as-a-Service (XaaS) cloud technology solutions across a wide range of industries, including healthcare, retail, government, education, telecom, technology e-commerce, and financial services. Our contact centers are powered by both on-site and remote agents, leveraging advanced technologies to enhance customer journeys, drive scalability and reduce costs. At MCI we are committed to fostering an environment where professionals can build meaningful careers, access continuous learning and development opportunities and contribute to the success of a globally expanding, industry-leading organization. We're hiring Bilingual Call Center Representatives to support diverse client projects across industries. If you're fluent in English and Spanish, passionate about helping others, and thrive in a fast-paced environment, this is your opportunity to grow your career while making a real impact. In this role, you'll troubleshoot basic technical issues, build meaningful customer relationships, and identify opportunities to upsell products and services all while delivering exceptional service. To be considered for this position, you must complete a full application on our company careers page, including screening questions and a brief pre-employment test. * ------------- POSITION RESPONSIBILITIES Key Responsibilities: * Handle inbound and outbound calls with professionalism, empathy, and efficiency. * Listen actively to understand customer needs and provide accurate solutions. * Use internal systems to manage accounts, process claims, and update records. * Follow scripts and procedures to ensure compliance and consistency. * Escalate complex issues to supervisors when necessary. * Maintain confidentiality and protect customer data. * Stay current with training materials, system updates, and product knowledge. * Meet performance goals including first-call resolution and customer satisfaction. CANDIDATE QUALIFICATIONS WONDER IF YOU ARE A GOOD FIT FOR THIS POSITION? All positive, and driven applicants are encouraged to apply. The Ideal candidates for this position are highly motivated and dedicated and should possess the below qualities: Qualifications: * High school diploma or GED. * Fluent in English and Spanish (spoken and written). * Strong typing skills (20+ WPM) and data entry experience. * Excellent communication, organization, and problem-solving abilities. * Ability to work scheduled shifts, including weekends and holidays. * Basic knowledge of Microsoft Office Suite and Windows applications. * Reliable internet connection (20Mbps+ download speed) for remote roles. * Customer-first mindset: empathetic, patient, and solution-oriented. * Ability to multitask, self-manage, and thrive in a dynamic environment. * Team-oriented with strong interpersonal skills. Preferred: * 1+ year of experience in customer service, technical support, inside sales, chat, or administrative roles in a contact center. CONDITIONS OF EMPLOYMENT All MCI Locations * Must be authorized to work in the country where the job is based. Subject to the program and location of the position * Must be willing to submit up to a LEVEL II background and/or security investigation with a fingerprint. Job offers are contingent on background/security investigation results. * Must be willing to submit to drug screening. Job offers are contingent on drug screening results. COMPENSATION DETAILS WANT AN EMPLOYER THAT VALUES YOUR CONTRIBUTION? At MCI, we believe that your hard work deserves recognition and reward. Our compensation and benefits packages are designed to be competitive and to grow with you over time. Starting compensation is based on experience, and we offer a variety of benefits and incentives to support and reward our team members. What You Can Expect from MCI: We understand the importance of balance and support, which is why we offer a variety of benefits and incentives that go beyond a paycheck. Our team members enjoy: * Paid Time Off: Earn PTO and paid holidays to take the time you need. * Incentives & Rewards: Participate in daily, weekly, and monthly contests that include cash bonuses and prizes ranging from electronics to dream vacations and sometimes even cars! * Health Benefits: Full-time employees are eligible for comprehensive medical, dental, and vision coverage after 60 days of employment, and all employees have access to MEC medical plans after just 30 days. Benefit options vary by location. * Retirement Savings: Secure your future with retirement savings programs, where available. * Disability Insurance: Short-term disability coverage is available to help protect you during unexpected challenges. * Life Insurance: Access life insurance options to safeguard your loved ones. * Supplemental Insurance: Accident and critical illness insurance * Career Growth: With a focus on internal promotions, employees enjoy significant advancement opportunities. * Paid Training: Learn new skills while earning a paycheck. * Fun, Engaging Work Environment: Enjoy a team-oriented culture that fosters collaboration and engagement. * Casual Dress Code: Be comfortable while you work. Compensation & Benefits that Fit Your Life MCI takes pride in tailoring our offerings to fit the needs of our diverse team across subsidiaries and locations. While specific benefits and incentives may vary by geography, the core of our commitment remains the same: rewarding effort, providing growth opportunities, and creating an