This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The purpose of this position is to lead a claims litigation team to help achieve Selective’s loss and claims expense objectives, as well as deliver excellent claims service to customers. Claims supervised are those in litigation and may involve complex and large monetary exposures. This claims leader must provide continuous training, coaching, and feedback to the members of their claims team. Must foster business partnerships with other company departments, including field agency management and inside underwriting teams. Responsibilities include fostering good relationships with independent agents. Must have expertise in commercial and personal lines, including coverage, contractual, and legal issues. Members of the team may handle both commercial and personal lines, and multiple lines of business, with large geographic territories, including multiple different states. These duties are performed consistent with company claims policies and procedures, prescribed authority, and standards of performance. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements. Responsibilities - Supervises, coordinates, and monitors activities of a claims litigation unit to ensure an accurate, quality product while maintaining high production standards and performance standards. - Schedules, prioritizes, and distributes workflow of litigation unit to ensure work is done in a timely fashion and all deadlines are met. - Audits procedures and controls to ensure compliance with company and statutory requirements; provides statistical data to management to ensure adherence to company policies, procedures, and state regulations. - Provides technical assistance to staff and assists them with the disposition of litigated claims with attorneys, insureds, and claimants. - Reviews completed adjustments for corrections and authorizes payments when required. - Establishes and adjusts claims reserves. - Recognizes fraudulent claims activity that would be subject to SIU referral in accordance with company guidelines and subsequent referral to law enforcement or regulatory agencies. - Reviews and implements claims audit recommendations on a continuous basis. - Reviews consumer/agency complaints; maintains a direct diary on litigated claims and an override diary on other selected claims. - Must be able to drive an automobile to travel within territory; car travel represents approximately 0-10% of employee’s time and requires a valid driver’s license. Qualifications - Excellent customer service skills. - Excellent leadership, communication, organizational, and interpersonal skills. - Must have valid state-issued driver’s license in good standing and be able to drive an automobile. - College degree preferred. - 3-5 years litigated claims experience. - 3+ years supervisory experience of technical level staff. - Prior auto claims experience preferred. Benefits - Competitive base salary. - Incentive plan eligibility at all levels. - Comprehensive health care plans. - Retirement savings plan with company match. - Discounted Employee Stock Purchase Program. - Tuition assistance and reimbursement programs. - 20 days of paid time off. Pay Range USD $108,000.00 - USD $163,000.00 /Yr. Additional Information Selective is an Equal Employment Opportunity employer. We respect and value every individual’s unique opinions, beliefs, abilities, and perspectives. We are committed to promoting a welcoming culture that celebrates diverse talent, individual identity, different points of view and experiences – and empowers employees to contribute new ideas that support our continued and growing success. Building a highly engaged team is one of our core strategic imperatives, which we believe is enhanced by diversity, equity, and inclusion. We expect and encourage all employees and all of our business partners to embrace, practice, and monitor the attitudes, values, and goals of acceptance; address biases; and foster diversity of viewpoints and opinions. For Massachusetts Applicants: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As a Health Claims Specialist at Revecore, you will bill and investigate health insurance claims to ensure maximum payment from insurance companies on behalf of our clients (hospitals and medical providers). - Investigate and research health insurance claims - Follow up on unresolved claims to facilitate payment for commercial health, Medicare, and Medicaid - Ensure maximized payments to our clients (medical providers) - Contribute to your team with various denial reports, audits, and overall support Qualifications - Experience researching and resolving claims for commercial health, Medicare, and Medicaid - Knowledge of filing correct UB04's and 1500 HCFA's with subrogation information to payers - Familiarity with billing health insurance as part of auto accidents - Experience working in EPIC - Working knowledge of Microsoft Office (Word, Excel, Outlook) - Technical proficiency to work on multiple computer screens and software applications simultaneously - Ability to maintain strong performance in a fast-paced environment with productivity metrics Requirements - A quiet, distraction-free environment to work from in your home - A secure internet connection is required - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads - Workspace area accommodates all workstation equipment and related materials - Must reside in the United States within specified states Benefits - Paid training and incentive plans - Medical, dental, vision, and life insurance benefits available from the first day of employment - Excellent work/life balance - Employee Resource Groups build community and foster a culture of belonging and inclusion - 401(k) contributions matched - Career growth opportunities - 12 paid holidays and generous paid time off

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Join an amazing team that is consistently recognized for our achievements and culture, including our most recent Forbes award of being one of America's Best Midsize Employers for 2025! If you’re passionate about helping people restore their lives when the unexpected happens, and providing the best customer experience, then our Mercury Insurance Claims team could be the place for you! We offer dynamic and challenging opportunities to those who want to make a meaningful impact. Under general supervision, the Claims Representative is responsible for investigating and resolving auto physical damage and property damage claims in a timely and efficient manner, while providing exceptional customer service in a team environment. The Claims Representative will handle a high volume of calls and make regular contact with customers on multiple platforms, collaborating cohesively with other team members to achieve department goals. Responsibilities - Thoroughly verifies and explains coverage to Policyholders, setting clear expectations on the claims process. - Sets reserves for anticipated losses, arranges vehicle