Claims Adjusters, Examiners, and Investigators

**Opportunities at WellMed** , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind **Caring. Connecting. Growing together.**

The **Senior Claims Examiner** is responsible for providing claims support to our teams in reviewing, analyzing, and researching complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim.

This position is full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6am - 6pm CST. It may be necessary, given the business need, to work occasional overtime.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

**Primary Responsibilities:**

+ Review, process and identify medical claims based on standard operating procedures on CPS.

+ Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates).

+ Review and apply member benefit plans and provider contracts, Pricing, CMS rate letter, SCA’s etc. to ensure proper benefits and contract language is applied to each claim.

+ Weekly/monthly goal of batches including meeting and maintaining a 95% quality standard and production standard of 90+ claims per day.

+ Examine each claim for appropriate coding of CPT and ICD codes against charges that are billed and entered.

+ Manually adjust pended escalated claims to resolve complex issues related to claim payments.

+ Adjudicate complex medical provider-initiated claims using analytical/problem solving skills.

+ Create and generate any overpayment documentation (notes in system, letter to typing) on all overpayments created by the examiner or any overpayments identified by examiner.

+ Support implementation of updates to the current procedures and participate in new system updates and training.

+ Communicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claims errors/issues, using clear, simple language to ensure understanding.

+ Ensures all claims reporting requirements are met; complete daily production reports and weekly pending reports.

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

**Required Qualifications:**

+ High School Diploma / GED

+ Must be 18 years of age OR older

+ 2+ years of experience in metric-based environment (production, quality)

+ 1+ years of experience processing medical, dental, prescription or mental health claims

+ 1+ years of experience working in a fast-paced, high volume environment processing 50+ claims per day

+ Proficiency with Microsoft Office Suite (Outlook, Word, Excel etc.)

+ Ability to navigate and learn new and complex computer system applications

+ Ability to work full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6am - 6pm CST. It may be necessary, given the business need, to work occasional overtime.

**Preferred Qualifications:**

+ Reside within commutable distance to 19500 W INTERSTATE, San Antonio TX 78257

**Telecommuting Requirements:**

+ Ability to keep all company sensitive documents secure (if applicable)

+ Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

+ Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

**Soft Skills:**

+ Proven exceptional ability to organize, prioritize and communicate effectively

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 - $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

**_Application Deadline:_** _This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants._

_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission._

_OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._

_OptumCare is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

\#RPO

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

**Job Posting Title**

Sr Customer Care Specialist

**Job Description**

+ This position is a frontline service position providing assistance to members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations is to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards. **Responsibilities**

+ Listens and probes callers in a professionally and timely manner to determine purpose of the calls.

+ Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.

+ Resolves customer administrative concerns as the first line of contact this may include claim resolutions and other expressions of dissatisfaction.

+ Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.

+ Assists in the mentoring and training of new staff.

+ Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).

+ Assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.

+ Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help achieve its business and operational goals.

+ Educates providers on how to submit claims and when/where to submit a treatment plan.

+ Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.

+ Informs providers and members on appeal process.

+ Leads or participates in activities as requested that help improve Care Center performance, excellence and culture.

+ Links or makes routine referrals and triage decisions not requiring clinical judgment.

+ Performs necessary follow-up tasks to ensure member or provider's needs are completely met.

+ Provides information regarding in-network and out-of-network reimbursement rates and states multiple networks to providers.

+ Refers callers requesting provider information to Provider Services regarding professional provider selection criteria and application process.

+ Refers patients/EAP clients to the Care Management team for a provider, EAP affiliate, or Facility.

+ Updates self on ever changing information to ensure accuracy when dealing with members and providers.

+ Supports team members and participate in team activities to help build a high-performance team.

+ Documents customers comments/information and forwards required information to the appropriate staff. **Education & Experience** **Education Level**

+ Required: High School, GED

+ Preferred: Associates, Bachelors **Experience Level**

+ Required: 2+ years Customer ServiceMust be eligible to work in the United States without the need for work visa or residency sponsorship. **Additional Qualifications**

+ Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment.

+ Responsible for meeting call handling requirements and daily telephone standards as set forth by management.

+ Must agree to observing service for the purpose of training and quality control.

+ Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.

+ Must be able to maneuver through various computer platforms while verifying information on all calls.

