This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. - Effectively follow-up on claim submission and remittance review for insurance collections. - Create and pursue disputed balances from both government and non-government entities. - Work as part of a dynamic team and adapt to changing work assignments. - Work independently and closely with management to resolve accounts. - Interact professionally with insurance plans, patients, physicians, attorneys, and team members. - Utilize basic computer skills to navigate various system applications. - Access payer websites to resolve accounts and document actions taken. - Maintain department daily productivity goals while meeting quality standards. - Identify and communicate issues related to system access and payor behavior. - Provide support for team members that may be absent or backlogged. Qualifications - Thorough understanding of the revenue cycle process. - Intermediate skill in Microsoft Office (Word, Excel). - Ability to learn hospital systems quickly and fluently. - Strong oral and written communication skills. - Strong interpersonal skills and analytical thinking skills. - Full understanding of Commercial, Managed Care, Medicare, and Medicaid collections. - Familiarity with terms such as HMO, PPO, IPA, and Capitation. - Intermediate understanding of EOB and hospital billing form requirements. - Ability to problem solve, prioritize duties, and follow through with tasks. Requirements - High School diploma or equivalent; some college coursework in business administration or accounting preferred. - 1-4 years of medical claims and/or hospital collections experience. - Minimum typing requirement of 45 wpm. Benefits - Pay: $15.80 - $23.70 per hour, depending on location, qualifications, and experience. - Potential signing bonus for qualified new hires. - Conifer observed holidays receive time and a half. - Medical, dental, vision, disability, and life insurance. - Paid time off (min of 12 days per year, accruing at approximately 1.84 hours per 40 hours worked). - 401k with up to 6% employer match. - 10 paid holidays per year. - Health savings accounts and flexible spending accounts. - Employee Assistance program and Employee discount program. - Voluntary benefits including pet insurance and legal insurance. - Paid leave for Colorado employees in accordance with Colorado’s Healthy Families and Workplaces Act.

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team. In this Role the candidate will be responsible for: • Processing of Professional claim forms files by provider • Reviewing the policies and benefits • Comply with company regulations regarding HIPAA, confidentiality, and PHI • Abide with the timelines to complete compliance training of NTT Data/Client • Work independently to research, review and act on the claims • Prioritize work and adjudicate claims as per turnaround time/SLAs • Ensure claims are adjudicated as per clients defined workflows, guidelines • Sustaining and meeting the client productivity/quality targets to avoid penalties • Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. • Timely response and resolution of claims received via emails as priority work • Correctly calculate claims payable amount using applicable methodology/ fee schedule Requirements: • 3 year(s) hands-on experience in Healthcare Claims Processing • 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools • High school diploma or GED. • Previously performing – in P&Q work environment; work from queue; remotely • Key board skills and computer familiarity – o Toggling back and forth between screens/can you navigate multiple systems. o Working knowledge of MS office products – Outlook, MS Word and MS-Excel. Preferred Skills & Experiences: • Amisys • Ability to communicate (oral/written) effectively in a professional office setting • Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities • Time management with the ability to cope in a complex, changing environment

The Material Damage Claims Specialist (MDS) is primarily responsible for the timely completion of internal estimates, appraisals, and valuations for the REPO Plus department. They serve as the physical damage experts/SMEs within the department and will routinely complete audits of outside insurance carrier (OIC) estimates/appraisals. Additionally, they are tasked with both initial and evergreen training related to automobile physical damage. Job Duties and Responsibilities:​ Physical Damage Estimate/Appraisal Production - Will complete internal estimates, appraisals, and valuations on REPO Plus claim files. - This may include desk estimates of damaged vehicles, total loss valuations, and reviews or audit of externally supplied material. - Work is generated from internal REPO Plus claim files as well as via request from lender clients. - Required to meet production goals set by REPO Plus management. - Required to meet QA goals set by REPO Plus management. Physical Damage Subject Matter Expert - Will field questions and provide answers to REPO Plus Adjusters and Analysts as needed such as: - Estimate Review - Total Loss valuations audit - Written responses to OIC appraisers - Will be involved in all testing necessary to validate new workflows/processes and system integrations or applications within the REPO Plus department (ex. Integrating the CCC platform with PEGA for REPO Plus). Physical Damage Training - Provide initial physical damage training for the REPO Plus department including the following: - Condition Report review training for incoming REPO Plus Processors - Physical damage/Estimate training for incoming REPO Plus Adjusters and Analysts - Evergreen training related to physical damage including updates to state regulations, industry standards, etc. Qualifications (Education, Experience, Certifications & KSA): - High school diploma or GED. - 8-10 years of work-related experience. - Required to maintain all applicable licensing (if required) and continuing education/training necessary to complete the above work in all 50 states. This may include: - State licensing - Training specific to changes within the automobile physical damage field (ICAR, etc.) The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with a job. #LI-SJ1 #LI-Remote We offer our employees a robust compensation package! Our comprehensive benefits include: medical, dental and vision insurance coverage; 100% company-paid life and disability coverage, 401k options with company match, three weeks PTO by the end of the first year and much more. Allied proudly promotes from within as part of a strong commitment to providing career growth opportunities for employees of all levels. Our diverse business portfolio allows employees broad career options with the advantage of staying with the same organization. All qualified candidates will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. To view our privacy statement click here To view our terms and conditions click here

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 Comp 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; and to ensure ongoing adjudication of claims within company standards and industry best practices or client specific requirements. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Analyzes and processes complex or technically difficult claims by investigating and gathering information to assist employer in determining their position on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. - Works to move claim towards appropriate claim closure which may include referral for settlement evaluation. - Monitors reserve adequacy throughout the life of the claim if applicable. - Monitors and reviews benefits due and payment calculations ensuring accuracy. - Prepares necessary state filings within statutory limits. - Follows best practice standards in contested claims including outside legal representation. - 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. - Participates in claim recoveries including, but not limited to: subrogation, Second Injury Fund recoveries, and Social Security offsets. - Communicates claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact. - Ensures claims files are properly documented and claims coding is correct. - Maintains professional client relationships. - Coordinates actuarial/settlement issues impacting employers with rate and settlement departments. - Assesses policy level status of clients; works in coordination with clients' service expectations and assigned service personnel. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line-of-business preferred. Experience Four (4) years claims management experience or equivalent combination of education and experience required. Skills & Knowledge - In-depth line-of-business knowledge of appropriate insurance principles and laws, recoveries offsets and deductions, and cost containment principles - Excellent oral and written communication skills, including presentation skills - PC literate, including Microsoft Office products - Analytical and interpretive skills - Strong organizational skills - Good interpersonal skills - Ability to work in a team environment - Ability to meet or exceed Performance Competencies - Supports the organization's quality program(s). - Performs other duties as assigned. WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. TAKING CARE OF YOU BY - We offer a diverse and comprehensive benefits package including: - Three Medical, and two dental plans to choose from. - Tuition reimbursement eligible. - 401K plan that matches 50% on every $ you put in up to the first 6% you save. - 4 weeks PTO your first full year. NEXT STEPS If your application is selected to advance to the next round, a recruiter will be in touch. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $47,000 - $50,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.