environment where every employee feels valued. If you're ready to join a company that recognizes your contributions and supports your growth, MCI is the place for you. Apply today! PHYSICAL REQUIREMENTS This job operates in a professional office environment. While performing the duties of this job, the employee will be largely sedentary and will be required to sit/stand for long periods while using a computer and telephone headset. The employee will be regularly required to operate a computer and other office equipment, including a phone, copier, and printer. The employee may occasionally be required to move about the office to accomplish tasks; reach in any direction; raise or lower objects, move objects from place to place, hold onto objects, and move or exert force up to forty (40) pounds. REASONABLE ACCOMMODATION Consistent with the Americans with Disabilities Act (ADA), it is the policy of MCI and its affiliates to provide reasonable accommodations when requested by a qualified applicant or employee with a disability unless such accommodations would cause undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment. If reasonable accommodations are needed, please contact Human Resources. DIVERSITY AND EQUALITY At MCI and its subsidiaries, we embrace differences and believe diversity benefits our employees, company, customers, and community. All aspects of employment at MCI are based solely on a person's merit and qualifications. MCI maintains a work environment free from discrimination, where employees are treated with dignity and respect. All employees are responsible for fulfilling MCI's commitment to a diverse and equal-opportunity work environment. MCI does not discriminate against any employee or applicant on the basis of age, ancestry, color, family or medical care leave, gender identity or expression, genetic information, marital status, medical condition, national origin, physical or mental disability, political affiliation, protected veteran status, race, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable laws, regulations, and ordinances. MCI will consider qualified applicants with criminal histories for employment in a manner consistent with local and federal requirements. MCI will not tolerate discrimination or harassment based on any of these characteristics. We adhere to these principles in all aspects of employment, including recruitment, hiring, training, compensation, promotion, benefits, social and recreational programs, and discipline. In addition, MCI's policy is to provide reasonable accommodation to qualified employees with protected disabilities to the extent required by applicable laws, regulations, and ordinances where an employee works. ABOUT MCI (PARENT COMPANY) MCI helps customers take on their CX and DX challenges differently, creating industry-leading solutions that deliver exceptional experiences and drive optimal performance. MCI assists companies with business process outsourcing, staff augmentation, contact center customer services, and IT Services needs by providing general and specialized hosting, software, staff, and services. In 2019, Marlowe Companies Inc. (MCI) was named by Inc. Magazine as Iowa's Fastest Growing Company in the State of Iowa and was named the 452nd Fastest Growing Privately Company in the USA, making the coveted top 500 for the first time. MCI's subsidiaries had previously made Inc. Magazine's List of Fastest-Growing Companies 15 times, respectively. MCI has ten business process outsourcing service delivery facilities in Georgia, Florida, Texas, New Mexico, California, Kansas, Nova Scotia, South Africa, and the Philippines. Driving modernization through digitalization, MCI ensures clients do more for less. MCI is the holding company for a diverse lineup of tech-enabled business services operating companies. MCI organically grows, acquires, and operates companies that have synergistic products and services portfolios, including but not limited to Automated Contact Center Solutions (ACCS), customer contact management, IT Services (IT Schedule 70), and Temporary and Administrative Professional Staffing (TAPS Schedule 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, Digital Experience Provider (DXP), Account Receivables Management (ARM), Application Software Development, Managed Services, and Technology Services, to mid-market, Federal & enterprise partners. MCI now employs 10,000+ talented individuals with 150+ diverse North American client partners across the following MCI brands: MCI BPO, MCI BPOaaS, MarketForce, GravisApps, Gravis Marketing, MarchEast, Mass Markets, MCI Federal Services (MFS), OnBrand24, The Sydney Call Center, Valor Intelligent Processing (VIP), BYC Aqua, EastWest BPO, TeleTechnology, and Vinculum. DISCLAIMER The purpose of the above is to provide potential candidates with a general overview of the role. It's not an all-inclusive list of the duties, responsibilities, skills, and qualifications required for the job. You may be asked by your supervisors or managers to perform other duties. You will be evaluated in part based on your performance of the tasks listed in this . The employer has the right to revise this at any time. This job description is not an employment contract, and either you or the employer may terminate employment at any time for any reason. Qualifications Entry-Level