+ Must be able to talk and type simultaneously. **Preferred Qualifications**

+ PBM Experience **Physical Demands**

+ Must be able to remain in a stationary position 50% of the time. Must be able to "move or traverse"

+ Must be able to constantly operate a computer and/or other office productivity equipment

+ Must be able to hear and constantly communicate information and ideas. Must be able to exchange accurate information

+ Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 poundsEvery employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $19.23 - $28.85 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail.

_Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. _

_We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law._

_Prime Therapeutics LLC is a Tobacco-Free Workplace employer._

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [email protected].

**What’s Under the Hood**

DriveTime Family of Brands includes SilverRock, which provides quality warranty and ancillary products, and a customer-friendly claims process. SilverRock offers a variety of ancillary products and administrative services encompassing everything from GAP coverage to vehicle theft and GPS tracking to dealership fleet management. Our ancillary product expertise is proven with over 1 million service contracts, products, and warranties, and over $300 million in claims.

**That’s Nice, But What’s the Job?**

In short, as a Claims Adjuster, you will use your knowledge of vehicle systems and repairs to validate, approve, and authorize payment for repair recommendations on warranty claims. You’ll work over the phone with service advisers and technicians to ensure correct repairs are performed to help get our customers back on the road, so automotive experience is a must!

**So What Kind of Folks Are We Looking for?**

+ **Passionate and goal-oriented.** We are looking for someone that is enthusiastic about their career and is passionate about meeting and exceeding their goals.

+ **Excellent verbal and written communication skills.** The ability to talk and write with confidence, charisma, and competence to a wide variety of audiences.

+ **Agile in a fast-paced environment** . We move, and we move quickly. Thriving in and contributing to an environment that never stops is a must.

+ **Plays well with others.** You will be working in a high-functioning team environment. We work together and we win together.

+ **Works well in a time crunch.** There will be multiple time-sensitive requirements and you will need the ability to meet deliverable due dates.

+ **Fantastic problem solver!** Some calls will be challenging. Your goal is not only to find the problem but more importantly, find the solution.

+ **Positive emotional resilience.** This is an environment where you will be faced with challenging calls on a daily basis. We want to make sure you have the ability to rise past them while maintaining an optimistic attitude.

**The Specifics.**

+ High School diploma required; Associate or Bachelor’s deree is preferred

+ 3 + years of experience with current automotive mechanical and diagnostics

+ **_Must be located in AZ, FL, GA, NC, TN, TX, UT or NV._**

**So What About the Perks? Perks matter**

+ **Work From Home.** Feel free to rock the casual wear while still being camera ready. You will be working from your home office (in an approved city & state) and make sure you have a conducive and quiet workspace with no distractions and reliable and secure internet.

+ **Medical, dental, and vision, oh my!** DriveTime Family of Brands covers a sizable amount of insurance premiums to ensure our employees receive top-tier healthcare coverage.

+ **But Wait, There’s More.** 401(K), Company paid life insurance policy, short and long-term disability coverage to name a few.

+ **Growth Opportunities.** You grow, I grow, we all grow! But seriously, DriveTime Family of Brands is committed to providing its employees with every opportunity to grow professionally with roughly over 1,000 employees promoted year over year.

+ **Tuition Reimbursement.** We’re as passionate about your professional development as you are. With that, we’ll put our money where our mouth is.

+ **Wellness Program.** Health is wealth! This program includes self-guided coaching and journeys, cash incentives and discounts on your medical premiums through engaging in fun activities!

+ **Gratitude is Green.** We offer competitive pay across the organization, because, well… money matters!

+ **Work From Home.** Feel free to rock those yoga pants while still being camera ready, just make sure you have a conducive and quiet workspace with no distractions and reliable and secure internet.

+ **No Digital Nomads.** We’ll need you to work from your home address that will be in one of the states where we are licensed to do business.

+ **Consistent Work Schedule.** You’ll get a set schedule Monday through Friday, with rotating Saturdays! With that, we do ask for some flexibility and overtime as needed.

+ **If You’re in Town.** For those employees in AZ and TX, we have in-office and hybrid arrangements available. We may even ask to see to see you in-person occasionally.

+ **Game Room.** Gimme a break – no, not a Kit Kat ad but we do have a ping-pong table, a pool table and other games if you ever need a break in your day.

