• Manage a caseload of commercial property claims from assignment through resolution. • Examine commercial claims investigated by independent adjusters to determine the extent of insurance coverage and validity of the claims. • Review and adjust commercial loss reserves, correspondence, reports, verify coverage and authorize payments submitted by independent adjusters. • Collaborate with internal personnel and/or legal counsel on claims involving litigation. • Investigate, evaluate, and adjust claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims. • Oversee independent adjuster files to ensure they have followed CFP IA Guidelines. • Verify and analyze data used in settling claims to ensure validity and that settlement is in accordance with company practices and procedures. • Maintain compliance with the Department of Insurance and Company procedures. • Identify fraud or illegal activity indicators and follow internal processes to refer the claims to the appropriate personnel for follow up. • Promptly negotiates settlements ensuring the settlement reflects the insured losses while confirming the insurer is protected from invalid claims.

About Us ForMotion is a global network of Orthotic and Prosthetic Patient Care clinics, focused on providing world-class, compassionate care for patients with mobility challenges.​ Our clinic is part of the ForMotion global network of Patient Care clinics owned by Embla Medical, which also owns Össur, a leading global provider of prosthetics and bracing and supports solutions; Fior & Gentz, an innovative developer of neuro orthotics; and College Park, creators of custom-built prosthetic solutions for people of all activity levels. We are dedicated to providing the best possible care to our patients to help them live Life Without Limitations. About the Role The Authorization Denial Appeal Specialist is responsible for managing and appealing denied prior authorizations for orthotic and prosthetic (O&P) devices across U.S ForMotion Clinics. This role partners closely with patients, clinicians, prescribing physicians, and payers to obtain required documentation, prepare comprehensive appeal submissions, and guide cases through payer review processes. The Specialist independently researches payer policies, develops case specific appeal strategies, submits complete appeal packages, and communicates appeal status through final determination. What You’ll Do   - Manage end to end appeal workflows for denied prior authorizations related to orthotic and prosthetic devices. - Collaborate with patients, clinicians, and prescribing physicians to obtain medical records, clinical notes, letters of medical necessity, and other supporting documentation required for appeals. - Obtain, track, and maintain signed Appointment of Representative (AOR) forms from patients to enable payer communication. - Research payer manuals, coverage guidelines, medical policies, and provider portals to identify denial rationale and appeal requirements. - Develop customized, case by case appeal strategies based on clinical justification, payer policy, and documentation standards. - Draft clear, comprehensive, and payer specific appeal letters supporting medical necessity and policy alignment. - Compile and submit complete appeal packages through payer portals, fax, mail, or other required submission channels. - Monitor appeal status through payer systems and follow up as needed to ensure timely review and resolution. - Coordinate and participate in Peer to Peer (P2P) reviews when required, including preparation of supporting materials and scheduling with clinicians or prescribing physicians. - Proactively communicate appeal status, updates, approvals, and denials to both the patient and the clinic throughout the review process. - Track appeal deadlines, determinations, and outcomes to ensure compliance with payer timelines. - Maintain accurate, compliant documentation in EMR systems and internal tracking tools. - Provide non-managerial guidance and subject matter support to peers regarding authorization and appeal processes. - Ensure strict adherence to HIPAA and other legal and ethical standards in the handling of protected health information. Who You Are - Ethical Conduct - Computer Proficiency - Demonstrates excellent people skills with the ability to interface with patients, physicians, and coworkers in a tactful, informed and service-oriented manner. - Detailed oriented. - Experience coordinating and participating in Peer to Peer (P2P) reviews. - Familiarity with Medicare, Medicaid, and commercial payer policies as they relate to O&P services. - Ability to interpret complex payer policy language and apply it to clinical scenarios. - Strong analytical, problem solving, and critical thinking skills. - Professional, patient centered communication style. - Ability to balance patient advocacy with payer compliance and regulatory requirements. - Bachelor’s degree in business, healthcare, or related field or equivalent combination of education and experience required. - 2+ years of experience in the O&P industry utilizing EMR systems. - Prior experience and working knowledge of Commercial, Medicare, & Medicaid Insurances including authorizations, appeals/denials. - Proficient with Microsoft Office, Opie/Nymbl EMRs, ICD10 coding, medical terminology Why You’ll Feel Good Working Here We believe people do their best work when they feel good—personally and professionally. That’s why we offer: - A culture rooted in trust, empathy, and Nordic-inspired flat hierarchies - Tailored onboarding and a buddy system to help you feel at home from day one - Continuous learning through e-learning, training, and language courses - A “you” culture where everyone—from interns to executives—is treated with respect - Competitive Compensation Packages - Medical, Dental, and Vision Benefits - 401(k) Retirement Plan with employer matching contribution - 9 paid holidays - 13 vacation days, birthday and two (2) volunteer days  - 8 sick days within your first year of employment - Paid Parental Bonding The US hourly range for this full-time position is $29.38 - $31.25/hr + bonus + benefits. Our salary ranges are determined by role, level, and location. The range displayed on each job posting reflects the minimum and maximum target for new hire salaries. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. Your recruiter can share more about the specific salary range for your preferred location during the hiring process. Please note that the compensation details listed in US role postings reflect the base pay only, and do not include bonus, equity, or benefits. ForMotion is a global network of Orthotic & Prosthetic patient care clinics providing exceptional care through award-winning mobility solutions and world-class healthcare professionals. Embla Medical is an equal opportunity employer and makes employment decisions on the basis of merit. We want to have the best available individual in every job. Embla Medical's equal opportunity policy prohibits all discrimination (based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical disability, mental disability, military service, pregnancy, child birth or related medical condition, actual or perceived sexual orientation, or any other consideration made unlawful by local laws around the world). Embla Medical is committed to complying with all applicable laws providing equal employment opportunities. This commitment applies to all individuals involved in the operations of Embla Medical and prohibits discrimination by any emplo​yee of Embla Medical, including supervisors and co-workers. Important Warning: Beware of fraudulent recruiters impersonating our company. Please take extra caution when asked for any sensitive personal information, such as social security numbers or bank account details. We will never ask you for any form of payment during the recruitment process. Please make sure you refer to our official website.

