Trabajos medical claims en Jersey City, New Jersey - Page 2Crear alertas

Job Description: Assign accurate CPT, HCPCS, and ICD-10 codes for all services performed at BHC facilities Apply appropriate modifier usage based on payer and service requirements Ensure documentation supports medical necessity, procedural complexity, and level of services Apply correct diagnosis sequencing and body-part specificity required for WC claims Support WC-specific documentation requirements, including injury dates. Causality, and treating physician narratives Collaborate with billing teams to ensure correct claim formats, attachments, and WC payer rules are met Ensure coding compliance with CMS, AMA, NCCI, and OIG guidelines Participate in internal and external coding audits , implement corrective actions as needed Identify coding trends that impact denials, underpayments, or compliance risk Provide feedback and education to provider to improve documentation and coding accuracy Assumes other responsibilities as appropriate to the position and organizational needs Requirements: High school diploma or equivalent required; Associate degree preferred Active coding certification required: CPC, CCS, or equivalent (AAPC or AHIMA) Minimum 3-5 years of medical coding experience in pain management, workers’ compensation billing Demonstrated experience with FRP or multidisciplinary rehab models as well as Commercial and Medicare pain management coding Ability to work in a fast-paced environment, meet daily deadlines, and collaborate with cross-functional RCM teams Experience with multiple EHR/ Practice Management systems (IMS, Nextgen, Athena, eClinicalWorks or similar) Basic understanding of NCCI edits and payer-specific billing guidelines Accuracy and attention to detail, analytical thinking and problem solving and high integrity and compliance focus Advanced proficiency in Microsoft Excel (e.g., formulas, pivot tables) and solid skills in other Microsoft Office applications Benefits: Amazing work/life balance Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO) 401(K) Plan with Employer Matching License & Tuition Reimbursements Paid Time Off Holiday Pay & Floating Holiday Employee Perks and Discount Programs Supportive environment to help you grow and succeed

Job Description: Serving as the regulatory affairs lead on cross‑functional teams Driving regulatory strategy and execution for Tier 1, high‑volume markets Conducting global regulatory change assessments Leading or supporting regulatory filings for continuity and lifecycle projects Providing regulatory review and input on technical documentation and reports Communicating regulatory outcomes and technical information to cross‑functional teams Supporting risk management, vigilance reporting, and other quality‑related initiatives Supporting the implementation of key corporate initiatives and enabling tools Requirements: Bachelor’s Degree or higher (completed and verified prior to start) Ten (10) years in regulatory affairs experience in the drug and/or medical device industry Experience authoring regulatory submissions and technical documentation for drug and medical device products Experience supporting regulatory activities in EMEA, APAC, and LATAM Experience revising, reviewing, and approving product labeling, including marketing claims Experience with dental products, including NDA and OTC monograph drugs and medical devices Experience supporting design control verification and validation activities for medical devices Experience applying regulatory knowledge through cross-functional project management Benefits: Medical, Dental & Vision Health Savings Accounts Health Care & Dependent Care Flexible Spending Accounts Disability Benefits Life Insurance Voluntary Benefits Paid Absences Retirement Benefits

Job Description: Analyzes and processes complex claims, works with high exposure claims involving litigation, and ensures ongoing claims within service expectations, industry best practices and specific client service requirements. Identifies and pursues potential third-party subrogation recoveries associated with highest exposure/complexity claims across all jurisdictions. Manages high-exposure, complex, multi-jurisdictional claims with a focus on identifying and pursuing third-party subrogation opportunities. Requirements: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Six (6) years of multi-jurisdictional liability (general liability, auto liability, products), subrogation and/or workers compensation claims handling experience or equivalent combination of education and experience required. Benefits: Flexible work schedule. Referral incentive program. Opportunity to work in an agile environment. Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Job Description: Responsible for reviewing, auditing, and data entry of medical bills for multiple states and lines of business within both Worker’s Compensation and Commercial Health arenas. Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts Analysis and review of 1 or more assigned states having fee schedules Utilize Fee Schedules, Online Documents, Client instructions, and other training material to properly review medical bills Review medical bills for compensability and relatedness to injury Reprice medical bills to Workers’ Compensation Fee Schedule and PPO Network Research usual and customary/fee schedule applications and system interface as appropriate Reviews specialized Medical Bills, which include hospital, surgery, and high-level physician bills Determine reimbursement outcomes by applying either Fee Schedule reduction, PPO reduction, Usual and Customary reduction, or Medicare reduction Communicates and defends to providers and clients the basis for the methodology used to accomplish the reduction of charges Analyzes and reviews high-level office visits, reports, and record reviews Interprets hospital review guidelines for both inpatient and outpatient claims Responsible for producing a final review for the recommendation of payment to the client Maintain productivity, as well as speed and level of accuracy, as determined by company standards. Requirements: Current knowledge of utilization review processes and managed care Knowledge of state-based fee schedules Strong knowledge of Medical Terminology and CPT/ICD-9/ICD-10 coding Ability to identify trends through analysis of practices to improve the overall utilization of resources and cost containment Ability to communicate those trends found through analytical study using a variety of reporting mediums Ability to work collaboratively and independently while meeting productivity standards Ability to work in a high-production environment while meeting productivity and quality standards Ability to represent Utilization Management in organizational committees, as assigned Excellent relationship management skills Demonstrated ability to problem-solve in complex situations Ability to engage in abstract thought Strong organizational and task prioritization skills Strong analytical, numerical, and reasoning abilities Well-developed interpersonal skills Ability to establish credibility and be decisive – while also recognizing and supporting our organization’s preferences and priorities Results-oriented with the ability to balance other business considerations Knowledgeable of multi-state workers’ compensation systems Computer literacy on Microsoft Office products and database programs Ability to construct grammatically correct reports using standard medical terminology Must have a track record of producing highly accurate work, demonstrating attention to detail. Benefits: Equal Employment Opportunity (Our EEO Statement): The Company is a veteran-owned Company and provides Equal Employment Opportunities (EEO) to all Team Members and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, national origin, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. The Company complies with applicable state and local laws governing non-discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. We are committed to creating an inclusive environment for all team members and applicants. We value the unique skills and experiences that veterans bring to our team and encourage veterans to apply.

Job Description: Performs recurring internal audits and oversight of 340B contract pharmacy programs, inpatient pharmacy programs, child sites and entity-owned pharmacies. Supports for implementation of new child sites, shipping addresses and/or contract pharmacies. Assists with Office of Pharmacy Affairs (OPA) database changes and updates. Monitors and audits state Medicaid claims to ensure compliance. Reconciles contract pharmacy payments against revenue posted by Finance. Evaluates patient eligibility in mixed-use areas and clinics in electronic medical records (EMR). Develops and updates 340B Program reporting packets for SSM ministries. Reviews ordering, negative and positive accumulations and unmapped items in third-party administrator’s (TPA) portal. Ensures compliant setup for secondary suppliers and wholesaler accounts. Performs other duties as assigned. Requirements: Experienced with 340B program operations and audits Advanced 340B Operations Certificate within 18-months of hire date - Apexus Bachelor's degree or equivalent combination of experience and education Five years' experience Benefits: Paid Parental Leave : we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday. Upfront Tuition Coverage : we provide upfront tuition coverage through FlexPath Funded for eligible team members.

Job Description: Perform a variety of duties related to the information technology applications. Assist with design, development, system configuration, implementation and support of information systems for the organization. Plan development, training and evaluation of application functionality. Work with the team and key customers to ensure appropriate development training and implementation of application functionality. Maintain certification in assigned EHR module or application (if applicable) and demonstrate system functionality to end users. Configure, support, and troubleshoot assigned applications or modules. Develop and document workflows, workflow changes, and data flow diagrams related to assigned application(s). Accurately document and manage tickets using approved tools and methodologies. Develop and execute testing scripts; create and maintain knowledge base articles, tip sheets, and end-user documentation. Participate in end-user learning sessions, meetings, and training activities. Requirements: Epic Resolute Professional Billing or Resolute Professional Claims and Remittance certification required to be considered. High School Diploma (or equivalent). One to two (1-2) years of healthcare operations (clinical, patient care, administrative or revenue cycle), information technology or health information technology experience. Current Epic certification(s). Must be willing to travel for training and achieve certification within 90 days of completion of training at Epic in application(s) as assigned. Bachelor's Degree in a related field (information technology or clinical/healthcare fields) preferred. Benefits: Medical, dental, and vision coverage starting the first of the month after hire for employees working 24+ hours/week. Discounted childcare through Bright Horizons. Voluntary benefits like pet insurance, legal services, and identity theft protection. PTO starts accruing from day one. 403(b) retirement plan and company match, Flexible spending accounts, Access to financial advisors, Up to $400/year in wellness rewards. 24/7 EAP counseling, Virtual mental health support, Food pantry, PTO donation program, Professional attire through the Classy Closet. Access to 100,000+ online courses, Leadership programs, Tuition reimbursement, Clinical ladders, Internal mobility.