The Claims Examiner III process insurance claims for property losses based on coverage, appraisal, and verifiable damage. They will interact with independent adjusters and policy holders, review claim forms and other records to determine insurance coverage. This person will make payment recommendations and settlements in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations. PRINCIPAL DUTIES & RESPONSIBILITIES • Investigate, evaluate, and resolve claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims. • Adjust reserves and provide reserve recommendations to ensure reserving activities are consistent with company policies. • Enter claim transactions, in a clear and concise manner. • Examine claims inspected by independent adjusters, including further investigation of questionable claims, verification of coverage, and timely issuance of payments to policyholders. • Conduct daily diary reviews on claim files to ensure status letters are sent to policyholders in accordance with Department of Insurance regulations. • Pay and process claims within designated authority level. • Supervise independent adjusters to ensure adherence to CFP IA Guidelines. • Maintain compliance with the Department of Insurance and Company policy and procedures. • Create correspondence to policyholders that is accurate and complete. Communicate with insureds and/or others involved to secure missing information. • Promptly negotiate settlements, making sure that the settlement reflects the actual insured losses while ensuring that the insurer is protected from invalid claims. • Confer with Claims Management and legal counsel on claims involving litigation. ADDITIONAL DUTIES & RESPONSIBILITIES Claims Examiner III: This role may include handling the entire claim (except inspection), or may be responsible for a specific coverage, such as Personal Property or Fair Rental Value. This role will focus on claims over $300,000 in damages, but the Claims Examiner III may receive smaller claims when necessary. EDUCATION & EXPERIENCE • Minimum bachelor's degree or equivalent preferred. • Excellent oral and written communication skills. • Working experience with MS-Office (especially Word and Excel) is required. • 2 + years property claims experience and excellent customer service. • Certified in CEA and Fair Claims Settlement Practices. ADDITIONAL REQUIREMENTS (PRIOR EXPERIENCE) Claims Examiner III: 5 years total claims experience, 2 years handling homeowner claims over $300,000 including 2 years carrier experience required.

As a digital transformation company -- and Great Place to Work certified -- Sutherland has been helping customers globally achieve greater agility and transform automated customer experiences for over 35 years. We work with some of the world's most known brands in dozens of industries, including Banking & Financial Services; Insurance; Communications, Media & Entertainment; Healthcare; Retail & Consumer Packaged Goods; Technology; Travel, Transportation, Hospitality & Logistics; and Mortgage Services, helping them to better support and serve their customers. Job Description In this position, you will be responsible for handling a variety of tasks to ensure payment collection activity is resolved, disputed or sent to Legal. This will include: Conducting collection activity on appealed claims by contacting government agencies, third party payers via phone, email, or online Providing ongoing appropriate collection activity on appeals Requesting additional information from Patients, Medical Records, and others as needed Communicating with insurance plans and researching health plans for benefits and types of coverage Reviewing contracts and identifying billing or coding issues and requesting re-bills, secondary billing, or corrected bills as needed. Handling other duties as assigned Qualifications Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, collections) procedures and policies Full understanding of Managed Care collections Familiarity with terms such as MMC, HMO, PPO, IPA and Capitation and how these payers process claims Knowledge of Managed Care contracts, Contract Language and Federal and State requirements Intermediate understanding of Hospital billing form requirements (UB04) and HCFA 1500 Medical claims and/or hospital collections experience Minimum high school education, technical training, and/or other related experience Bilingual in English/Spanish English Wage: $17.50 Bilingual (EN/SP) Wage: $18.50 Additional Information We will supply equipment, but to work from home, you must have: Excellent Internet connectivity: Internet access speeds of at least 5 Mbps upload and 30 Mbps download - the faster the better! In-house network, and a hard-wired Internet connection capable of continuously supporting outstanding call quality and high-speed response rates. (wireless and/or satellite Internet Service Providers are not compatible with our systems) A quiet and distraction-free, secure place to work. IMPORTANT NOTE: This job is open only to residents of the United States, and you must be authorized to work in the US in order to be considered for employment. EEOC and Veteran Documentation During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status. At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance ADA Accommodation Coordinator Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence: Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002 Cedar Rapids, IA : 333 1st Street SE Ste. 200 Cedar Rapids IA 52401 Coralville, IA: 