• Work directly with clients to ensure satisfaction • Troubleshoot technology and financial industry issues • Build and maintain strategic client relationships • Provide solutions and own the client relationship from start to finish

Albert & Mackenzie is a well-established and expanding workers’ compensation defense law firm with a strong presence across California. Proudly recognized as a Great Place to Work for five consecutive years (2021–2025), the firm has also earned multiple Best Places to Work awards. Responsibilities: - Managing a caseload of lien files which involves rating the permanent disability under the AMA guides, reviewing medical records, understanding apportionment, completing settlement documents, and resolving liens - Performing lien negotiations and legal representations - Appearing before a judge for Mandatory Settlement Conferences, Status Conferences, and Walking Thru settlements - Providing timely communication with clients and written summaries on a routine basis Qualifications: - Three years of experience working as a Hearing Representative in California Workers’ Compensation Defense (Required) - Knowledge of CA Workers’ Compensation law - Highly motivated, results-driven, high energy, and a sense of urgency - