Job Title: Government Programs Professional Review Claims Specialist Number of Positions: 1 Location: Okemos, MI Location Specifics: Fully Remote Job Summary: Candidates must reside within a reasonable commuting distance of our Okemos, MI office for team meetings, collaborative sessions, and training. At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation. At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community. Position Description To analyze and adjudicate dental claims with complicated treatment plans to ensure accurate benefits administration. Primary Job Responsibilities - Analyzes and processes dental claims so appropriate determinations can be finalized with correct procedures, policies, and bypasses; adjudicates claims, and maintains claim records. - Administers claim processing guidelines/standards, Delta USA processing policies, group contracts, provider agreements, and state laws applicable to claims adjudication. - Investigates difficult provider reconsideration requests, makes determinations, performs or coordinates adjustments; prepares claims for a second and/or third opinion when necessary and consults with contracted dentists on questionable treatment cases. - Pre and post-screens claims and/or inquiries for dental consultant(s); reviews and prepares claims for and coordinates external dental consultant activities. - Provides dental expertise and/or interpretation of dental policies, procedures codes, and processing guidelines to internal and external contacts. - Organizes, creates, and performs defined test cases on claims processing system, and documents/reports status of testing including recommendations for improvements. Analyzes and compiles information/data for reports to control and/or monitor claims inventory. - Researches, coordinates, and adjudicates Third Party Liability claims and recoveries; compares member information, prepares claims, and performs adjustments as necessary to ensure proper Third Party Liability (COB) adjudication. Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above. #LI-Remote Minimum Requirements: Position requires an associate's degree, technical, vocational, or business school with coursework related to dentistry, two years of experience in chair side assisting, and a RDA or RDH licensure. Will accept any suitable combination of education, training, or experience. Position requires advanced knowledge of dental terminology and dental procedures and the ability to read and interpret radiographs, electronic images and photos; experience working with word processing and spreadsheet software; effective verbal and written communication skills; ability to resolve complex problems and use independent judgment; experience with provider system; client contracts and Roosevelt is preferred. The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

Division or Field Office: Claims I Division Department of Position: Commercial Gen Liability Dept Work from: Home within ERIE's Footprint Salary Range: $79,191.00 - $126,500.00 * salary range is for this level and may vary based on actual level of role hired for *This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location (State) based on ERIE's geographical differences, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment. At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia. Benefits That Go Beyond The Basics We strive to be Above all in Service® to our customers—and to our employees. That’s why Erie Insurance offers you an exceptional benefits package, including: - 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. Position Summary Exercises independent discretion in handling complex and/or high exposure commercial liability claims and commercial litigation. - The successful candidate can work anywhere within Erie's Footprint. - The successful candidate will have a minimum of 3-5 years of experience handling Commercial General Liability claims. - The successful candidate must be willing to travel when required for claim investigation. Duties and Responsibilities - Conducts investigations, evaluates and makes recommendations regarding coverage, liability, and resolution strategies. - Handles or assists in handling of litigated claims as directed. Makes recommendations regarding litigation as appropriate. - Responds to complaints and inquiries and resolves issues. - Selects and directs outside experts, and vendors. - Trains and mentors less experienced staff. - Completes required training. The first three duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished. This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident. Capabilities - Values Diversity - Nimble Learning - Self-Development - Information Management Skills - Collaborates - Customer Focus - Job-Specific Knowledge - Cultivates Innovation - Optimizes Work Processes (IC) - Instills Trust - Ensures Accountability - Decision Quality Qualifications Minimum Educational Requirements - High school diploma or GED required. - Associates or bachelors degree preferred. Additional Experience - Five years' previous claims handling experience or equivalent experience in the legal field required. - Travel for training may be required. Designations and/or Licenses - Completion of Associate in Claims (AIC) program preferred. - Commercial, Property, Casualty, Underwriter (CPCU) designation preferred. - Appropriate license as required by state. - Valid driver's license and good driving record required. Physical Requirements - Use of Personal Protective Equipment (PPE) is required for this role. - Ability to move over 50 lbs using lifting aide equipment; Occasional (<20%) - Climbing/accessing heights; Rarely - Driving; Occasional (<20%) - Lifting/Moving 0-20 lbs; Occasional (<20%) - Lifting/Moving 20-50 lbs; Occasional (<20%) - Manual Keying/Data Entry/inputting information/computer use; Often (20-50%) - Pushing/Pulling/moving objects, equipment with wheels; Occasional (<20%)

Division or Field Office: Claims I Division Department of Position: Home & Auto Liability Dept Work from: Remote Salary Range: $56,367.00 - $90,040.00 * salary range is for this level and may vary based on actual level of role hired for *This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location (State) based on ERIE's geographical differences, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment. At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia. Benefits That Go Beyond The Basics We strive to be Above all in Service® to our customers—and to our employees. That’s why Erie Insurance offers you an exceptional benefits package, including: - 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. Position Summary Exercises independent discretion and judgement in claims handling involving complex liability issues, to include coverage issues and minor injury claims. - The successful candidate must reside within the state of Kentucky. - This is a remote, work from home position; travel could be required into the closest branch office for events or meetings. - This position requires a KY Adjusters license; must be willing to obtain KY license. Duties and Responsibilities - Conducts investigations, evaluate and make recommendations regarding coverage and liability. - Sets and maintains reserves. Obtains documents to establish the value of claims and negotiates settlement or declines claim. - Documents files and submits final report. - Identifies subrogation opportunities and initiates appropriate action. - Negotiates with all parties, or their representatives, within designated authority. - Completes required training. - Trains and mentors. - Travel for training may be required. The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished. This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident. Capabilities - Values Diversity - Nimble Learning - Self-Development - Collaborates - Customer Focus - Cultivates Innovation - Information Management Skills - Instills Trust - Optimizes Work Processes (IC) - Job-Specific Knowledge - Ensures Accountability - Decision Quality Qualifications Minimum Educational and Experience Requirements - High school diploma or equivalent and two years of claims or customer service experience, preferably with casualty claims, required. - Equivalent educational experience will be considered. - Associate's or Bachelor's degree, preferred. Designations and/or Licenses - Appropriate license as required by state. Physical Requirements - Lifting/Moving 0-20 lbs; Occasional (<20%) - Lifting/Moving 20-50 lbs; Occasional (<20%) - Ability to move over 50 lbs using lifting aide equipment; Occasional (<20%) - Pushing/Pulling/moving objects, equipment with wheels; Occasional (<20%) - Climbing/accessing heights; Rarely - Driving; Occasional (<20%) - Manual Keying/Data Entry/inputting information/computer use; Frequent (50-80%)

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Patriot MGA is seeking a detail-oriented professional to investigate, evaluate, and resolve first- and third-party private passenger Auto Liability Casualty claims. The ideal candidate is self-motivated, highly organized, driven to achieve, and demonstrates excellent decision-making ability. Key Responsibilities: - Proactively investigates and resolves questions regarding the coverage, liability, and damages of private passenger auto liability claims. - Ensures proper reserving and diary/task management on all assigned claims. - Adheres to all Patriot MGA standard operating procedures and best claims practices. - Delivers outstanding customer service for Patriot MGA’s insureds, claimants, carriers, and partners. - Positively contributes to Patriot MGA business culture and morale. - Adjusts files in compliance with all State regulations. - Thoroughly documents all claims activities to support investigation decisions. - Actively evaluates and negotiates bodily injury claims with injured parties or their representation. - Properly documents and answers all demands consistent with Patriot MGA best claims practices and State regulations. - Reports to the Claims Supervisor or Claims Manager. Qualifications - At least 2 years’ experience adjuster auto liability claims - Must possess a Texas Adjusters License (either P&C or All-Lines) - Bi-Lingual English/Spanish preferred Requirements - Strong attention to detail. - Ability to thrive in a high stress, high pace work environment. - Demonstrated ability to positively affect team culture and morale. - Demonstrated ability to stay organized in a high pace environment. - Demonstrated ability to handle confrontational situations with first- and third-party customers. Benefits - Salary Range: $60,000-$75,000 USD/Per Year