3273 Ridgeway Drive Coralville IA 52241 Dublin, OH : 5500 Glendon Court Dublin OH 43016 New Albany, OH : 7795 Walton Parkway New Albany, OH 43054 Chicago, IL : 175 W. Jackson Blvd. 12th Fl. Chicago IL 60604 Indianapolis, IN: 8909 Purdue Road Suite 501 Indianapolis, IN 46268 Irving, TX: 2201 W. Royal Lane Suite 125 Irving, TX 75063 Memphis, TN : 8125 Sedgwick Way, Memphis TN 38125 Southfield, MI : 300 Galleria Officentre Southfield MI 48034 Orlando, FL : 12650 Ingenuity Dr Orlando FL 32826 Eden Prairie, MN : 11000 Prairie Lakes Drive Eden Prairie, MN 55344 PRIMARY PURPOSE: To process claims and determine accommodation options following written guidelines and procedures pursuant to ADA, state and/or client requirements; to make timely referrals for appropriate disability and federal/state leave of absence eligibility review; and to ensure the ongoing processing of claims. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Informs claimants of documentation required to process claims, required time frames, and claims status either by phone, written correspondence and/or claims system. * Reviews medical information to determine if the claimant meets the requirements under ADA, state, and/or client requirements for a qualifying condition. * Makes claim determinations to approve non-complex ADA claims or makes a recommendation to team lead to deny claims based on the ADA, state, and/or client requirements. Processes ADA claims ensuring compliance with duration control guidelines, ADA and state regulations, and/or client-specific process provisions. * Determines accommodation options; makes timely claims referrals for appropriate disability or federal/state leave of absence eligibility reviews where applicable. * Conducts initial employee interview per process guidelines. * Utilizes the appropriate clinical and vocational resources in case assessment (i.e. duration guidelines, in-house clinicians, ADA job accommodation specialists). * Refers cases as appropriate to team lead. * Maintains professional client relationships. ADDITIONAL FUNCTIONS and RESPONSIBILITIES * Performs other duties as assigned. * Supports the organization's quality program(s). QUALIFICATIONS Education & Licensing High school diploma or GED required. Experience Two (2) years of related experience or equivalent combination of education and experience required. One (1) year of benefits or claims management experience preferred. Skills & Knowledge * Excellent oral and written communication skills * PC literate, including Microsoft Office products * Analytical and interpretive skills * Strong organizational skills * Excellent interpersonal skills * Good negotiation skills * Ability to work in a team environment * Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $19.00 - $21.00 USD Hourly. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Job DescriptionSalary: DOE THIS IS NOT A REMOTE POSITION. Accepting applications for a Medical Billing Specialist to work in our MCH Business office. This benefits eligible position would work Monday through Friday, 8:00 am to 4:30 pm. This position would ensure that all necessary information for proper billing is recorded in patient files. This would require communicating with patients as necessary regarding account information. THIS IS NOT A REMOTE POSITION. Duties to include: *Prepare claims to submit to both primary and secondary insurance companies for payment on patient accounts. *Transmits claims electronically to Medicare, Medicaid, Blue Cross and NEIC carriers daily *Contacts insurance companies in effort to collect submitted patient claims *Resubmits any information required by insurance companies in order to process claims *Responsible to resubmit unpaid claims on aging reports and work to meet the department aging goals *Processes accuracy of insurance payments Knowledge of basic bookkeeping, general accounting, collecting, and standard office practices and procedures. Attention to detail is a must. Medical billing experience preferred. Graduation from High School or equivalent. Ability to use Internet and process claims thru the hospital system. THIS IS NOT A REMOTE POSITION

The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won't receive a response). Regular or Temporary: Regular Language Fluency: English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: Analyzes and processes claims by gathering information and drawing conclusions. Acts as a liaison between insured and insurance carrier to report, track and manage claims process. Provides leadership to all employees within the claims department. ESSENTIAL DUTIES AND RESPONSIBILITIES Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. 1. Supervise a multi-person team ensuring all pertinent information is communicated. 2. Evaluate claims, reporting forms and cancellations and initiate necessary corrections to ensure accuracy of dates, coverage, signature, commission, premium, attachments, etc. 3. Authenticate all relevant activity on assigned files and makes recommendation for additional activity as appropriate. 4. Determine where new loss claims should be reported. 5. Manage all claim documentation. 6. Use discretion to submit the necessary information and/or correspondence to the Agent or Insurer to process claims appropriately. 7. Analyze claim coverage with insurance carriers to ensure claims are paid accurately. 8. Assess eligibility status of denied claims. 