+ **In-House Gym.** We want our employees to be the best versions of themselves. So come early, take a break in your day, or finish strong with a workout!

+ **Enjoy Social Events?** Bring it on. Rally with your team for festive gatherings, team competitions or just to hang out!

+ **We Care and Value YOU!** Feel the love and let us treat you to company outings, personal rewards, amazing prizes & much more!

+ **Paid Time Off.** Not just lip service: we work hard, to play hard! Paid time off includes (for all full-time roles) wellness days, holidays, and good ole' fashioned YOU time! For our Part-timers, don't fear you get some time too...vacation time is available - the more you work, the more you earn!

**Anything Else? Absolutely.**

DriveTime Family of Brands is Great Place to Work Certified! And get this: 90% of our rockstar employees say they feel right at home here. We could spend a lot of time having you read about ALL our awards, but we’ll save time (and practice some humility) just naming a few others; Comparably Awards: Best Company for Diversity, Best Company Culture and Best Company Leadership, oh and don’t forget Phoenix Business Journal Healthiest Employers (okay, we’ll stop there)!

Hiring is contingent upon successful completion of our background and drug screening process. DriveTime is a drug-free, tobacco-free workplace and an Equal Opportunity Employer.

And when it comes to hiring, we don't just look for the right person for the job, we seek out the right person for DriveTime. Buckle up for plenty of opportunities to grow in a professional, fun, and high-energy environment!

Location:

2721 N Central Ave, Phoenix, Arizona 85004 United States of America

Repwest Insurance is looking for a Claims Service Representative in our Claims Reporting Unit. The function of the Claims Reporting Unit is to set up new claims for U-Haul Storage, U-Haul Equipment, Commercial Policy Holders and Managing General Agencies. In addition, the CRU provides other support functions for the Republic Western’s Field Claims Offices, the Commercial Claims Unit, the subrogation Unit and the Equipment Damage Unit. Duties include answering inbound calls and entering information into a PC based program.This is a fast paced environment; hours vary from 5:00am to 6:00pm. Candidates must be able to work evenings and weekends.

+ Customer service background

+ HS Diploma; able to type 30+ wpm a plus

+ General clerical experience; able to use Microsoft Office

+ Good communication skills

+ Claims or insurance experience is a plus

Requirements:

+ Must be available evenings and weekends

+ This is not available for remote work

+ This is a fast-paced, multi-tasking environment; hours vary from 6:00am to 5:00pm. Candidates must be willing to accommodate fluctuating schedules, weekends, and the occasional holiday.

Work Status:

+ Full-Time

Here are just some of the programs U-Haul/Repwest has available:

+ Full Medical coverage

+ New indoor fitness gym

+ Onsite medical clinic for you and your family

+ Career stability

+ Opportunities for advancement

+ Valuable on-the-job training

+ Prescription plans

+ Dental & Vision Plans

+ Business and travel insurance

+ YouMatter Employee Assistance Program

+ Paid holidays, vacation, and sick days

+ Employee Stock Ownership Plan (ESOP)

+ 401(k) Savings Plan

+ Life insurance

+ Critical Illness/Group Accident

+ 24-hour physician available for kids

+ Subsidized gym/ membership

+ MetLaw Legal program

+ MetLife auto and home insurance

+ Discounts on cell phone plans, hotels, and more

+ LifeLock identity Theft

+ Tuition reimbursement program

+ Free online courses for personal and professional development at U-Haul University

+ Savvy consumer wellness programs- from health care tips to financial wellness

+ U-Haul federal credit union

+ Wellness Program

U-Haul Holding Company, and its family of companies including U-Haul International, Inc. (“U-Haul”), continually strives to create a culture of health and wellness. Consistent with applicable state law, U-Haul will not hire or re-hire individuals who use nicotine products. The states in which U-Haul will decline to hire nicotine users are: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Pennsylvania, Texas, Utah, Vermont, Virginia, and Washington. U-Haul has observed this hiring practice since February 1, 2020 as part of our commitment to a healthy work environment for our team.

U-Haul is an equal opportunity employer. All applicants for employment will be considered without regard to race, color, religion, sex, national origin, physical or mental disability, veteran status, or any other basis protected by applicable federal, provincial, state or local law. Individual accommodations are available on requests for applicants taking part in all aspects of the selection process. Information obtained during this process will only be shared on a need to know basis.