Job Description: Provide expert validation, feedback, and real-world context on the product's features and AI-generated outputs. Critically assess the accuracy and relevance of AI-generated summaries against source medical documents. Actively use and evaluate pre-release versions of the product’s features leveraging claims-handling knowledge. Accurately and consistently label medical information within insurance claims data. Provide detailed feedback on how the product integrates into existing daily claims management workflows. Offer constructive criticism on the product's user interface and overall user experience. Requirements: Ideally 1-5+ years of recent, hands-on experience as a Worker’s Compensation, Lost Time Claims Adjuster (Bodily Injury/Liability focus). Comfortable working with computers and learning new software applications. Exceptional ability to review complex documentation (medical, legal, financial) and critically evaluate. Excellent written and verbal communication skills, with the ability to articulate feedback clearly to a non-claims audience. Meticulous attention to detail and a commitment to accuracy in evaluation and validation of output. Preferred: Experience in training, mentoring, or process improvement roles within a claims environment. Benefits: This opportunity is part of a paid user research project focused on Workers’ Compensation claims expertise. Compensation will vary based on participation level, experience, and scope of involvement.

Job Description: The Analyst will provide claims loss analysis reports weekly, monthly or as determined by management. Complete loss analysis reviews to safeguard the servicer’s assets and insure compliance with insurer requirements Analyze and rebut insurer curtailments for all government insured filed claims, including but not limited to conveyance, claims for advances, loss mitigation and non conveyance claims Quality Control review for Default Claims, including supplemental claims to reduce loss exposure and provide loss analysis reports Assist in compiling claims data for government claims audits, in addition reviewing auditors' findings and providing rebuttal responses Complete monthly write offs of remaining balances once all claims and supplemental funds received on an account Act as a subject matter expert to the claims department to insure compliance on all claims filings Correspond with vendors and site employees Act as a point of contact/liaison, ensuring that policies and procedures relating to invoicing and remittance are followed, including compliance with federal laws and regulations Demonstrates professional behavior and teamwork, is punctual, dependable and adheres to Company policies and procedures Maintain regular and punctual attendance. Requirements: High School diploma or equivalent required Bachelor’s Degree from a Four (4) year College or University preferred Minimum of five years of experience in the rebuttal of compensatory fees and curtailments process, investor claims processing, auditing and loss analysis reporting; or equivalent combination of education and experience. Strong understanding of FHA, VA and GSE claims guidelines Excellent organization skills Attention to detail with a high level of accuracy Excellent communication skills Analytical and Problem Solving skills Works well in a team environment Ability to meet deadlines in a fast paced environment Ability to manage time well and prioritize tasks Microsoft Office experience and advanced Excel knowledge Ability to effectively present information to supervisory, etc. Ability to write reports and correspondence Ability to read, analyze and interpret documents such as technical journals, financial reports, legal documents, policies and procedures Ability to calculate basic financial figures and amounts Proficient in computer skills and knowledge of word processing, spreadsheet, accounting, general ledger, accounts receivable, accounts payable, e-mail and internet software Ability to define problems, collect data, establish facts, and draw valid conclusions Ability to work with little supervision. Ability to meet critical departmental and federal timelines with accuracy and efficiency. Ability to build relationships with both internal and external clients/vendors. Strong work and business ethics. Benefits: PTO Medical Dental Vision 401(k) plan with company match Life insurance Long term and short-term disability options FSA/HSA Tuition reimbursement Other voluntary benefits

Job Description: Reduce outstanding accounts receivable by managing claims inventory Speak to patients and insurance companies in a professional manner regarding their outstanding balances Gather information from patients, clients/family members, client clinical areas, government agencies, employers, third party payors and/or medical payment programs, etc. both in-person and by telephone to register patients, gather or update information, obtain referrals and pre-authorizations, complete appropriate forms, conduct evaluations, determine benefits and eligibility (insurance, public programs, etc.), determine financial responsibility and/or to identify sources of payment for services Request, input, verify, and modify patient’s demographic, primary care provider, and payor information Provide excellent customer service and timely response to questions and issues related to benefits, billing, claims, payments, etc. Answer questions by phone and provide quotes for services; identify financial resources, etc. in accordance with the client policies and procedures Utilize various databases and specialized computer software for revenue cycle activities including eligibility verifications, pre-authorizations, medical necessity, review/updating of patient accounts, etc. Explain charges, answer questions, and communicate a variety of requirements, policies, and procedures regarding patient financial care services and resources to patients, staff, payors, and agencies Work with Claims and Collections in order to assist patients and their families with billing and payment activities Requirements: High School Diploma/GED 2+ years of Denials Management experience 2+ years Medical Billing/Follow-up experience Medicare, Medicaid, and commercial payor experience Proficiency with PC-based applications (Microsoft Outlook, Word, and Excel) Download speed of 30MB or higher & upload speed of 10MB or higher are REQUIRED. Access to a Secure and Private workspace Employment eligibility: Candidates must be legally authorized to work in the United States at the time of hire As a condition of employment, a pre-employment background check will be conducted At this time, we are unable to consider candidates residing in the state of New York for this position Benefits: Comprehensive paid training Medical, dental, and vision insurance HSA and FSA available 401(k) with company match Paid Wellness Time and Holidays Employer paid life insurance and long-term disability Internal growth opportunities

Job Description: Identify, develop, and implement solutions to improve accuracy and integrity of claims payments across the Plan. Scope PI initiatives and analyze claims data. Develop implementation assessment plans and collaborate with internal and external stakeholders. Optimize payment processes by leveraging understanding of Providence Health Plan infrastructure and related functions. Requirements: Bachelor's Degree, or 3 years equivalent experience. 3 years experience with performance improvement/organizational change tools. 3 years experience working with large data sets and analytics teams. 3 years claims processing experience within the health insurance industry. Experience with reimbursement methodologies, including the Centers for Medicare & Medicaid Services (CMS), provider contracts, and medical coding practices. Healthcare experience in project coordination encompassing operations analysis, outcomes measurement methodology, data management and quality improvement process design. Benefits: Health care benefits (medical, dental, vision) 401(k) Savings Plan with employer matching Paid parental leave Paid vacations Paid holidays Time off benefits Disability insurance Life insurance Voluntary benefits Well-being resources

Job Description: Ensure all claims are billed to insurance companies both accurately and timely. Ensure accurate entry of work into designated billing system. Review EOB’s to ensure appropriate payment and appeal any incorrect payments. Obtain all necessary information from patients and providers needed for proper billing. Manage accounts and make appropriate phone calls to the payers for status. Identify accounts that require follow-up. Resubmit claims as needed. Provide records or further direction to the payers/patients as needed. Showing up to work promptly and daily. Answering incoming calls and making outbound phone calls to patients, payers, and legal offices. Other Job related duties as assigned Requirements: 1+ years of direct electronic medical billing and collections experience Knowledge of excel Familiarity with ICD-10, CPT coding, and HCFA 1500 claim forms, as well as Texas payers. Experience with rejected claims, denials, and appeals Strong oral and written communication and interpersonal skills. Able to prioritize and multi task a large work volume with a high level of efficiency and attention to detail. Dependable and able to work independently. Shows up to work daily and is prompt. Prior Billing or collecting experience or experience working for a payer. Takes initiative and prioritizes aged A/R appropriately. Experience with ABA billing - preferred Experience with writing denial letters

Job Description: Serve as the primary legal advisor on medical device regulatory requirements, partnering with Regulatory Affairs to support Oura’s FDA submissions and global filings and helping shape the legal and regulatory strategy for regulated product features. Partner cross-functionally with Product, Science, Regulatory Affairs, and Engineering teams from the ideation stage to ensure features are built to meet global standards without sacrificing user experience. Establish scalable product development governance frameworks that integrate regulatory, privacy, clinical, and product requirements throughout the product lifecycle. Provide comprehensive legal support for pre-market requirements, including the review of user-facing terms, disclosures, and consent mechanisms to ensure global alignment. Advise on legal and regulatory considerations for AI-enabled and algorithm-driven health features, including issues related to model transparency, validation, performance monitoring, and emerging regulatory frameworks governing machine learning. Provide legal guidance on clinical validation strategies, including the design and oversight of clinical studies, institutional review requirements, research partnerships, and the use of real-world evidence to support regulatory submissions. Review promotional materials, labeling, and marketing claims for compliance with applicable consumer protection laws, advertising standards, and regulatory requirements. Provide legal input on post-market requirements, including change controls and interactions with regulatory authorities. Support regulatory strategy for entry into new international markets and jurisdictions. Track and brief leadership on evolving FDA, EU MDR, and global regulatory developments on the regulation of wearables and AI-enabled technology to future-proof Oura’s long-term product roadmap. Coordinate with external counsel and specialized consultants on complex regulatory filings or specialized product legal matters as needed. Requirements: Juris Doctor (J.D.) degree from an accredited U.S. law school; active license to practice law in the United States with 8+ years of relevant legal experience. Deep understanding of U.S. medical device regulations and guidance, including applicable FDA frameworks for general wellness products, software as a medical device, clinical evaluation, labeling, and post-market obligations. Familiarity with international medical device regulatory frameworks including EU MDR and ISO standards. Ability to identify and mitigate risks across diverse regulatory domains, including data privacy, consumer protection, and marketing claims. Demonstrated ability to operate effectively within cross-functional product teams and influence product strategy in highly iterative development environments. Collaborative mindset with an exceptional ability to translate complex legal requirements into actionable, practical advice for non-legal stakeholders in a fast-paced environment. Benefits: Competitive salary and equity packages Health, dental, vision insurance, and mental health resources An Oura Ring of your own plus employee discounts for friends & family 20 days of paid time off plus 13 paid holidays plus 8 days of flexible wellness time off Paid sick leave and parental leave