9. Anticipate and meets all customer needs (both internal and external). 10. Maintain claims and suspense system ensuring follow-up for receipt of policies, endorsements, inspections reports, correspondence, claims, etc. from outside sources. 11. Process all departmental claims in a timely manner according to company policy. 12. Facilitate the training of new employees in the department. 13. Perform other duties as assigned. QUALIFICATIONS Required Qualifications: The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Bachelor's degree with a concentration in business or equivalent work experience 2. Three years of Claims handling experience and commercial and multi-line knowledge 3. Ability to critically review a claim file for relevant information, accurately access the information and make necessary recommendations 4. Ability to make independent decisions following CRC guidelines with minimal or no supervision 5. Good organizational, time management, and detail skills 6. Extensive knowledge of insurance and CRC processes 7. Ability to maintain a high level of tact and professionalism 8. Good leadership skills to influence all departmental employees in a positive manner 9. Possess strong interpersonal skills 10. Strong verbal and written communication skills 11. Strong computer and office skills 12. Ability to work extended hours when necessary Preferred Qualifications: 1. New York adjuster license or New York attorney license 2.Three years of GL claims handling experience; New York Labor Law Sections 200,240,241 preferred. The annual base salary for this position is $120,000.00 - $140,000.00. General Description of Available Benefits for Eligible Employees of CRC Group: All regular teammates (not temporary or contingent workers) working 20 hours or more per week are eligible for benefits, though eligibility for specific benefits may be determined by the division of CRC Group offering the position. CRC Group offers medical, dental, vision, life insurance, disability, accidental death and dismemberment, tax-preferred savings accounts, and a 401k plan to teammates. Teammates also receive no less than 10 days of vacation (prorated based on date of hire and by full-time or part-time status) during their first year of employment, along with 10 sick days (also prorated), and paid holidays. Depending on the position and division, this job may also be eligible for restricted stock units, and/or a deferred compensation plan. As you advance through the hiring process, you will also learn more about the specific benefits available for any non-temporary position for which you apply, based on full-time or part-time status, position, and division of work. CRC supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. CRC is a Drug Free Workplace. EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Disability Representative **Disability Representative** **Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near:** **Dublin, OH** : 5500 Glendon Court Dublin OH 43016 Are you looking for an impactful job requiring that offers an opportunity to develop a professional career? Bring your 2+ years' experience in a office setting or medical experience and grow with us! + A stable and consistent work environment in an office and/or virtual setting + A training program to learn how to help employees and customers from some of the world's most reputable brands. + An assigned mentor and manager who will guide you on your career journey. + Career development and promotional growth opportunities through increasing responsibilities + A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** To process claims and determine benefits due pursuant to a disability plan; to make timely payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets; and to ensure the ongoing processing of claims. **ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic and empathetic candidates that want to grow a career. Ideal candidates will thrive in a collaborative team environment, show motivation, and drive in their work ethic, are customer-oriented, naturally empathic and solution-focused. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Makes claim determinations to approve non-complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan. + Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. + Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system. **QUALIFICATIONS** + Education & Licensing: High school diploma or GED required. + Skills: Strong oral and written communication, computer literate - including Microsoft Office, organizational skills required + PC literate, including Microsoft Office products, Windows environment. + Must meet minimum typing requirements. + Experience: Clerical or customer service experience or equivalent combination of education and experience preferred **TAKING CARE OF YOU** + Entry-level colleagues are offered a world class training program with a comprehensive curriculum. + An assigned mentor and manager that will support and guide you on your career journey. + Career development and promotional growth opportunities + A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more. Work environment requirements: Physical: Computer keyboarding Auditory/visual: Hearing, vision and talking. Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of a specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is (16.00 - 19.50). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.