Cognizant is a large IT Consulting Firm that leverages modern technologies to transform a variety of business operations. We are seeking **Fully Remote US Based** Claims Processors to join our growing team. The **Claims Processor** is responsible for the timely and accurate adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support to claims and client for issues related to claims adjudication and adjustments, Service Now and Inquiry resolution, and any basic questions regarding health coverage as stated in the Plan Document.

**Role Responsibilities**

+ Responsible for reviewing the data in the claim processing system (Facets) and comparing it with the corresponding UB, HCFA paper, or EDI information.

+ Responsible for reviewing medical records when necessary to determine if the service rendered was medically appropriate and criteria has been met.

+ Responsible for reviewing claim and line item edits and warning messages for determination of whether to pay claim/line item(s).

+ Ensure that all designated tasks are handled within the appropriate timeframe in order to meet internal and external SLAs

+ Assigned special projects or other duties as determined by management.

+ Will work closely with other departments

**Desired Qualifications**

+ At least a High School Diploma or equivalent is required

+ A minimum of 1 years claims processing is required

+ Facets experience is highly preferred

+ Knowledge of physician practice and hospital coding, billing, and medical terminology, CPT, HCPCS, ICD-9

+ Experience with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims

+ Knowledge of Medicare billing & payment and coverage guidelines and regulations

+ Experience in the analysis and processing of claims, utilization review/quality assurance procedures

+ Must be able to work with minimal supervision.

+ Creative thinker with good problem-solving skills specifically related to healthcare claim adjudication

+ Possess the ability to work at a computer for extended periods.

+ Must have basic Microsoft Excel skills

**Salary and Other Compensation**

Applications will be accepted until July 11th, 2025.

The hourly rate for this position is between $15.20 – $17.75 per hour, depending on experience and other qualifications of the successful candidate.

This position is also eligible for Cognizant’s discretionary annual incentive program, based on performance and subject to the terms of Cognizant’s applicable plans.

**Benefits:** Cognizant offers the following benefits for this position, subject to applicable eligibility requirements:

+ Medical/Dental/Vision/Life Insurance

+ Paid holidays plus Paid Time Off

+ 401(k) plan and contributions

+ Long-term/Short-term Disability

+ Paid Parental Leave

+ Employee Stock Purchase Plan

**Disclaimer:** The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.

Cognizant will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.

Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

**What’s Under the Hood**

DriveTime Family of Brands includes SilverRock, which provides quality warranty and ancillary products, and a customer-friendly claims process. SilverRock offers a variety of ancillary products and administrative services encompassing everything from GAP coverage to vehicle theft and GPS tracking to dealership fleet management. Our ancillary product expertise is proven with over 1 million service contracts, products, and warranties, and over $300 million in claims.

**That’s Nice, But What’s the Job?**

In short, as a Claims Adjuster, you will use your knowledge of vehicle systems and repairs to validate, approve, and authorize payment for repair recommendations on warranty claims. You’ll work over the phone with service advisers and technicians to ensure correct repairs are performed to help get our customers back on the road, so automotive experience is a must!

**So What Kind of Folks Are We Looking for?**

+ **Passionate and goal-oriented.** We are looking for someone that is enthusiastic about their career and is passionate about meeting and exceeding their goals.

+ **Excellent verbal and written communication skills.** The ability to talk and write with confidence, charisma, and competence to a wide variety of audiences.

+ **Agile in a fast-paced environment** . We move, and we move quickly. Thriving in and contributing to an environment that never stops is a must.

+ **Plays well with others.** You will be working in a high-functioning team environment. We work together and we win together.

+ **Works well in a time crunch.** There will be multiple time-sensitive requirements and you will need the ability to meet deliverable due dates.

+ **Fantastic problem solver!** Some calls will be challenging. Your goal is not only to find the problem but more importantly, find the solution.

+ **Positive emotional resilience.** This is an environment where you will be faced with challenging calls on a daily basis. We want to make sure you have the ability to rise past them while maintaining an optimistic attitude.