Job Description: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services Supports effective implementation of performance improvement initiatives for capitated providers Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members Provides medical expertise in the operation of approved quality improvement and utilization management programs Assists the Chief Medical Director in the functioning of the physician committees Conduct regular rounds to assess and coordinate care for high-risk patients Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals Participates in provider network development and new market expansion as appropriate Assists in the development and implementation of physician education with respect to clinical issues and policies Identifies utilization review studies and evaluates adverse trends in utilization of medical services Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment Develops alliances with the provider community through the development and implementation of the medical management programs May represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues May be required to work weekends and holidays in support of business operations, as needed Requirements: Medical Doctor or Doctor of Osteopathy Utilization Management experience and knowledge of quality accreditation standards preferred Actively practices medicine Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous Experience treating or managing care for a culturally diverse population preferred Active Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services Certification in Internal and/or Family Medicine specialty, preferred Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs. Benefits: competitive pay health insurance 401K and stock purchase plans tuition reimbursement paid time off plus holidays flexible approach to work with remote, hybrid, field or office work schedules

Job Description: Submits timely, accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are correctly authorized and that required documentation is on file. Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided. Evaluates payments received for correctness and applies payments accurately to the system. Verifies that payments received are correct according to the fee schedule. Applies the payment correctly to the patient account. Ensures that secondary bills and patient invoices are mailed within 48 hours of receipt of payment. Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service. Transfers payments belonging to other offices within 48 hours of receipt. Follows up on invoices submitted to ensure prompt and timely payment. Calls to verify that claims submitted were received and are in processing. Sends letters to the patient or responsible party when their insurance carrier fails to make payment reasonable time frame. Generates and mails statements and collections letters. Follows-up on all denials within 48 hours of receipt. Ensures compliance with policies and guidelines outlined in the contract terms and fee schedule. Follows HIPPA guidelines when accessing and sharing patient information to maintain patient and business confidentiality. Requirements: High School Diploma or equivalent 0 – 6 months previous Infusion Reimbursement or Intake/Admissions experience Basic level skill in Microsoft Excel Basic level skill in Microsoft Word Benefits: Medical, Dental, & Vision Insurance Paid Time off Bonding Time Off 401K Retirement Savings Plan with Company Match HSA Company Match Flexible Spending Accounts Tuition Reimbursement myFlexPay Family Support Mental Health Services Company Paid Life Insurance Award/Recognition Programs

Job Description: Performs advanced level work related to denial management Processes and follows up on all appeal types, at an expert level, to all payers Takes actionable steps to resolve open claims, as needed, including refiling or appealing claims, or resolving manual tasks assigned to AR for review Works outstanding accounts receivable from assigned projects Functions as an SME across multiple workflows and various payers Provides peer payer and system training support Identifies denial patterns and escalates to management for follow-up and/or root cause resolution Makes recommendations to work queues and claim edits to improve efficiency and reduce denials Reviews payer communications related to changes in medical and reimbursement policies Researches payer trends identified by offshore partners to recommend training/process improvement Identifies opportunities for and actively participates in process improvement initiatives Maintains strictest confidentiality Maintains basic proficiency with using spreadsheets Maintains productivity and quality standards established by RCM All other duties as assigned Requirements: High school graduate or equivalent Associate or bachelor’s degree in business administration or related field of study preferred Minimum of 3 years accounts receivable experience preferred Excellent verbal and written skills to maintain professionalism in all methods of communication Basic math skills for calculating anesthesia units, proper reimbursement, and percentages for appropriate adjustments General understanding of medical terminology Advanced knowledge of insurance processing, payer policies, guidelines, and explanation of benefits (EOB’s) Knowledge of commercial payer, Medicare, and Medicaid guidelines Data entry skills with high accuracy General knowledge and understanding of CPT, ICD-10, and ASA codes Good problem-solving skills Decision making ability with sound judgment Strong analytical skills and attention to detail, including gathering and aggregating information Ability to work effectively with all team members, including physicians and external vendors or patients Must be able to work in a virtual team environment Ability to work independently with limited supervision Computer application skills to include MS Word, MS Excel, MS Outlook, and MS Teams Benefits: Eligible for a quarterly bonus

Job Description: Investigate assigned Florida Workers’ Compensation claims Evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim while setting appropriate reserves Provide benefits and initiate state filings promptly while exercising discretion and independent judgement Initiate investigation and assign defense counsel when appropriate Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments Handle EDI filings and rejections in conjunction with EDI adjuster Monitor medical treatment in conjunction with assigned Nurse Case Manager Review, document, and approve medical bills for payment within three days of receipt Authorize appropriate medical services as outlined per Florida Statute 440.13 Determine whether vocational rehabilitation services are needed for an employee to return to work Coordinate light duty availability and reasonable accommodations with medical providers and employers Maintain adequate reserves for life of claim utilizing reserve worksheets, ODG Guidelines, Workers’ Computation software and Davies Claims North America reserving philosophy Attend client meetings as necessary, and maintain regular telephone contact to ensure client satisfaction Maintain diary and workflow requirements Maintain working knowledge of FL Workers’ Compensation Statutes and Rules, and their application Direct defense counsel in handling of litigation claims With defense input, make timely decisions regarding litigated issues Protect Medicare’s interest in conjunction with MMSEA Section 111 Reporting requirements Review claims for possible red flags Demonstrate capability of identifying and pursuing subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden Request reimbursement at least quarterly and follow up for timely receipt from excess carrier(s) Adhere to client profile instructions Report any overall account or client concerns to the supervisor or upper management Report any E&O concerns to the QA Manager and Executive Vice President Maintain 97% claim closure ratio Requirements: 3-5 years of Lost Time/Legal claims handling experience; preferred 5+ years Possess FL-All Lines Adjuster or Workers’ Compensation License and maintain CEU credits for license Previous experience with settling claims Experience with Microsoft Office Suite Proactive, independent, and takes initiative with consistent follow through Superb communication skills, verbal and written, conducted in a timely manner Superior time management skills with capability of working with and meeting deadlines Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment Excellent team player with interpersonal skills High level attention to detail and problem-solving skills Capable of working collaboratively and independently with minimal supervision Exhibit discretion with sensitive and confidential information Benefits: Medical, dental, and vision plans to support your health and that of your family A 401(k) plan with employer matching Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees Paid holidays Life insurance and short‑term and long‑term disability coverage Paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements Diversity and inclusion initiatives

Job Description: Offer clinical expertise and act as a liaison in disability cases Ensure effective administration of absence and disability claims while delivering compassionate care Deliver case presentations to a panel Manage caseload efficiently and organize priorities Drive return to work process from beginning of case to closure Requirements: Be a Registered Nurse, Nurse Practitioner, or comparable license with experience Minimum of 5 years medical advisory experience in occupational health, worker compensation, disability, health case management, or utilization review Minimum of 2 years' experience as a Clinical Case Manager Dedication to providing high quality customer service Degree as RN and valid licensure Benefits: health, dental and vision coverages starting Day One wellbeing programs retirement plans with contribution matching generous time off parental leave continuing education career growth opportunities flexible working arrangements

Job Description: Engage with the supply chain and independently drive EPC and equipment supply contracts. Structure, negotiate, and execute gas generation equipment contracts for energy projects and data centers, ensuring alignment with industry standards, timelines, and financial objectives. Lead and manage equipment supply request for proposal (RFP) processes. Build and maintain strong relationships with EPC contractors, equipment suppliers, and key vendors to ensure successful project delivery. Manage contract amendments and post-contract activities, including claims, performance monitoring, and warranty considerations. Collaborate cross-functionally with Development, Engineering, Construction, Project Finance, and Legal teams to ensure seamless contract execution. Focus primarily on equipment supply agreements, with additional involvement in EPC contract execution. Requirements: 5+ years of experience in gas generation equipment procurement for utility-scale energy projects. Strong interpersonal skills with the ability to build and maintain external relationships. Clear and concise communication skills, with the ability to simplify complex concepts. Strong quantitative and analytical capabilities. Engineering background preferred. Proficiency in G-Suite, Excel, Slack, and other collaboration tools. Benefits: 100% premium coverage for you and your dependents on medical, dental, and vision Unlimited PTO, plus two company-wide breaks (Fourth of July & end of year) Up to 12 weeks of fully paid parental leave, plus 6 additional weeks for birth parents; access to family planning and family care support through Carrot and Maven Free access to Spring Health, including 5 free therapy and psychiatry sessions, plus a Headspace account for mindfulness and meditation through our physical health vendor, Wellhub+ $150 monthly food stipend $150 monthly reimbursement for cell phone and internet Pet insurance allowance Full home office setup Free access to UrbanSitter with $625 in quarterly company-paid credits ActiveHero One Medical