The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance. Representative must be able to work independently as well as work closely with management and team to take appropriate steps to resolve an account. Team member should possess the following: * Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed. * Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions * Access payer websites and discern pertinent data to resolve accounts * Utilize all available job aids provided for appropriateness in Patient Accounting processes * Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account * Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership * Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities * Provide support for team members that may be absent or backlogged ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards. * Perform special projects and other duties as needed. Assists with special projects as assigned, documents, findings, and communicates results. * Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor. * Participate and attend meetings, training seminars and in-services to develop job knowledge. * Respond timely to emails and telephone messages as appropriate. * Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies * Intermediate skill in Microsoft Office (Word, Excel) * Ability to learn hospital systems - ACE, VI Web, IMaCS, OnDemand quickly and fluently * Ability to communicate in a clear and professional manner * Must have good oral and written skills * Strong interpersonal skills * Above average analytical and critical thinking skills * Ability to make sound decisions * Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors * Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims. * Intermediate understanding of EOB. * Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms. * Ability to problem solve, prioritize duties and follow-through completely with assigned tasks. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * High School diploma or equivalent. Some college coursework in business administration or accounting preferred * 1-4 years medical claims and/or hospital collections experience * Minimum typing requirement of 45 wpm PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Office/Team Work Environment * Ability to sit and work at a computer terminal for extended periods of time WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Call Center environment with multiple workstations in close proximity As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $17.62 - $24.68 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

Imagenet LLC is a premier healthcare technology company revolutionizing medical claims processing as well as document management with unparalleled service, security, and efficiency. Our core mission is to help clients reduce costs and increase productivity by providing streamlined solutions in document imaging, data validation, adjudication, and on-demand retrieval of documents and data. We are looking for Experienced Claims Processor to join our rapidly growing team. Experience is required for this position. Job Overview: In this role, you will be responsible for accurately and efficiently processing medical claims in compliance with payer requirements and internal policies. Job Type: Full-time - This is a fully remote position Pay: up to $19.00 per hour DOE Responsibilities: Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies. Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing. Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues. Participate in ongoing training and professional development activities. Maintain accurate and detailed records of claims processing activities. Review claim forms and supporting documents Determine eligibility, verify data accuracy Request additional information when needed Process claims end-to-end Identify and escalate complex or unusual claims for further review or investigation. Participate in ongoing training and professional development activities. Handle more complex claims with multiple services, providers Experience: At least 1-2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment. Understanding of health claims processing/adjudication Ability to perform basic to intermediate mathematical computation routines Medical terminology strongly preferred Understanding of ICD-9 & ICD-10 Basic MS office computer skills Ability to work independently or within a team Time management skills Written and verbal communication skills Attention to detail Must be able to demonstrate sound decision-making skills What We Offer: Remote work offered Equipment provided Paid training to set you up for success Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k) Paid Time Off (PTO) 7 paid holidays A supportive team and a company that values internal growth Ready to Grow Your Career? We'd love to meet you! Click “Apply Now” and tell us why you'd be a great addition to the Imagenet team. About Imagenet, LLC Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers. The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients. Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.