**The Specifics.**

+ High School diploma required; Associate or Bachelor’s deree is preferred

+ 3 + years of experience with current automotive mechanical and diagnostics

+ **_Must be located in AZ, FL, GA, NC, TN, TX, UT or NV._**

**So What About the Perks? Perks matter**

+ **Work From Home.** Feel free to rock the casual wear while still being camera ready. You will be working from your home office (in an approved city & state) and make sure you have a conducive and quiet workspace with no distractions and reliable and secure internet.

+ **Medical, dental, and vision, oh my!** DriveTime Family of Brands covers a sizable amount of insurance premiums to ensure our employees receive top-tier healthcare coverage.

+ **But Wait, There’s More.** 401(K), Company paid life insurance policy, short and long-term disability coverage to name a few.

+ **Growth Opportunities.** You grow, I grow, we all grow! But seriously, DriveTime Family of Brands is committed to providing its employees with every opportunity to grow professionally with roughly over 1,000 employees promoted year over year.

+ **Tuition Reimbursement.** We’re as passionate about your professional development as you are. With that, we’ll put our money where our mouth is.

+ **Wellness Program.** Health is wealth! This program includes self-guided coaching and journeys, cash incentives and discounts on your medical premiums through engaging in fun activities!

+ **Gratitude is Green.** We offer competitive pay across the organization, because, well… money matters!

+ **Work From Home.** Feel free to rock those yoga pants while still being camera ready, just make sure you have a conducive and quiet workspace with no distractions and reliable and secure internet.

+ **No Digital Nomads.** We’ll need you to work from your home address that will be in one of the states where we are licensed to do business.

+ **Consistent Work Schedule.** You’ll get a set schedule Monday through Friday, with rotating Saturdays! With that, we do ask for some flexibility and overtime as needed.

+ **If You’re in Town.** For those employees in AZ and TX, we have in-office and hybrid arrangements available. We may even ask to see to see you in-person occasionally.

+ **Game Room.** Gimme a break – no, not a Kit Kat ad but we do have a ping-pong table, a pool table and other games if you ever need a break in your day.

+ **In-House Gym.** We want our employees to be the best versions of themselves. So come early, take a break in your day, or finish strong with a workout!

+ **Enjoy Social Events?** Bring it on. Rally with your team for festive gatherings, team competitions or just to hang out!

+ **We Care and Value YOU!** Feel the love and let us treat you to company outings, personal rewards, amazing prizes & much more!

+ **Paid Time Off.** Not just lip service: we work hard, to play hard! Paid time off includes (for all full-time roles) wellness days, holidays, and good ole' fashioned YOU time! For our Part-timers, don't fear you get some time too...vacation time is available - the more you work, the more you earn!

**Anything Else? Absolutely.**

DriveTime Family of Brands is Great Place to Work Certified! And get this: 90% of our rockstar employees say they feel right at home here. We could spend a lot of time having you read about ALL our awards, but we’ll save time (and practice some humility) just naming a few others; Comparably Awards: Best Company for Diversity, Best Company Culture and Best Company Leadership, oh and don’t forget Phoenix Business Journal Healthiest Employers (okay, we’ll stop there)!

Hiring is contingent upon successful completion of our background and drug screening process. DriveTime is a drug-free, tobacco-free workplace and an Equal Opportunity Employer.

And when it comes to hiring, we don't just look for the right person for the job, we seek out the right person for DriveTime. Buckle up for plenty of opportunities to grow in a professional, fun, and high-energy environment!

The **Absence Case Management** **Team Leader** leads a team of Absence Management Case Managers to get results within their team and the organization. As the team lead you will support team members, guide goal achievement, present progress updates and ensure meeting standards. The Team Leader also assists staff with career development and progression while encouraging candor while challenging the status quo to improve the way we work. You will partner with internal cross functional areas for program direction, goal setting, service delivery and development of action plans and using bench strength.

In addition, the Team Leader will validate that all FML, STD, State, and PFL are accurately adjudicated according to plan provisions, established standard methodologies and within state and federal guidelines. The Team Leader will run and resolve issues that pertain to claim administration procedures, cost containment activities, reports, quality control and complex customer issues. The Team Leader will work with external customers/clients to enhance the overall experience for the customer while facilitating the overall functioning of the team then you will present to leadership on team status and performance.

You will

+ Partner with leadership to develop and communicate objectives and performance goals for the team.

+ Lead direct report performance by coordinating with HR to implement coaching plans and performance improvement plans.