inspections and rental authorizations, and makes referrals to specialty teams as warranted. - Serves as the primary customer contact and coordinates with other departments; researches and timely responds to customer inquiries and/or concerns with empathy to ensure customer satisfaction and retention. - Demonstrates the ability to resolve claims in a timely and accurate manner. - Continuously monitors progress and exposures, issues accurate and timely payments. - Investigates and evaluates claims by conducting interviews, reviewing documentation, and gathering evidence. - Documents interactions, conversations, and activities related to claims in a clear and concise manner using company systems and tools. - Identifies and escalates files with more significant indemnity exposure or attorney representation to their supervisor for review, transfer, or further investigation. Qualifications - Minimum: High School Diploma or GED. - Preferred: Associate degree. - You may be required to obtain a Company sponsored Adjuster’s license to handle claims, to be secured upon hire. Experience - Minimum: Customer service experience required. - Preferred: 6-12 months of related experience. - Experience with handling high call volume in a professional call center. Skills & Abilities - Minimum: Solid comprehension of basic principles and practices of Company policies upon completion of a formal and informal training program. - Ability to multi-task in a fast-paced environment, prioritize responsibilities, and deliver accurate work-product to expedite claims resolution and manage a high volume of claims. - Has a passion for serving customers in their time of need. - Possesses effective written and verbal communication skills to professionally represent the Company in multi-channel correspondence with Policyholders, agents, claimants, and other insurance carriers. - Independently makes high-quality claims adjusting decisions. - Collaborates well with others. We are one team with a common goal. - Ability to build rapport utilizing emotional intelligence. - Views conflict resolution as an opportunity. - Has self-motivation and accountability while working remotely. - Demonstrated proficiency with MS Office products (Outlook, Word) and claims related software. - Must have dedicated workspace that is free from distractions. - Preferred: Demonstrates intellectual curiosity by seeking out efficiencies through process improvement or technology. - Takes ownership of any process they can improve. - Assumes positive intent in all interactions. - Seeks growth within and beyond this role. Benefits - Competitive compensation - Flexibility to work from anywhere in the United States for most positions - 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 Pay Range USD $32,363.00 - USD $56,701.00 /Yr.

Job Description: The Business Analyst II reports to the Supervisor of the Central Business Unit (CBU) and performs moderate to complex tasks within our claims platform. This position may interface with system architects and corporate staff on benefit and contract updates, and system projects to support resolution of issues. We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Pennsylvania, Rhode Island, Vermont, and Washington. Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings Schedule - This teammate will be working a M-F schedule, 8 hours a day, 40 hour work week. Full time position. Days off will consist of IHC holidays. Job Functions 1. Oversight of payment activities including Fee-for-Service and Capitation payments. 2. Close collaboration with Finance department to ensure all payments and bank transfers are reconciled. 3. Continuous development and implementation of payment process. 4. Be a liaison between Intermountain Nevada and its provider community. 5. Verify all payments process are followed and documenting for FRCF reconciliation. 6. Escalation of vendor provider payment concerns, frustrations, and disputes to appropriate teams. 7. Assists in projects with moderately complex system modifications/updates. 8. Perform escheatment process for uncollected payments 9. Collaborate with PCR and Finance to produce Revenue Cycle quarterly reports for Service Line leaders keeping leadership informed of trends, issues, and concerns. 10. Analyze reports from multiple sources and meet routinely with front line leadership to simplify concerns, creation actionable steps, and set goals moving forward. 11. Ensure better controls over all payment cycle operations to make the MSO more profitable. 12. Tracking of missing payments and ensuring they are correctly reissued. 13. Performs other work-related duties and responsibilities as directed, assigned or requested. Provides expert-level skill in all areas of provider/vendor payment. Responsible for over $1 billion dollars per year in fee-for-service and capitation payments to our community of healthcare providers. Works closely with our payment vendor to ensure timely payments are made, resolve system issues, coordinate system upgrades, and deliver on new payment options as they become available. Partners with Intermountain Nevada Finance team to ensure funds are correctly withdrawn, all policies are followed, implement the escheatment process, and to resolve discrepancies. Main point of contact for providers/vendors payment questions. The Claims Payment Controller is responsible for ensuring the accurate and timely payment of all Intermountain Fee-for-Service and Capitation payments. The Claims Payment Controller accomplishes this by performing moderate to complex tasks within the claims and payment platforms. The position interfaces with system architects, business analysts, and corporate staff on all payment reconciliations, troubleshooting, and system projects to support resolution of issues. Minimum Qualifications - 5-8 years claims processing or system set-up experience, managed care preferred - High School Diploma or GED required, some college preferred - General knowledge of provider contracts, fee schedules and payment methodologies - Knowledge of health plan benefit interpretation and set up - Knowledge of current compliance legislation - Strong interpersonal skills required - Demonstrated proficiency in MS Excel and Word required - Strong problem-solving skills required Preferred Qualifications - Responsible for quality and continuous improvement within the job scope. - Responsible for all actions/responsibilities as described in company controlled documentation for this position. - Contributes to and supports the corporation's quality initiatives by planning, communicating and encouraging team and individual contributions toward the corporation's quality improvement efforts. Location: Nevada Central Office Work City: Las Vegas Work State: Nevada Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $25.02 - $39.41 We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package here. Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process. All positions subject to close without notice.