**The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one.** _If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to_ Accessibility (careers@crcgroup.com?subject=Accommodation%20request) _(accommodation requests only; other inquiries won't receive a response)._ **Regular or Temporary:** Regular **Language Fluency:** English (Required) **Work Shift:** 1st Shift (United States of America) **Please review the following job description:** Analyzes and processes claims by gathering information and drawing conclusions. Manages and evaluates General Liability claims affecting primary and excess policies in a fast-paced E&S Claim environment. **ESSENTIAL DUTIES AND RESPONSIBILITIES** Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. 1. Independently evaluating information on coverage, liability, and damages to determine the extent of exposure to the insured and all financial partners. 2. Countrywide Litigation Management providing world class claims service to our clients, developing and executing litigation plans, managing legal budgets and lawsuits through resolution. 3. Determine where new loss claims should be reported. 4. Use discretion to submit the necessary information and/or correspondence to the Agent or Insurer to process claims appropriately. 5. Analyze claim coverage with insurance carriers to ensure claims are paid accurately. 6. Assess eligibility status of denied claims. 7. Providing outstanding customer service and fostering great working relationships with insureds, brokers and underwriters in the handling and adjudication of all claims. 8. Maintain claims and suspense system ensuring follow-up for receipt of policies, endorsements, inspections reports, correspondence, claims, etc. from outside sources. 9. Process all departmental claims in a timely manner according to company policy. 10.Ability to travel to mediations and trials as needed. 11. Perform other duties as assigned. **QUALIFICATIONS** **Required Qualifications:** The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Bachelor's degree with a concentration in business or equivalent work experience 2. Three years of General Liability Claims handling experience and commercial and multi-line knowledge 3. Ability to critically review a claim file for relevant information, accurately access the information and make necessary recommendations 4. Ability to make independent decisions following CRC guidelines with minimal or no supervision 5. Good organizational, time management, and detail skills 6. Extensive knowledge of insurance and CRC processes 7. Ability to maintain a high level of tact and professionalism 8. Good leadership skills to influence all departmental employees in a positive manner 9. Possess strong interpersonal skills 10. Strong verbal and written communication skills 11. Strong computer and office skills 12. Ability to work extended hours when necessary **Preferred Qualifications:** 1. Multi-State Resident and Non-Resident adjuster 2. Ability to thrive in a remote team environment 3. Experience in the Construction and E&S Claim Environment with a high degree of specialized and technical competence in interpreting general liability policies and exposures for both property damage and bodily injury claims. **General Description of Available Benefits for Eligible Employees of CRC Group:** At CRC Group, we're committed to supporting every aspect of teammates' well-being - physical, emotional, financial, social, and professional. Our best-in-class benefits program is designed to care for the whole you, offering a wide range of coverage and support. Eligible full-time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax-advantaged savings accounts; and a 401(k) plan with company match. CRC Group also offers generous paid time off programs, including company holidays, vacation and sick days, new parent leave, and more. Eligible positions may also qualify for restricted stock units and/or a deferred compensation plan. **_CRC Group supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. CRC Group is a Drug Free Workplace._** EEO is the Law (************************************************************************************************** Pay Transparency Nondiscrimination Provision E-Verify (********************************************** Contents/E-Verify\_Participation\_Poster\_ES.pdf) Join CRC Group, a leader in specialty wholesale insurance, and take your career to new heights. We're a dynamic team dedicated to innovation, collaboration, and excellence. Why CRC Group? - Growth: Advance your career with our learning and leadership development programs. - Innovation: Work in a forward-thinking environment that values new ideas. - Community: Be part of a supportive team that celebrates success together. - Benefits: Enjoy competitive compensation, health benefits, and retirement plans. Who We're Looking For We seek passionate individuals who thrive in a fast-paced, collaborative environment. If you value integrity and are driven to succeed, CRC Group is the place for you.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Disability Representative Sr PRIMARY PURPOSE: To provide disability case management and claim determinations based on complex medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinating investigative efforts, thoroughly reviewing contested claims, negotiating return to work with or without job accommodations, and evaluating and arranging appropriate referral of claims to outside vendors. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan. Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan. Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians). Communicates with the claimants providers to set expectations regarding return to work. Determines benefits due, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions. Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence. Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system. Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims. Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities. Negotiates return to work with or without job accommodations via the claimants physician and employer. Refers cases as appropriate to team lead and clinical case management. Maintains professional client relationships. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited university or college preferred. Experience Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience required. Skills & Knowledge Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures Working knowledge of medical terminology and duration management Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Ability to work in a team environment Excellent negotiation skills Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.