+ Develop employee goals to promote career growth that enhance level of knowledge for future opportunities.

+ Collaborate with internal business partners including Short Term Disability, Long Term Disability, Service, Sales and Account Management, Group Quality Management, and other areas within the Company.

+ Create regular action plans based on results from employee engagement surveys – the Team Leader owns and acts on engagement survey results.

+ Review and analyze daily, weekly, and monthly reports on team productivity 1) for operational reporting and monitoring purposes; 2) to identify trends and training opportunities; and 3) to create action plans for improvement.

+ Review processes/reports regularly for process improvement opportunities.

+ Own relationship with client and get involved, when necessary, in meetings, phone calls, and keeping a tight loop on service issues.

+ Prioritize the customer/client experience in day-to-day interactions and processes.

+ Identify Continuous Improvement opportunities by reviewing process and eliminating unnecessary steps.

+ Empower staff to submit process improvement ideas to revise workflows and procedures.

+ Support claims initiatives by encouraging/providing relevant feedback and being an effective change leader for project rollouts.

+ Schedule and facilitate team meetings and individual touchpoints.

+ Mentor, coach, lead and develop talent by acting as a partner in recommending and coordinating training resources, tools, and plans for individuals to achieve personal and departmental goals and objectives.

+ Review claim staff QA/CMA assessments for training or enhancement opportunities.

+ Use data and analytics to improve or change business process.

You have

+ Bachelor’s degree in related field and/or equivalent relevant disability work experience; integrated absence management preferred.

+ 3+ years of disability claims experience.

+ 3+ years of demonstrated leadership experience.

+ Extensive knowledge of disability products, business rules and procedures.

+ Familiarity with mandated state and federal regulations.

+ Professional oral, written and presentation skills.

+ Validated organizational and time management skills.

+ Excellent math proficiency and analytical skills.

+ Strong PC skills, including Microsoft Office applications.

Leadership Behaviors

Team Leadership

+ Hire, develop and retain top talent. Recognize and reward team members. Model leadership behavior and act as a servant leader to ensure team success. Communicate effectively with team, champion, and challenge changes with positivity. Own messaging and decision making. Lead team through ambiguity.

Problem Solving

+ Be creative and take calculated risks to achieve goals and results. Make mistakes and learn quickly from them, model this behavior for your team.

Customer/Client Focused

+ Act with vitality and ownership to resolve customer issues. Proactively identify and resolve issues when possible. Work to ensure self and team prioritize the customer experience.

Results Focused

+ Drive team to achieve results, focusing on desired outcomes. Action plan for team management despite operational challenges.

LOCATION

This is a remote position with preference given to candidates in close proximity to a Guardian office with minimal travel to other locations and conferences.

**Salary Range:**

$57,330.00 - $94,185.00

The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

**Our Promise**

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

**Inspire Well-Being**

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues. Explore our company benefits at www.guardianlife.com/careers/corporate/benefits . _Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits._

**Equal Employment Opportunity**

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

**Accommodations**

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [email protected] .

**Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.**

Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being — mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com .

At **UnitedHealthcare** , we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.**

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

We offer 3 to 5 weeks of paid training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

**Primary Responsibilities:**

+ Providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjudicating Long Term Disability claims.

+ Communicating ongoing status and decisions both in writing and verbally

+ Authorizes the appropriate payment or refers claims to Team Lead or Manager for validation of adverse or over limit approvals

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

**Required Qualifications:**

+ High School Diploma /GED OR equivalent work experience

+ Must be 18 years of age OR older

+ Presently Employed within UHC Consumer Operations

+ 1+ years of reviewing and rendering initial liability determinations on Long Term Disability claims

+ 1+ years of experience issuing monthly payments on Long Term Disability claims

+ Experience with Microsoft Word (ability to create, modify and send documents)

+ Experience with Microsoft Excel (ability to create, modify and send spreadsheets)

+ Ability to work full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

**Telecommuting Requirements:**

+ Ability to keep all company sensitive documents secure (if applicable)

+ Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

+ Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The salary range for this role is $49,300 to $96,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

**_Application Deadline:_** _This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants._

_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission._

_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._

_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

\#RPO

Specialist Claims - CH07DE

We’re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help others accomplish theirs, too. Join our team as we help shape the future.