Job Description: Partner with customer-facing team leaders to map and analyze customer requirements for new solutions Identify operational inefficiencies, manual processes, and automation opportunities for each solution Build solution blueprints and workflow automations using current platform features Work directly with AI agents and prompting tools to design automated solutions Validate, test, and iterate blueprints for accuracy, consistency and performance Document solution architecture, demonstrations, and implementation guidelines Provide detailed feedback to Product Managers regarding feature gaps and enhancements needed to support solution scalability Support rollout and enablement of blueprint solutions across teams and customers Requirements: 5+ years of experience in Financial Services (e.g., Banking, Insurance, Asset Management, Lending, or FinTech) Familiarity with financial operations, compliance, or risk-related processes (e.g., onboarding, audits, claims, or payments) Experience in Product Management, Process Automation, Business Analysis, or Solutions Consulting Strong understanding of business workflow mapping, process modeling, and process improvement methodologies Proven experience translating business requirements into structured automated workflows or solutions Hands-on technical experience with automation tools, workflow builders, AI prompting, or low/no-code platforms Excellent communication and collaboration skills across both technical and non-technical audiences Analytical mindset with ability to measure solution impact through data. Benefits: time off programs medical dental vision mental health support paid parental leave life and disability insurance 401(k) employee stock purchasing program

Job Description: You will communicate with claimants, employers and various medical professionals through phone and e-mail to gather information regarding the Short-Term Disability claim. You will collaborate with fellow case managers, nursing case managers and consulting physicians to make appropriate and timely claim determinations. You will review complex medical records and effectively leveraging a variety of tools and resources to understand appropriate approval durations and future action planning. You will complete accurate financial calculations consistent with company and state guidelines. You will provide exceptional customer service and proactively recognize customer needs and areas of opportunity. You will identify and recommend process improvements and organizational initiatives to positively influence the team and quality. Requirements: High School diploma or GED. 1-2 years of experience in claims, leaves or customer service. Strong written and verbal communication skills. Excellent organization skills with the ability to multi-task. Ability to work with others in a fast-paced, team environment. Ability to quickly learn complex systems and product knowledge. Ability to navigate through multiple systems/databases/platforms/software while engaging in customer conversations. Ability to be adaptable/flexible as business needs change. Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook). Must have internet bandwidth of 12 Mbps (Megabits per second). Benefits: Clearly defined career tracks and job levels, along with associated behaviors for each of Lincoln's core values and leadership attributes Leadership development and virtual training opportunities PTO/parental leave Competitive 401K and employee benefits Free financial counseling, health coaching and employee assistance program Tuition assistance program Work arrangements that work for you Effective productivity/technology tools and training

Job Description: Own the hook, angle, and offer library that powers all performance copy across paid, lifecycle, and on-site channels Develop testable copy variants and feed them into the test queue maintained jointly with Performance Marketing and CRO Translate Product Marketing positioning and Consumer Insights VoC into customer-facing copy that converts Write and oversee high-volume copy production across ads, LPs, VSLs, email, and SMS Set the standard for copy quality and brand voice consistency across all conversion environments Write and lead copy development for Meta, TikTok, Google search, YouTube, and native advertising Develop advertorial and editorial-style ad formats for native channels Partner with the Creative Director and design team to ensure copy and visual work as one Adapt proven DR copy for emerging platforms where psychology and format differ Write and oversee landing page copy for paid acquisition, with conversion as the primary metric Develop VSL scripts that drive watch-through, engagement, and conversion across long-form environments Partner with the Head of CRO to test and iterate on-page copy structure, claims, and CTAs Support new product launches with VSL-led acquisition copy Partner with the Director of Lifecycle on copy strategy and the Email/SMS Marketing Manager on day-to-day campaign and flow execution across email and SMS programs Write subject lines, preview text, and message bodies optimized for engagement and conversion Develop segmented copy variants for different customer cohorts and lifecycle stages Maintain copy consistency across the lifecycle journey from welcome through win-back Own FTC compliance for all conversion-facing copy in coordination with legal counsel Maintain claims libraries and disclaimer standards across performance environments Serve as the final QC checkpoint for all customer-facing conversion copy Keep claims documentation and review processes current as the regulatory environment evolves Manage a copy team of two ICs (Copywriter level), with the capacity to expand as the channel and testing volume scale Set performance expectations, KPIs, and development plans for the team Build copy review and feedback processes that maintain quality while enabling speed Allocate copy resources across competing channel demands based on impact and timing Report to the CMO and operate as the conversion copy authority under their direction on overall copy quality and brand voice Collaborate with the Creative Director (peer under CMO) on integrated copy and creative output Coordinate with the Head of Content (under VP of Brand) on brand voice consistency between organic and conversion environments Partner with the Director of Product Marketing (peer under CMO) on product positioning, claims, and launch messaging Partner with the Consumer Insights Lead (peer under CMO) on VoC, custom language, and review intelligence Work closely with the VP of Performance Marketing, Director of Lifecycle, Head of CRO, and Head of Ecommerce on copy needs across paid, lifecycle, conversion, and site Requirements: 7-10+ years of writing performance and direct response copy at DTC consumer brands in health, wellness, beauty, or consumables Hands-on writer with a portfolio of high-converting copy across ads, landing pages, VSLs, and email Proven ability to develop hooks, angles, and offers that scale paid media efficiency VSL writing experience strongly preferred, with a track record of long-form copy that converts at scale Lifecycle copy experience across Klaviyo, Attentive, or comparable email and SMS platforms Native advertising and advertorial copy experience (Taboola, Outbrain) strongly preferred Has managed a small copy team of two to four with clear accountability and quality standards Strong understanding of FTC compliance for supplement, health, or wellness advertising Comfortable writing volume and iterating fast based on performance data Experience partnering with design, paid media, and CRO functions in a high-velocity test-and-learn environment Remote-first mindset with the ability to lead distributed teams effectively Located within driving distance of Los Angeles, CA, preferred Benefits: Competitive base salary, $176,000-$197,000+ performance bonus Flexible time off + 9 annual company holidays Your Birthday is a paid vacation day - take the day to celebrate your awesomeness! 100% company-paid base plan Medical, Dental, and Vision Insurance for employees 100% company-paid Life Insurance and Short-Term Disability Coverage 3% Employer contributions to 401(k) regardless of employee participation! (Free money) Matching charitable contributions up to $2,500/year $1,200/annual Work from Home (WFH) stipend Employee recognition and rewards program Calm app subscription Pet insurance Free monthly employee product samples and team discounts Employee Referral Program Fully remote position Professional development fund for employees (We love HI-ER Education) And a collaborative, innovative work culture High-impact role with visibility to executive leadership

Asbestos Claims Specialist - East Orange, NJ Insurance Claims Specialist Adjuster Examiner Analyst Attorney Environmental Toxic Tort Asbestos Pollution Health Hazard _ . REMOTE WORK FROM HOME AVAILABLE Manage all aspects of defense litigation for toxic tort, asbestos and pollution claims. Shall draft and oppose motions, mediation statements, and deposition summaries, in addition to preparing for and attending depositions, mediation, arbitrations, and trials. Comprehensive compensation plan with competitive bonus and full medical, dental, vision, life and liability insurance included. Full company matched 401(k), and opportunities to advance within the organization. For complete details contact Greg Foss at: (609) 584-9000 ext 270 Or submit resume online at: Or email to: Please reference #41792NJ465 when responding. Diedre Moire Corporation Education Requirements: Bachelor Degree Minimum Experience Requirements: 5-10 years Job City Location: East Orange Job State Location: NJ Job Country Location: USA Salary Range: $110,000 to $160,000 Diedre Moire Corporation, Inc. diedremoire.com WE ARE AN EQUAL OPPORTUNITY EMPLOYER and our employment decisions are made without regard to race, color, religion, age, sex, national origin, handicap, disability or marital status. We reasonably accommodate individuals with handicaps, disabilities and bona fide religious beliefs. Jobs Career Position Hiring. CONSIDERED EXPERIENCE INCLUDES: Insurance Claims Specialist Adjuster Examiner Analyst Attorney Environmental Toxic Tort Asbestos Pollution Health Hazard #DiedreMoire #JobSearch #JobHunt #JobOpening #Hiring #Job #Jobs #Careers #Employment #jobposting #InsuranceJobs DISCLAIMER: We will make every effort to consider applications for all available positions and shall use one or more of the contact methods and addresses indicated in resume or online application. Indicated location may be proximate or may be desirable point of embarkation for paid or unpaid relocation to another venue. Job descriptions may fit single or multiple presently available or anticipated positions and are NOT an offer of employment or contract implied or otherwise. Described compensation is not definite nor precise and may be estimated and approximate and is negotiable depending on market conditions and candidate availability and other factors and is solely at the discretion of employers. Linguistics used herein may use First Person Singular and First Person Plural grammatical person construction for and with the meaning of Third Person Singular and Third Person Plural references. We reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. Response to a specific posting or advertisement may result in consideration for other opportunities and not necessarily the incentive or basis of the response. Nothing herein is or may be considered a promise, guarantee, offer, pledge, agreement, contract, or oath. If you submit an application or resume which contains your email address, we will use that email address to communicate with you about this and other positions. We use an email quality control service to maintain security and a remove and dead address filter. To cancel receiving email communications, simply send an email from your address with the word remove"" in the subject line to Or, visit the website at . If you have further concern regarding email received from us, call (609) 584-5499

