• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies. • Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing. • Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues. • Participate in ongoing training and professional development activities. • Maintain accurate and detailed records of claims processing activities. • Review claim forms and supporting documents • Determine eligibility, verify data accuracy • Request additional information when needed • Process claims end-to-end • Identify and escalate complex or unusual claims for further review or investigation.

Summary: The Life Claims & Annuity Sr. Specialist is responsible for assessing and making decisions on variable/portfolio death claims, death under income plan, variable/fixed annuity, and Northwestern Access Fund accounts. This role involves partnering with the contestable team on variable contestable claims. Ensuring compliance with a $2M signature authority limit involves analyzing various documents such as death certificates, claim forms, and legal documentation. Additionally, the specialist conducts routine reviews of claims by contract language and state laws. Primary Duties & Responsibilities: Decision Making and Claims Review - Make fair, accurate, and timely decisions on variable/portfolio death claims, death under Income plans, variable/fixed annuities, and Northwestern Mutual Access Fund accounts. Maintaining compliance with a $2M signature authority limit. - Examine claim information obtained, including beneficiary data, policy values, policy status, and analyze information received during the claim review process, such as death certificates, claim forms, assignment forms, divorce decrees, and estate and trust documentation. - Research and evaluate solutions to arising situations and resolve concerns as needed. Deviate from procedures to handle unique situations effectively. - Exhibit empathy, professionalism, and tact in all interactions, especially when handling sensitive or contentious claims. - Provide exceptional customer service to policyholders, beneficiaries, and financial advisers, addressing their questions and concerns throughout the claims process. - Communicate claims decisions to beneficiaries and other parties clearly and sensitively, providing detailed explanations and supporting documentation as needed. - Manage phone and transactional responsibilities while demonstrating a strong commitment to confidentiality. - Maintain organization, accuracy, and timeliness in individual case management systems; capture and document claim-related information accurately and/or refer tasks as appropriate. - Maintain production and claim quality standards to ensure efficiency and accuracy. Continuous Improvement and Innovation - Participate in continuous improvement initiatives to enhance claims handling processes, reduce turnaround times, and improve accuracy. - Assist with special projects and initiatives as needed to support the business. - Embrace new technology and serve as an advocate by educating beneficiaries and field representatives. - Support digital savvy capabilities in self and others and adapt to changing environments and new situations effectively and positively. Qualifications: - Bachelor’s degree or an equivalent combination of education and progressively responsible work experience. - A Series 6 FINRA License is required. - Previous experience in claims, income plan, or annuity preferred. - High degree of accuracy in handling detailed technical work. - Self-motivated with proven responsibility for work results and group goals. - Technically savvy with the ability to toggle between multiple applications and computer monitors simultaneously. - Strong organizational skills, able to independently prioritize to meet deadlines. - Exhibits empathy and strong client focus, with excellent customer service skills. - Excellent communication skills (both verbal and written) to include the proven ability to negotiate. - Leadership and decision-making skills, to include the abilities to evaluate/identify, diagnose, and implement decisions/solutions to questions/problems within the scope of the job. - Ability to analyze complex information and ask thoughtful questions. Desired Skills: - Adaptive Communication (Intermediate) - Attention to Detail (Advanced) - Customer Centricity (Intermediate) - Decision Making (Intermediate) - Analytical Thinking (Advanced) - Empathetic Communication (Intermediate) - Prioritization (Intermediate) - Claims Acumen (Intermediate) - Annuity Product Knowledge (Intermediate) This position has been classified as a Registered Representative under NMIS guidelines and requires fingerprinting.Series 6 - FINRA, SIE - FINRA Compensation Range: Pay Range - Start: $57,260.00 Pay Range - End: $106,340.00 Geographic Specific Pay Structure: Structure 110: $63,000.00 USD - $117,000.00 USD Structure 115: $65,870.00 USD - $122,330.00 USD We believe in fairness and transparency. It’s why we share the salary range for most of our roles. However, final salaries are based on a number of factors, including the skills and experience of the candidate; the current market; location of the candidate; and other factors uncovered in the hiring process. The standard pay structure is listed but if you’re living in California, New York City or other eligible location, geographic specific pay structures, compensation and benefits could be applicable, click here to learn more. Grow your career with a best-in-class company that puts our clients' interests at the center of all we do. Get started now! Northwestern Mutual is an equal opportunity employer who welcomes and encourages diversity in the workforce. We are committed to creating and maintaining an environment in which each employee can contribute creative ideas, seek challenges, assume leadership and continue to focus on meeting and exceeding business and personal objectives.