A new role can expand your knowledge and your network, and help you learn more about our business. If you think this opportunity is a fit for your career you should apply. If you are not sure you can have a conversation with your manager.

The Specialist role of Workers Compensation, Major Case unit will manage the investigation, litigation, disposition and settlement of specialized claims, in compliance with corporate claim standards and procedures, and statutory, regulatory and ethics requirements. They will maintain, effectively create and communicate file strategies, and plans for achieving optimum claim outcomes and demonstrate advanced technical and jurisdictional expertise.

This role will be a part of a team of Major Case Unit Claim Specialists as well as a Home OfficeConsultant.

Timely and accurate reserving, Resolution and Settlement Strategies, Efficient, Timely and Accurate Investigations and Medical Management are responsibilities of this position. The position will also require strong written and verbal communication and presentation skills to ensure our internal and external customers are kept informed.

Responsibilities:

+ The MCU Claim Specialist will handle claims in the Western United States including CA, AZ, CO, NM, UT, NV

+ Maintain current knowledge of claim loss cost containment initiatives, and use them appropriately and consistently with company practices and procedures to manage assigned claims

+ Identify and initiate mitigation, subrogation and other recovery opportunities on assigned claims

+ Maintain high standards and a clear understanding of goals for self

+ Maintain action-oriented, confident approach to work assignments

+ Use critical thinking skills to gather information, apply sound reasoning, draw appropriate conclusions and make sound decisions based on a mixture of analysis, experience and judgment

+ Stay current on issues impacting Workers’ Compensation including industry and marketplace trends, strategic direction of the organization, organizational structure and leadership, team goals and internal initiatives

+ Identify fraud indicators and initiate investigation on assigned claims

+ Demonstrate technical and jurisdictional expertise

+ Monitor financial results, trending and variances and identify, implement and manage appropriate adjustments

+ Communicate orally and in writing in a clear succinct manner

+ Possess superior analytical and critical thinking skills; expert knowledge of complex medical terms, excellent time management abilities

+ Properly apply statutory laws and regulations of applicable jurisdiction

Claim File Management and Technical Expertise:

+ Manage the completion and execution of the investigation, litigation, disposition and settlement of specialized claims, in compliance with corporate claim standards and procedures, and statutory, regulatory and ethics requirements

+ Accurately and timely assess the indemnity, medical and expense exposure of assigned Specialized claims and manage the accurate and timely setting of reserves

+ Use organizational and communication skills to effectively manage the resolution of assigned claims, manage claim deadlines, and use resources appropriately

+ Use claim functional knowledge to appropriately interpret and apply insurance coverage;

+ Accurately resolve complex coverage and compensability issues

+ Demonstrate advanced expertise to use case management practices to effectively reduce loss costs.

+ Manage claims consistent with our Knowledge Management Tool, Claims Excellence Standards and Performance Improvement goals

Talent Management:

+ Effectively hold self-accountable for achievement of business results

+ Evaluate, acknowledge and manage individual performance through the use of appraisal tools

+ Effectively address and manage performance that does not meet required standards

+ Mentor and share jurisdictional and technical knowledge with peers, as needed, in order to build capabilities within the supported field claim offices

Customer Service:

+ Maintain dedication to meeting expectations and requirements of internal and external customers

+ Obtain first-hand customer information and use it for improvements in products and services

+ Establish and maintain effective relationships with customers, gaining their trust and respect

+ Demonstrate diplomacy and tact to effectively avoid or diffuse high-tension situations

+ Negotiate skillfully in tough situations with internal and external groups

+ Set aggressive and realistic expectations for responding and follow through on commitment. Always demonstrate professionalism and establish credibility when interacting with customers

+ Personally enhance The Hartford’s reputation in the marketplace

+ Treat all customers with respect and careful attention

+ Clearly explain complex or technical information that is helpful to customers

Teamwork and Team Building:

+ Contribute to the building of appropriate rapport and constructive and effective relationships with people inside and outside the organization

+ Represent The Hartford as a credible, trustworthy, flexible and dependable resource; Demonstrate courtesy, honesty, integrity, respect and competence when interacting with others

+ Embrace role and offer advanced expertise to help teammates. solve problems, learn new skills and accomplish goals

+ Consistently act with the highest level of integrity and adhere to general principles of business ethics

Qualifications:

+ Minimum of 5+ years of P&C- Workers Compensation claim industry experience required

+ Strong technical understanding of Workers Compensation statutes and case law required

+ Jurisdictional knowledge and experience required (Western)

+ Ability to be coached, guided and mentored as you develop strategies on larger complex workers compensation claims

+ SCLA or CPCU designation preferred

+ Established ability to execute including a proven track record managing complex projects and initiatives

+ Strong analytical ability

+ Bias for action and continuous improvement

+ Effective communication, interpersonal and negotiation skills.