• Dispatch over 750 vehicles weekly using internal technology to technicians and/or third-party locksmiths. • Manage and update claims within the portal. • Follow up with technicians daily to provide accurate ETAs to customers on open claims. • Verify pictures and invoicing for accuracy before uploading to the customer via the portal. • Request voids and rebill claims when documentation is incorrect to ensure proper closure. • Provide customer quotes as needed for claim resolution. • Monitor claims cycle time and ensure timely processing. • Communicate cycle time updates with technicians and managers. • Maintain accurate records and documentation for all claims. • Support administrative tasks including data entry, report generation, and system updates. • Audit claim documentation weekly to ensure compliance with customer and internal standards. • Maintain organized digital records for all claims, dispatches, and communications for audit readiness. • Generate weekly and monthly reports on claim volume, cycle time, and resolution rates. • Identify trends in claim delays or errors and recommend process improvements. • Liaise with the Keys Inventory and Dispatch teams to ensure alignment on vehicle availability and technician capacity. • Partner with Customer Service to resolve escalated claims or customer concerns. • Propose updates to claim workflows or dispatch logic based on recurring issues or feedback. • Participate in system enhancement discussions (e.g., Aango portal updates or dispatch tech upgrades). • Train new team members on claim handling procedures and dispatch protocols. • Create and maintain SOPs for claims processing and dispatch workflows. • Other Duties as Assigned

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description A well-established Third-Party Administrator (TPA) is seeking an experienced Senior Workers’ Compensation Claims Adjuster to join their team supporting New England accounts. This role is fully remote and requires a seasoned claims professional who can independently manage a complex Vermont workers’ compensation caseload while delivering excellent service to both the client and injured workers. - Manage a full caseload of New England workers’ compensation claims from inception to closure. - Investigate claims thoroughly to determine compensability and appropriate reserves. - Ensure all claims are handled in compliance with New England workers’ compensation laws and regulatory requirements. - Coordinate and communicate with injured workers, employers, medical providers, attorneys, and other stakeholders. - Establish and adjust reserves based on claim developments and exposure. - Direct medical management, including coordination with nurse case managers when appropriate. - Evaluate claims for settlement opportunities and participate in negotiations when necessary. - Manage litigated claims, working closely with defense counsel to develop strategies and control costs. - Maintain accurate claim documentation and provide timely claim updates to the client. - Deliver high levels of customer service to a dedicated client account while meeting all service standards and KPIs. Qualifications - 5+ years of Workers’ Compensation Claims Adjusting experience, with either MA, CT, NH, VT, ME, or RI claim handling required. - Strong understanding of New England Workers’ Compensation regulations and claims procedures. - Experience handling complex and litigated claims. - Prior experience working for a TPA or insurance carrier preferred. - Strong organizational, analytical, and negotiation skills. - Ability to manage a full caseload independently in a remote work environment. - Active adjuster license or ability to obtain quickly. Requirements - Strong knowledge of New England workers’ compensation statutes. - Proven experience handling litigated and complex claims. Benefits - Compensation: $80,000 - $95,000/year - Annual Bonus Potential - 100% Remote Work Environment - Comprehensive benefits package - Opportunity to support a stable, long-term dedicated account - Collaborative and supportive claims leadership team