Job Description: This is a remote, work-from-home position with the candidate ideally living within the Commonwealth of Virginia. A company car with paid gas card will be provided. Strong commercial insurance experience is preferred. Trains, develops and guides Agents and district sales managers (DSM) in a designated branch territory in the promotion and sale of commercial lines products, providing assistance in the areas of production, product knowledge and application, and underwriting. Establishes and maintains relationships with branch managers and Agents to improve Agent willingness and ability to pursue and place quality commercial business with the ERIE. Assists branch managers in establishing short- and long-range objectives related to commercial lines sales, with an emphasis on growth, underwriting profitability and agency development and training. Provides hands-on training and guidance to Agents on ERIE's commercial lines products, resources, and services, including identifying web-based resources and training programs for Agent use. Builds commercial expertise of new and existing Agents for increased independence and sound judgment when pursuing commercial business. Provides hands-on training and guidance to branch DSMs on ERIE's commercial lines products, resources, and services, including identifying web-based resources and training programs. Builds commercial expertise of new and existing DSMs for increased independence and sound judgment when working with Agents to pursue commercial business. Identifies Agents requiring additional guidance and interaction from their DSMs on commercial lines products and services. Works directly with DSMs, branch managers, and commercial underwriting staff to develop a plan to deliver that guidance and interaction as appropriate. Contacts and visits Agents regularly to evaluate quotations and applications for multiple commercial lines to determine acceptability, including larger, more complex commercial accounts. Makes acceptability and pricing decisions on risks within defined binding authority. Refers risks that are beyond binding authority to a senior commercial lines underwriter, risk analyst or underwriting supervisor. Develops and maintains effective relationships and contact with Home Office commercial lines underwriting management and production underwriters. Serves as a company representative in maintaining favorable Policyholder relationships. Works closely with adjusters and other claims personnel on matters of mutual concern. Develops and maintains strong working knowledge of ERIE's commercial product lines, including policy features and key endorsements and sources of information on ERIE's products. Represents the company in community relations activities as directed. Requirements: Bachelor’s degree, and six years of sales, underwriting, claims, loss control or marketing experience required; or Associate’s degree and eight years of sales, underwriting, claims, loss control or marketing experience, required; or High school diploma or GED and ten years of sales, underwriting, claims, loss control or marketing experience, required. Incumbent must live in territory assigned unless a change is approved by the company. Occasional overnight travel required. Acceptance of hours beyond the normal work week and some restrictions on vacation during peak periods. Willingness to obtain property/casualty insurance license for assigned state or branch office service territory required. Valid driver's license and good driving record required. One of the following professional designations is preferred: ARM, AU, ALCM, CRM, CIC, CPCU, or General Insurance Program. Benefits: Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work. Low contributions to medical and prescription premiums. We currently pay up to 97% of employees’ monthly premium costs. Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service. 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension. Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave. Career development. Including a tuition reimbursement program for higher education and industry designations. Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year.

Job Description: Comprehensive review of new and transfer file assignments with initial evaluation letter to claims Summarizing discovery responses and medical records within 30 days of receipt Taking and defending depositions of parties, lay witnesses, and expert witnesses Completion of deposition summaries within 20 days Legal research; preparation of motions, oppositions and replies to motion; court appearance at law and motion Trial preparation, trial and posttrial motions Preparation of pretrial documents, motions in limine and oppositions thereto Managing assignments from managing and senior managing attorneys Requirements: Requires a law degree and admission to the bar in the state(s) where practicing Licensed in the state(s) where practicing 3 plus years as a licensed attorney with insurance defense experience preferred 1st and 2nd chair trial experience a plus Effective communication, persuasion and analytical skills Considerable automobile travel, up to 20% of work time Must meet established company standards regarding personal driving history and current license status Must be able to work independently with minimum direction and good organizational skills Benefits: Competitive base salary Incentive compensation Flexibility to work remotely Company vehicle Paid time off (vacation time, sick time, 9 paid Company holidays, volunteer hours) Incentive bonus programs (potential for holiday bonus, referral bonus, and performance-based bonus) Medical, dental, vision, life, and pet insurance 401 (k) retirement savings plan with company match Engaging work environment Promotional opportunities Education assistance Professional and personal development opportunities Company recognition program Health and wellbeing resources, including free mental wellbeing therapy/coaching sessions, child and eldercare resources, and more

Job Description: Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) for all lines of business Coordinates rate adjustments with claims areas Provides monthly and quarterly reports outlining trends Serves as a resource in resolving coding issues Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department Determines methodology to identify cases for validation review Conducts validation reviews/coordinates rates adjustments with appropriate claims area Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and contracting rates Manages records retrieval, release, HIPAA compliance, and all aspects of document management Serves as expert resource on methodology and procedures for medical records and coding issues Requirements: Associates in a job-related field 2 years job related work experience as degree equivalency 3 years medical record management to include coding and validation review experience Excellent verbal and written communication skills Organizational skills Customer service skills Analytical or critical thinking skills Good judgment Ability to handle confidential or sensitive information with discretion Extensive medical records and coding knowledge Working knowledge of contract evaluations, claims processing and adjudication practices Registered health information administrator (RHIA) OR Registered health information technician (RHIT) OR Certified Professional Coder (CPC) OR Certified Inpatient Coder (CIC) or Certified Professional Medical Auditor (CPMA) OR, active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multi-state unrestricted RN license as defined by Nurse Licensure Compact (NLC) Benefits: Subsidized health plans Dental coverage Vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more

Job Description: Respond to member inquiries via phone, email, or chat with professionalism and empathy Resolve member level issues related to pharmacy benefits, claims, eligibility, and other service needs Escalate complex cases to senior support staff as needed Document all member interactions accurately to ensure compliance and service quality Identify recurring issues and share feedback with leadership for process improvement Work closely with Client Support Supervisors and Account Managers to ensure seamless service delivery Participate in team huddles and training sessions to stay informed on product updates and policy changes Maintain a positive and solutions-oriented approach in all member interactions Review general team processes for accuracy and recommend updates to leadership Engage in ongoing training to build skills in customer service, systems navigation, and healthcare knowledge Seek mentorship and feedback to grow into more advanced support or account-facing roles Requirements: 1–2 years of experience in customer service, healthcare, insurance, or benefits Strong verbal and written communication skills Ability to manage member issues with empathy and attention to detail Associate’s degree in Business, Healthcare Administration, or related field preferred Familiarity with CRM platforms, call center tools, or SOP documentation preferred Interest in career growth within client support or account management Benefits: medical, dental, and vision coverage paid time off retirement savings options wellness programs other resources, based on eligibility

Job Description: Communicating with claimants, employers and various medical professionals through phone and e-mail to gather information regarding Short Term Disability Claims, Family Medical Leaves, and state benefits when applicable Collaborating with fellow case managers, nurse case managers and consulting physicians to make appropriate and timely claim determinations Reviewing complex medical records and effectively leveraging a variety of tools and resources to understand appropriate approval durations and future action planning Completing accurate financial calculations consistent with company and state guidelines Requirements: High School diploma or GED 1-2 years of experience in claims, leaves, or customer service Strong written and verbal communication skills Excellent organization skills with the ability to multi-task Experience with disability and/or absence management claims Benefits: Clearly defined career tracks and job levels, along with associated behaviors for each of Lincoln's core values and leadership attributes Leadership development and virtual training opportunities PTO/parental leave Competitive 401K and employee benefits Free financial counseling, health coaching and employee assistance program Tuition assistance program Work arrangements that work for you Effective productivity/technology tools and training

Job Description: Manage claims within organizational standards and best practices Responsible for the adjudication of medical only claims and limited lost time workers' compensation claims Work closely with case managers, attorneys, and vendors Manage subrogation liens and negotiate claim settlements to achieve the best possible outcome Complete appropriate contacts within 24 hours of assignment Establish and maintain appropriate diary for follow-up Evaluate and determine compensability of workers’ compensation claims Monitor and control costs, timely documentation of the electronic claim file Communicate claim status with the injured teammate and other parties as necessary Develop action plans and strategies for prompt payment/denial of claims Requirements: Bachelor's degree required or a combination of education and related experience Adjusters license for assigned jurisdiction as required by specific jurisdiction as applicable 2-5+ years’ experience managing progressively difficult Workers Compensation lost time claims Proficiency in MS Office Preferred: Associates in Claims designation Experience with self-insured/self-administered organizations Experience with Riskconnect and/or Origami Benefits: Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program

Job Description: reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records analyzes, enters and manipulates database responds to or clarifies internal requests for medical information prioritizes requests and interprets and adapts procedures, processes and techniques Requirements: Coding Certification required : AAPC CPC (no Apprentice) Minimum of 3 years' experience as a Certified Medical Coder Demonstrate ability to problem-solve complex coding issues Experience with Medicare and Medicaid coding guidelines Strong data entry and attention to detail skills with the ability to manage multiple tasks in a fast-paced setting with competing priorities Intermediate experience with Microsoft Word and Excel, Outlook, and Teams Benefits: medical, dental and vision benefits 401(k) retirement savings plan time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) short-term and long-term disability life insurance