+ Ability to influence and communicate across multiple levels of the organization

+ Satisfactory completion of the candidate testing/certification process

+ Ability to use computer technology to efficiently perform job functions

+ Knowledge and experience using basic software program

+ Bachelor’s degree preferred

+ State required certification exams and adjusting licenses as jurisdiction requires

Additional Information:

+ This role can have a Hybrid or Remote work schedule. Candidates who live near one of our locations will have the expectation of working in an office 3 days a week (Tuesday through Thursday).

+ For full-time, occasional, part-time, or remote positions: (1) high speed broadband internet service is required, we do not recommend or support DSL, wireless, Mifi, Hotspots, Fiber without a modem and Satellite; (2) Internet provider supplied modem/router/gateway is hardwired to the Hartford issued computer with an ethernet cable; and (3) minimum upload/download speeds of 5Mbps/30Mbps will be required. To confirm whether your Internet system has sufficient speeds, please visit http://www.speedtest.net from your personal computer.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford’s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$106,400 - $159,600

Equal Opportunity Employer/Sex/Race/Color/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

About Us (https://www.thehartford.com/about-us) | Our Culture (https://www.thehartford.com/about-us/corporate-culture) | What It’s Like to Work Here (https://www.thehartford.com/careers/our-employees) | Perks & Benefits (https://www.thehartford.com/careers/benefits)

Every day, a day to do right.

Showing up for people isn’t just what we do. It’s who we are – and have been for more than 200 years. We’re devoted to finding innovative ways to serve our customers, communities and employees—continually asking ourselves what more we can do.

Is our policy language as simple and inclusive as it can be? Can we better help businesses navigate our ever-changing world? What else can we do to destigmatize mental health in the workplace? Can we make our communities more equitable?

That we can rise to the challenge of these questions is due in no small part to our company values that our employees have shaped and defined.

And while how we contribute looks different for each of us, it’s these values that drive all of us to do more and to do better every day.

About Us (https://www.thehartford.com/about-us)

Our Culture

What It’s Like to Work Here (https://www.thehartford.com/careers/our-employees)

Perks & Benefits (https://www.thehartford.com/careers/benefits)

Legal Notice (https://www.thehartford.com/legal-notice)

Accessibility StatementProducer Compensation (https://www.thehartford.com/producer-compensation)

EEO

Privacy Policy (https://www.thehartford.com/online-privacy-policy)

California Privacy Policy

Your California Privacy Choices (https://www.thehartford.com/data-privacy-opt-out-form)

International Privacy Policy

Canadian Privacy Policy (https://www.thehartford.com/canadian-privacy-policy)

Unincorporated Areas of LA County, CA (Applicant Information)

MA Applicant Notice (https://www.thehartford.com/ma-lie-detector)

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Examiner - Workers Compensation - Dedicated - Telecommute Virginia

**PRIMARY PURPOSE** : To analyze complex or technically difficult workers' compensation 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; and to identify subrogation of claims and negotiate settlements.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Analyzes and processes complex or technically difficult workers' compensation 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.

+ Negotiates settlement of claims within designated authority.

+ Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

+ Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

+ Prepares necessary state fillings within statutory limits.

+ Manages the litigation process; ensures timely and cost effective claims resolution.

+ Coordinates vendor referrals for additional investigation and/or litigation management.

+ Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.

+ Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

+ Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

+ Communicates claim activity and processing with the claimant and 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.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

+ Supports the organization's quality program(s).

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required.

Virginia jurisdictional experience is required. Missouri and Wisconsin experience is a plus.

**Skills & Knowledge**

+ Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

When applicable and appropriate, consideration will be given to reasonable accommodations.

**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

**Physical:** Computer keyboarding, travel as required

**Auditory/Visual:** Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

\#LI-Remote

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**

**Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**