• Prepare, submit, and track insurance claims for Applied Behavior Analysis (ABA) services. • Review claims for accuracy and completeness prior to submission. • Follow up on outstanding, rejected, or denied claims with insurance providers. • Investigate and resolve claim discrepancies, denials, and payment issues. • Work closely with billing, scheduling, and clinical teams to ensure services are billed correctly. • Verify client insurance information and ensure authorizations align with billed services. • Maintain accurate records of claims, payments, and correspondence with payers. • Ensure compliance with payer requirements, company policies, and healthcare billing regulations. • Provide regular updates and reports on claim status and reimbursement trends.

Job Summary: The Claims Management Analyst III is responsible for leading eBusiness initiatives and coordination of activities across multiple functional areas. Essential Functions: - Manage the EDI (Electronic Data Interchange) trading partners and network of clearinghouses to ensure accurate and timely exchange of information - Works closely with Vendor Management to improve and maintain the trading partner agreement with the trading partners. This includes cost reduction and adding services - Develop and maintain a partnership with the trading partner account representatives - Manage trading partner performance, establish and monitor service level agreements, regulatory requirements, and contractual metrics - Provide Subject Matter Expertise (SME) to all departments regarding eBusiness specific EDI transactions - Build, sustain and leverage relationships to constantly allow for continuous improvement of the EDI business process - Responsible for eBusiness EDI requirements that support regulatory, compliance, and business needs And eBusiness EDI regulatory reporting - Provide critical reporting and analysis of functional performance, and make recommendations for enhancements, cost savings initiatives and process improvements - Review and analyze the effectiveness and efficiency of existing processes and systems, and participate in development of solutions to improve or further leverage these functions - Participate in the process of estimating initiative budgets as well as developing business cases and tracking the benefits - Understand business strategy, define and lead eBusiness initiatives such as working with IT and others internal departments to automate functions - Understand the process to receive claims, claims rejections and denial processes, claims payment methodologies, adjudication processing, and Encounters to enable synergies among It and business groups - Contribute to and/or develop user stories or provide user story guidance for sprint planning - Develop, document and perform testing and validation as needed - Develop and maintain an in-depth knowledge of the company’s business and regulatory environments - Identify issues, risks, and mitigation opportunities - Perform any other job duties as requested Education and Experience: - Bachelor’s degree or equivalent years of relevant work experience is required - Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required Competencies, Knowledge and Skills: - Advanced knowledge of healthcare EDI files (837, 277CA, 999, 270/271, 276/277, etc.) - Advanced computer skills - Demonstrated exceptional communication (verbal and written) and high level of professionalism - Data analysis and trending skills to include query writing Knowledge of Claims IT processes and systems - Working knowledge of managed care and health claims processing - Ability to effectively interact with all levels of management within the organization and across multiple organizational layers - Demonstrates excellent analysis, collaboration skills, facilitation and presentation skills - Strong interpersonal, leadership and relationship building skills - Decision making and problem solving skills - Ability to work independently and within a team environment - Time management skills; capable of multi-tasking and prioritizing work - Attention to detail - Effective decision making / problem solving skills - Critical thinking and listening skills Licensure and Certification: - None Working Conditions: - General office environment; may be required to sit or stand for extended periods of time Compensation Range: $72,200.00 - $115,500.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-RW1