Job Description: Leading the team of service professionals who will service the book Directing roll-out of program and service plans Monitoring accounts for trends and reacting appropriately when action needs to be taken Communicating relevant information about individual accounts to the marketing and underwriting departments Building strong contacts with insureds’ senior management and being their primary relationship contact Performing other duties as directed Requirements: Bachelor's degree At least 10 years of experience in account management, production, and/or managing a loss control department for a commercial insurance company, preferably in workers’ compensation Additional experience in underwriting, loss control, or claims is a plus Strong analytical and math skills Proficient in Word, Excel, and working with loss runs Must reside in Virginia Benefits: Competitive healthcare Retirement plans Paid time off Medical, dental, and vision coverage Wellness plans Parental leave Adoption assistance Tuition reimbursement 401(k) plan with company match Employee stock purchase plan Commuter benefits

Job Description: To analyze complex or technically difficult bodily injury and general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; to identify subrogation of claims and negotiate settlements. Manages mid-level bodily injury and general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. Requirements: Bachelor's degree from an accredited college or university preferred. 5 years of Liability claims management experience or equivalent combination of education and experience required. Jurisdiction: Multi State Licensing: Required, NY and Hawaii preferred. Benefits: Flexible work schedule. Referral incentive program. Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Job Description: Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. Negotiating settlement of claims within designated authority. Communicating claim activity and processing with the claimant and the client. Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. Requirements: 5 years of claims management experience or equivalent combination of education and experience required. High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Jurisdiction Knowledge: GA, AL, MS, KY, NC, IN. Licensing: TX preferred Benefits: Flexible work schedule. Referral incentive program. Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Job Description: Examine claim records and forms to investigate and resolve first level disputes, including completion of acknowledgement and determination letters Review and process second level claims, such as adjustments and corrected claims Work closely with leadership on identified trends related to improper processing and claim-related concerns or discrepancies that result in a dispute Assist the team in carrying out departmental responsibilities and collaborate with others to support short- and long-term goals and priorities Establish and maintain effective working relationships with team and collaboration with interdepartmental staff and leadership Work closely with leadership on identified trends related to improper processing and claim related concerns or discrepancies that result in a dispute Requirements: Minimum of three (3) years’ health plan claims processing experience, and two (2) years’ health plan claims dispute experience analyzing and resolving provider claims problems Experience in a Managed Care Plan (MCP) or PACE organization (PO) claims processing environment highly preferred In depth experience with Medicare and Medicaid claims processing Strong computer and appropriate software knowledge (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word, Teams) and job specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position Ability to balance competing priorities, exercise discretion, and consider all relevant factors in navigating gray areas and resolving ambiguities Proficient in the principles and practices of managed health care, health care systems and medical terminology (e.g., revenue Codes, Current procedural Terminology (CPT), Healthcare Common Procedure Coding system (HCPCS) and Internal Classification of Disease (ICD-10) Understanding of Industry pricing methodologies, such as Medicare/Medi-Cal fee schedule and Diagnosis Related Groups (DRG) and benefit interpretation and administration Benefits: Medical insurance coverage (Medical, Dental, Vision) Work/life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days Advancement opportunities - We’ve got a track record of hiring and promoting from within, meaning you can create your own path! And additional benefits

Job Description: Maintains practice management system by entering accurate data, verifying and updating insurance, and claims information Prepares, reviews, submits, and follows up with clean claims to various companies/individuals Collects, posts, and manages patient account payments Investigates rejected claims to see why denials were issued and correct claims Facilitates swift payment of invoices due to the organization by sending patient invoices, billing reminders, and making collection calls on outstanding balances Reviews and provides RCM weekly and monthly reports including productivity and financial reports Follows HIPAA guidelines when accessing and sharing patient information Provides timely and professional customer service, verify discrepancies by and resolve patient billing issues, answer questions from patients, facility staff, and third-party vendors Requirements: High school graduate or equivalent 5+ years of billing experience Minimum three years of Healthcare experience preferred Knowledge of revenue cycle processes, medical insurance, and general accounting principles High degree of accuracy and attention to detail Ability to manage multiple tasks/projects, and deadlines simultaneously Excellent communication skills, both verbal and written. Proficient computer skills, including Microsoft Office applications Benefits: This position is eligible for a quarterly bonus Bonuses are not guaranteed and are awarded based on company and individual performance

Job Description: Monitor and ensure timely payment of freight invoices to carriers Review freight invoices that are rejected for payment by freight audit provider, research and resolve discrepancies between provider and carrier Ensure all freight invoices are accurately coded for internal rebilling to appropriate UMG department or Label group Review and submit shipment paperwork to support the processing of carrier invoices Assist in periodic audit of carrier payments by freight audit provider Generate and publish shipment reports, freight spend metrics, and cost reports Maintain open communication with UMG Supply Chain Team, UMG Label Groups, and carriers Track shipments, identify and submit freight claims, follow-up with carriers for resolution and payment processing Support the transportation team with bid requests, carrier selection, scheduling, and tracking outbound/inbound loads to ensure on-time delivery Create shipment paperwork, customs documents, and schedule appointments Requirements: Understanding of modes of transportation, cost, and carrier tariffs Able to understand, interpret, and analyze carrier tariffs Proficient in transportation management systems (TMS) or an order management system Understanding and familiarity with supply chain concepts and transportation documents (BOL, DR, CI) Strong computer skills including extensive experience with Microsoft Office Suite High Level of attention to detail Ability to analyze data and trends, make educated conclusions based upon data Experience in consumer products, retail operations, or e-commerce is preferred 3 years’ experience and proven, positive track record as a Transportation Analyst, Logistics Analyst or Transportation Coordinator or in a comparable role A minimum of 1-2 years of experience in a customer or vendor facing role High School Diploma or GED equivalent. Benefits: Comprehensive medical, dental, and vision coverage Including 100% coverage for out-patient in-network mental health services Fertility coverage for eligible medical plan participants Wellbeing reimbursements for fitness classes, spa treatments, meal services, travel, and so much more (up to $720/year) Student Loan Repayment Assistance and Tuition Reimbursement 401(k) with 100% immediate vesting on the first 5% of your contributions, plus an additional UMG contribution Flexible Paid Time Off (PTO) for exempt employees 3-weeks PTO for non-exempt employees 2-weeks paid Winter Break 10 Company Holidays (including Juneteenth and Wellbeing Day) Summer Fridays (between Memorial Day and Labor Day) Generous paid parental leave for every type of parent

Job Description: Support P&L management and financial analysis to drive profitability and achieve annual financial targets Conduct ongoing analysis of shipment and POS data to identify trends, opportunities, and risks, and develop action plans in response Support development and execution of advertising, promotional, and media plans in partnership with internal and external resources Help maintain and evolve consumer and customer-facing content, claims, and product benefit communication Leverage consumer data, macro trends, and category insights to evaluate new product extensions and adjacencies Partner with innovation and project management teams to bring new products to market on time and on brief Align brand channel strategy with sales team priorities Develop persuasive sales presentation materials for line reviews and brand initiatives Support pricing strategy development and alignment Requirements: 3-5 years of brand or product management experience in a CPG environment Demonstrated ability to manage multiple workstreams in a fast-paced, dynamic environment Strong analytical skills, comfortable with shipment data, POS trends, and P&L analysis Experience developing consumer-facing communications, media plans, and sales materials Ability to influence and drive alignment across a wide range of cross-functional stakeholders Clear, concise communicator, both verbally and in writing Experience supporting new product development with cross-functional partners Bachelor's degree required; MBA a plus Benefits: Flexible work options (remote) Generous paid time off Competitive salaries and bonus incentives 401K company match Competitive medical, dental, & vision insurance Pet insurance Annual fitness stipend Unmatched employee discount on all products Summer Hours LinkedIn Learning membership

Job Description: Support efficient administration of all facets of the North America (NA) Workers' Compensation (WC) Program Work collaboratively by effectively communicating and liaising with all stakeholders directly (TPAs, carriers, cross functional teams, vendors and employees) Provide employer oversight of claim processing and claim strategy resulting in efficient management of expense Influence TPA partners to expedite appropriate resolutions for employee escalations Proactively recognize and investigate factual discrepancies in claims or claims handling Evaluate individual claim outcome using various courses of action and provide workable solutions to the Workers' Compensation Manager Provide excellent customer service and respond to all escalated questions/inquiries/requests from NA employees and stakeholders Analyze data and identify opportunities and plausible solutions to improve the employee experience and operational efficiency of the Workers' Compensation Program Act as a first-tier subject matter expert regarding WC compliance with US federal and state labor code requirements Participate in claim reviews; prepare reports for finance and other key stakeholders Develop content, communications, and lead trainings, webinars and employee meetings with minimal supervision Assist internal partners and vendors in understanding and adapting to new programs and changes Participate in department wide projects, such as Employee Experience Journey Maps or Wellbeing, when required Requirements: Proficient in systems relating to workers' compensation claims administration, claim analytics, loss run reporting Proficient at Excel, Outlook, PowerPoint, Microsoft Word System proficiency with Workday, PeopleSoft, Salesforce a plus Benefits: group health insurance benefits (medical, vision, dental) FSA and HSA healthcare accounts life and accident insurance adoption and fertility assistance paid parental leave of up to 6 weeks short/long term disability paid time off for vacation, personal needs, and sick time up to 17 days of Choice Time Off (CTO) per calendar year up to 11 paid holidays per calendar year opportunity to contribute to 401(k) savings and investment plan or deferred compensation plan with employer match of 100% on the first 3% of contributions for eligible employees

