The Claims Examiner is responsible for the accurate and timely processing of medical, dental, vision and prescription drug claims. The incumbent is expected to provide courteous and prompt responses to customer inquiries. The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position. ESSENTIAL JOB FUNCTIONS: - Essential job functions include the following. Other functions may be assigned as business conditions change. - Verifies the accuracy and receipt of all required documentation for each claim submitted. - Collaborates with providers, plan participants, other claims payers, or any other party necessary to obtain information necessary to accurately process a claim. - Analyzes information necessary for processing. This includes, but is not limited to, general participant and provider information, managed care affiliation, diagnosis codes, dates, place, type of service, procedure codes, and charges. - Assures that the system processes the claim correctly and determines payment according to the plan as written. - Word-processes correspondence to plan participants and providers in reference to pre-determinations and in response to basic benefit questions. - Answers telephone calls from plan participants, group contacts, and customer service representatives pertaining to benefits and claims inquiries. - Resolves problematic claims with the assistance of the Team Leader, Claims Manager and/or the Director of Claims. - Assigns critically ill patients to large case management. Assists the case manager with direct negotiation and the efficient use of benefits. - Assists other examiners as needed due to workload requirements, including assigned back-up when examiners are absent. - Aids the Team Leader and/or the Claims Manager in the resolution of claim appeals and disputes by providing documentation for review. - Researches, calculates and requests refunds when necessary. - Contributes to the daily workflow with regular and punctual attendance. - Thoroughly researches and completes renewal reports in a timely manner in consultation with the Marketing Department. - Process eligible claims on groups before the end of their stoploss contract renewal period. - Assists the Legal Department with subrogation claims as necessary. - Attends various group meetings as required. - Assists with audits as needed. - Assists with plan benefit set-up and changes as needed. Minimum Education: High school graduation or GED required. Minimum Experience: Basic computer and customer service experience required. Other Qualifications: - Excellent oral and written communication skills required. - PC skills, including Windows and Word. - Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication. - Must be able to adapt to software changes as they occur. - Typing ability of 45 wpm net - Excellent listening skills. - Basic mathematical skills. - High level of interpersonal skills to work effectively with others. - Ability to organize and recall large amounts of detailed information. - Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations. - Ability to meet productivity standards with 99% financial accuracy and 95% procedural accuracy. - Thorough knowledge of claims processing procedures and requirements. - Ability to project a professional image and positive attitude in any work environment. - Ability to comply with privacy and confidentiality standards. - Ability to be flexible, work under pressure and meet deadlines. - Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions. - Ability to operate typical office equipment. - Working knowledge of general office procedures. About Allegiance by Cigna Healthcare Since 1981, Allegiance by Cigna Healthcare has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high‑touch approach to member and client service, Allegiance supports some of the nation’s most innovative health benefit strategies. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Job Description Summary Under general supervision assures accurate and timely insurance claim processing to include resolving claim edits and paper claims for submittal. Resolves denied/unpaid insurance claims in a timely manner. Entity Medical University Hospital Authority (MUHA) Worker Type Employee Worker Sub-Type​ Regular Cost Center CC005226 SYS - HB Support Services Pay Rate Type Hourly Pay Grade Health-20 Scheduled Weekly Hours 40 Work Shift Job Description - Account maintenance: Updating registration, authorization issues, identifying charge correction, , processing adjustments as needed and denial follow up according to payer rules and departmental policies. - Use electronic billing system appropriately to follow up on outstanding denied claims and all no response claims.Corrects claims in electronic billing system for missing or invalid insurance or patient information according to procedures, and places account on hold if you can't resolve - Follow up on denied or no response claims by calling third party payers or using payer websites. Gathering information from patients or other areas to resolve outstanding denied or no response claims. Researching accounts to take appropriate action necessary to resolve. - Keep management aware of issues and trends to enhance operations and escalates slow-pay issues to managerial level when necessary. - Uses payer websites to stay current on payer rules and changes to include reading newsletters and communicating payer/claim issues and trends. - Maintains 95% quality standards on account follow and activity. - Maintains productivity standard as set forth by management team. - Other duties as assigned. Additional Job Description Education: High School Degree or Equivalent Work Experience: 0-6months If you like working with energetic enthusiastic individuals, you will enjoy your career with us! The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees

• Analyzes and processes complex or technically difficult auto liability PIP/No-fault claims by investigating and gathering information to determine coverage, the exposure on the claim. • Manages claims through well-developed action plans to an appropriate and timely resolution. • Calculates and assigns timely and appropriate reserves to claims. • Prepares necessary state fillings within statutory limits. • Manages the litigation process; ensures timely and cost effective claims resolution.

Claims Senior Casualty Adjuster Job Summary The Claims Senior Casualty Adjuster handles moderate to high complexity claims involving material damage, property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, negotiation strategies and claims resolution of moderate to high complexity claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices. Under general supervision, works within specific limits of authority to resolve claims. Job Duties - Conduct phone and/or field investigations to determine liability and damages. May attend and participate in legal proceedings. Identify and obtain statements from insureds, claimants and witnesses. - Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address moderate complexity coverage issues. - Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data. - Negotiate within settlement authority with insureds and claimants to resolve first and third party claims. - Update database production reports, and document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc. - Control expenses for areas of responsibility. - Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required. - Respond quickly to customer needs and problems. - Independently resolve claims within authority level. Qualifications - Bachelors Equivalent combination of education and experience Preferred - 7-9 years Prior claims handling experience. Preferred - 4-6 years Property, Auto, Casualty or relevant claims administration experience. Required - Comprehensive knowledge of claims administration best practices and procedures. - Advanced knowledge of insurance, fault assessment, negligence and subrogation principles required. - Comprehensive understanding of building and vehicle repair procedures and third-party liability issues. - Advanced knowledge of Microsoft Office suite, general computer software and claims software. - Advanced organization and planning recognition skills required. - Advanced oral and written communication skills required. - Advanced interpersonal skills required. - Advanced leadership skills among peers required. - Exhibit proficiency and understanding of medical terminology and causality - Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required - Chartered Property Casualty Underwriter - Insurance Institute of America Preferred - Associate in Claims - Insurance Institute of America Preferred - An insurance/claims adjuster license may be required for claims administration in specific states. Travel Requirements - Occasional travel to business meetings or conferences. (5% proficiency) The starting pay range for this position is $80,100 - $107,000 per year. Additionally, you will be eligible to participate in our incentive program based upon your team and individual performance. Remarkable benefits: • Health coverage for medical, dental, vision • 401(K) saving plans with company match AND Pension • Tuition assistance • Floating holidays and PTO for community volunteer programs • Paid parental leave • Wellness programs • Employee discounts (membership, insurance, travel, entertainment, services and more!) Auto Club Enterprises is the largest club within the national AAA federation. We have nearly 17,000 employees in 24 states helping more than 18 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win. All of Us! With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team. "Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.” AAA is an Equal Opportunity Employer Our organization participates in E-Verify