RN UAS Nurse openings with a major health insurance / managed care company based in the Bronx, Brooklyn, or Manhattan, NY area! Starting ASAP!! Apply now with Chris M. at A-Line! Job Summary: Complete in-person UAS assessments with members in their homes or living facilities along with necessary documentation. * combination of remote work with field visits in the Bronx, Brooklyn, or Manhattan, NY area. Job Duties: RN must prep for the visit the morning of or afternoon before (Review of EMR and previous assessments)• Be prepared to use critical thinking and problem solving skills.• Travel to the members' homes to conduct the visit and assessment,• Accurately document assessment results according to the provided documentation template• Review all documentation and utilize Lenavi to identify inconsistencies that need to be corrected or validated.• Complete and load supplemental tools and documents.• Each day varies, nurse needs to be flexible with schedule and process changes, critical thinking and problem solving, prepared for travel, weather variability. What previous job titles or background work will in this role? Experience as a UAS Assessment nurse Individuals that have MLTC, MAP or Maximus experience Shift Times: Mon-Fri 8:30am-5pm with a 1-hour lunch break. OT may be required Pay Rate: $52 - $58 hourly (determined on experience) plus mileage reimbursement Required Skills: · Licenses/Certifications: Current New York State RN license – no restrictions on license · Clinical background – RN experience (1+ years) · Case Management or UAS Experience highly preferred · Experience working with Managed Care plans highly preferred · Documentation skills and good computer skills needed · Must have Computer literacy, including with Microsoft Programs like Excel, Outlook, and Word Why Apply with A-Line? · Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability · 401k after 1 year of employment: With employer match and profit sharing · GREAT Hours! Monday through Friday, 40 hours per week · Competitive Pay Rate INDSV Keywords: UAS, URAC, CCM, BSN, ADN, ASN, Case Manager, Case Management, InterQual, Medicare, Medicaid, CMS Guidelines, Utilization Review, Utilization Management, Registered Nurse, MCO, RN, Nurse, Managed Care, Medical Claims, Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient Counselor, Healthcare, Inbound Calls, Outbound Calls, URAC, CCM, BSN, ADN, ASN, Case Manager, Case Management, InterQual, Medicare, Medicaid, CMS Guidelines, Utilization Review, Utilization Management, Registered Nurse, MCO, RN, Nurse, Managed Care, Medical Claims, Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient Counselor, Healthcare, Inbound Calls, Outbound Calls, URAC, CCM, BSN, ADN, ASN, Case Manager, Case Management, InterQual, Medicare, Medicaid, CMS Guidelines, Utilization Review, Utilization Management, Registered Nurse, MCO, RN, Nurse, Managed Care, Medical Claims, Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient Counselor, Healthcare, Inbound Calls, Outbound Calls. Job Duties: RN must prep for the visit the morning of or afternoon before (Review of EMR and previous assessments)• Be prepared to use critical thinking and problem solving skills.• Travel to the members' homes to conduct the visit and assessment,• Accurately document assessment results according to the provided documentation template• Review all documentation and utilize Lenavi to identify inconsistencies that need to be corrected or validated.• Complete and load supplemental tools and documents.• Each day varies, nurse needs to be flexible with schedule and process changes, critical thinking and problem solving, prepared for travel, weather variability.

Job Description: The Billing and Collections Specialist is responsible for the timely follow-up of claims billed and resolution of accounts Oversees the account receivables and maintain detailed/accurate account documentation. Follow up on open claims thoroughly, accurately, promptly, and with all supporting documentation Responsible for maintaining and updating billing guidelines, fee schedules, contract rates, etc. Review, document, and resolve all incoming correspondence and payor calls; Assist as needed Report all payor issues and/or denial trends to Lead/Supervisor May appeal and/or rebill underpaid claims and assist with payments, as needed Other duties as assigned Requirements: High school diploma or general education degree (GED); and one to two years’ related experience and/or training; or equivalent combination of education and experience 1-2 years’ medical billing and claims reimbursement experience; preferred Knowledge of all Government, Commercial and Private payers; preferred Knowledge of medical and billing terminology; preferred Knowledge of HIPAA and other industry specific regulations; preferred Strong interpersonal skills and a high degree of collaboration at all levels Excellent organizational skills, detail oriented, ability to prioritize, multi-task and meet deadlines Intermediate customer service and phone skills Excellent problem-solving skills Intermediate with Microsoft Office, including Word, Excel and Outlook Benefits: For more information on our industry-leading benefits, please visit our benefits page here.

Job Description: Own the entire sales cycle for net new logo opportunities, from qualified discovery through contract execution Conduct deep, consultative discovery focused on revenue leakage, claims workflow, collections, denials, AR, staffing strain, and operational inefficiencies Clearly articulate how ClinicMind’s EHR and RCM solutions improve reimbursement, reduce friction, and support sustainable practice growth Develop and present tailored demos and proposals that align to each practice’s workflows and financial goals Consistently manage a clean, accurate pipeline with disciplined stage progression and CRM hygiene Meet or exceed monthly and quarterly new-logo and ARR targets Collaborate closely with SDRs, Sales Management, Marketing, and Onboarding to ensure strong qualification, smooth handoffs, and successful implementations Provide market feedback to leadership on objections, competitive dynamics, and product opportunities Requirements: 3+ years of quota-carrying experience selling healthcare technology or services Direct experience selling EHR systems, RCM solutions, medical billing services, or practice management platforms Proven success selling to healthcare providers and practice leadership, not just healthcare-adjacent products Ability to lead credible discovery conversations around reimbursement, billing workflows, collections, AR, and operational pain points Documented history of meeting or exceeding new business revenue targets Candidates without prior healthcare EHR or RCM selling experience will not be considered. Experience selling into chiropractic, physical therapy, or SMB healthcare practices (strongly preferred) Familiarity with payer mix, claims submission, denials management, and collections processes (strongly preferred) Experience selling bundled or multi-product SaaS or services solutions (strongly preferred) Comfort operating in consultative, value-based sales environments (MEDDICC, Challenger, Sandler, NEPQ, or similar) (strongly preferred) Experience working in disciplined sales organizations with clear KPIs and operating rhythms (strongly preferred) Benefits: Competitive base salary Uncapped commission tied directly to net new ARR Accelerators for sustained high performance Compensation structure designed to meaningfully reward top producers Full compensation details will be shared during the interview process.

JOB TITLE: Claims SME JOB LOCATION: Remote WAGE RANGE*: $48hr to $50hr w2 JOB NUMBER: 26-00767 REQUIRED EXPERIENCE: Medicaid Management Information Systems (MMIS) in: *Claims front end, back end, pricing, edits/audits, EDI Requirements gathering and system design Waterfall Software Development Life Cycle (SDLC) JOB DESCRIPTION A Technical Business Analyst (TBA) bridges the business (operation) needs and IT solutions to improve system efficiency and achieve the state business goals as well as end user experience. TBAs require strong technical knowledge of systems and processes, along with excellent communication skills to translate business needs into actionable technical details and vice versa translating technical details in a way for the business to understand. Daily Tasks Include: Communicate with the client Facilitate recurring/adhoc client meetings and project team meetings (dev/qa) Ellicit and document functional business requirements and analyze impact of changes across the MMIS. Facilitate design sessions and create detailed system design specifications to be used by the project team for implementation of new system requirements or software. Assist in testing, defect resolution, and system implementation of change requests and defect fixes. Collaborate with stakeholders (developers, testers, state, etc.) to resolve system issues (defects, heat tickets) and improve system functionality Monitor task progress and compliance with scope, budget, and schedule Knowledge Base Required: Medicaid Management Information Systems (MMIS) in: Claims front end, back end, pricing, edits/audits, EDI Requirements gathering and system design Waterfall Software Development Life Cycle (SDLC) Creation of technical (design) documentation Defect triage Ensure IT solutions align with Medicaid regulations Skills Required: Exceptional analytical skills Exceptional verbal and written communication and presentation skills Ability to translate technical jargon into business-friendly language Collaborate with developers, testers, and cross-functionally to validate system functionality SQL for data querying and analysis Strong understanding of system integration, data mapping, and testing processes Tools: SharePoint Outlook MS Word and Excel SQL Developer ClearQuest Doors Next Generation (DNG) Equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities * While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to: job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Benefits offered include medical, dental and vision benefits; dependent care flexible spending account; 401(k) plan; voluntary life/short term disability/whole life/term life/accident and critical illness coverage; employee assistance program; sick leave in accordance with regulation. Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions. Benefits offered are in accordance with applicable federal, state, and local laws and subject to change at TCM's discretion.

Job Description: Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. Represents Company in depositions, mediations, and trial monitoring as needed. Communicates claim activity and processing with the client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. Performs other duties as assigned. Supports the organization's quality program(s). Requirements: 6 years of claims management experience or equivalent combination of education and experience required. Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred. Benefits: medical dental vision 401k and matching PTO disability and life insurance employee assistance flexible spending or health savings account other additional voluntary benefits

Job Description: Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly. Responsible for litigation process on litigated claims. Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims. Reports large claims to excess carrier(s). Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. Communicates claim action/processing with insured, client, and agent or broker when appropriate. Performs other duties as assigned. Supports the organization's quality program(s). Requirements: Five (5) years of claims management experience or equivalent combination of education and experience required in-depth knowledge of personal and commercial line auto policies Bachelor's degree from an accredited college or university preferred Professional certification as applicable to line of business preferred Secure and maintain the State adjusting licenses as required for the position. Benefits: medical dental vision 401k and matching PTO disability and life insurance employee assistance flexible spending or health savings account other additional voluntary benefits

Job Description: Represent injured employees in North Carolina workers' compensation claims Manage cases across all phases, including pre-litigation, discovery, settlement negotiations, and appeals Litigate cases before the Deputy Commissioner, Full Commission, and North Carolina Court of Appeals Draft pleadings, motions, discovery, and appellate briefs Negotiate settlements and advocate for favorable outcomes on behalf of clients Guide clients through the legal process with clarity and confidence Oversee and collaborate with case managers and paralegals Requirements: J.D. from an accredited law school Licensed to practice law in North Carolina Minimum of 2 years of experience in workers' compensation (plaintiff or defense; plaintiff-side preferred) Experience handling complex workers' compensation claims Strong understanding of medical issues and hearing processes in these cases Excellent analytical, writing, and communication skills Highly organized, detail-oriented, and able to manage multiple priorities in a fast-paced environment Self-motivated with the ability to work independently Experience with Litify is a plus

Job Description: 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. Follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. 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. 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. Requirements: 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 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. Benefits: 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.

Job Description: Monitor EVV systems in real-time and contact caregivers who have not clocked in or out successfully, in order to understand the issue and request the paper timesheet. Follow processes for escalation when necessary Provide educational/training assistance to caregiver staff on appropriate use of the EVV systems in order to drive compliance Request retro schedule change requests and manual visit confirmation requests and follow up until resolved and billing is complete Work with insurance companies and EVV companies as necessary to resolve demographic and/or authorization issues within the EVV system Complete root cause research and resolve errors in EVV systems; resulting in accurate service hours and the correct billing of claims to payers Complete root cause research and resolve errors populating on Excel reports, resulting in information accurately importing into our system, the correct billing of claims to payers and our systems accurately reconciling Serve as subject matter expert on all EVV systems and provide training to others as needed. Serve as subject matter expert on rules surrounding billing in accordance to regulatory requirements set forth by payers, state, and federal agencies. Exhibit excellent interpersonal and communication skills necessary to interact with our customers and staff members in all departments and branches. Maintains positive working relationships with all other staff to gain their cooperation and support. Provide support in implementing improvements to processes and electronic information systems to ensure ongoing efficiency across the organization. Monitoring and trending EVV data to ensure procedures and processes are working properly. Providing support and assistance to Operations and/or Reimbursement departments as needed for specials projects or needs. Maintains a high degree of confidentiality at all times due to access to sensitive information Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department Follows all Medicare, Medicaid, and HIPAA regulations and requirements Abides by all regulations, policies, procedures and standards Performs other duties as assigned Requirements: High school diploma or GED equivalent Administrative experience required; customer service experience preferred Strong communication skills and interpersonal skills Computer proficiency required; including intermediate level knowledge in Microsoft Excel Knowledge of home care operations, including Horizon preferred Knowledge of state Electronic Visit Verification (EVV) systems preferred Ability to work collaboratively and individually Analytical and problem solving skills required Ability to read, interpret and implement regulations and administrative rules from a variety of sources including the State and Federal government Benefits: Medical, Dental and Vision Benefits Continued Education PTO Plan Retirement Planning Life Insurance Employee discounts

Job Description: Serve as primary owner of the US self-insured medical, prescription drug benefit and dental programs, with deep understanding of plan funding, claims administration, and stop-loss structure Partner with the US consultant (WTW) and third-party administrators to manage plan performance, cost trends, and utilization, bringing forward proactive, creative recommendations to reduce trend Own and manage relationships with all US benefits vendors including medical, dental, vision, life, disability, EAP and voluntary Drive vendor performance, escalate issues, manage SLAs, and ensure vendors are actively working as our partner Lead annual plan design review and renewal strategy in close partnership with WTW, ensuring recommendations are evidence-based and cost-effective Own the annual open enrollment process end-to-end, planning, benefits administration updates, communications, and post-enrollment audits Develop and execute a communications strategy that is employee-centered, clear, and drives informed benefit decision-making Create and maintain employee-facing benefit resources including guides, orientation, FAQs and change communications Partner with HR Technology and benefits administration vendor to ensure accurate plan configuration, eligibility rules, and file management for benefit events Act as the escalation point for complex employee benefits issues and appeals, ensuring timely, empathetic, and accurate resolution Ensure plan documents, SPDs, and legal notices are accurate, current, and compliant (ERISA, ACA, HIPAA, COBRA, and other applicable regulations) Ensure all required filing, including federal, state, and local are filed Directly supervise and develop one US Benefits Analyst, providing coaching, direction, and workload management Partner with the Global Head of Total Rewards to manage the WTW global consultant relationship across PerkinElmer's 30+ country footprint Hold the global broker accountable for preparation, country expertise, proactive market intelligence, and vendor advocacy Ensure global benefit recommendations are grounded in data and market benchmarking, not simply legacy structures or renewal defaults Actively engage WTW on emerging regulatory requirements, country-specific plan competitiveness, and benefit trends across regions Lead and develop PerkinElmer's global pooling strategy, working with WTW and network carriers to maximize financial efficiency across the international benefits portfolio Analyze pooling dividend performance and cost experience across countries, present recommendations to leadership with clear financial rationale Ensure pooling structures are aligned with local statutory requirements and competitive benefit positioning in each market. Requirements: Bachelor’s degree in business, finance, human resources, or a related field 10+ years of progressive benefits experience, with significant depth in US self-insured health plan design, administration, and strategy 2+ years of global benefits administration and familiarity with global pooling CEBS (Certified Employee Benefit Specialist) or CBP (Certified Benefits Professional) designation preferred Demonstrated experience managing consultant relationships and holding external partners accountable for performance and value delivery Strong command of US benefits regulatory compliance, including ERISA, ACA, HIPAA, COBRA, FMLA, and related requirements Experience managing open enrollment end-to-end, including testing and communications Analytically strong — able to work with claims data, cost trend analysis, and financial modeling; comfortable presenting to senior leadership. Benefits: Health insurance Dental programs Vision programs Life insurance Disability insurance Employee assistance programs (EAP) Flexible work arrangements

Job Description: Lead the design and development of advanced statistical and machine learning models that improve claims outcomes, operational efficiency, and risk management. Serve as the technical authority for complex modeling initiatives including fraud detection, claims severity prediction, litigation risk modeling, and recovery optimization. Develop predictive and prescriptive models using structured and unstructured claims data, including adjuster notes, medical records, and policy documentation. Architect modeling approaches that leverage modern techniques such as gradient boosting, deep learning, NLP, anomaly detection, and probabilistic modeling. Partner with AI Engineering teams to productionize models and integrate them into enterprise AI platforms and operational systems. Design feature engineering strategies and modeling pipelines using large-scale enterprise datasets. Establish best practices for model development, experimentation, validation, and reproducibility. Lead advanced analytical techniques such as causal inference, scenario simulation, and risk scoring methodologies. Build and maintain model evaluation frameworks that measure accuracy, bias, stability, and business impact. Monitor deployed models for drift, degradation, and changing data distributions, and recommend recalibration strategies. Provide technical guidance to data scientists and analysts across the organization. Mentor junior team members on statistical methods, machine learning techniques, and analytical rigor. Translate complex analytical findings into clear, actionable insights for business leaders and operational teams. Collaborate with Claims Operations, Finance, Risk, and IT stakeholders to identify high-impact analytical opportunities. Evaluate external data sources and third-party analytical solutions that enhance predictive capabilities. Ensure analytical methodologies align with enterprise governance standards and regulatory expectations. Contribute to Sedgwick’s broader AI and advanced analytics strategy by identifying emerging technologies and modeling approaches. Lead research and innovation initiatives that advance Sedgwick’s predictive analytics capabilities. Requirements: Master’s or PhD in Data Science, Statistics, Mathematics, Computer Science, Economics, or related quantitative discipline. 8–12+ years of experience in data science, statistical modeling, or advanced analytics roles. Deep expertise in machine learning algorithms, statistical modeling techniques, and predictive analytics methodologies. Strong programming skills in Python, R, or similar analytical languages. Extensive experience working with large, complex datasets in enterprise environments. Proven experience designing and implementing end-to-end modeling pipelines. Strong understanding of model validation, feature engineering, and performance evaluation techniques. Experience collaborating with engineering teams to deploy models into production systems. Familiarity with distributed data processing tools and modern data platforms preferred. Experience in insurance, claims management, healthcare, or financial services analytics preferred. Ability to communicate advanced analytical concepts to both technical and non-technical stakeholders. Demonstrated ability to lead complex analytical initiatives that drive measurable business value. Strong mentoring and technical leadership capabilities. Benefits: Work-life balance Professional development opportunities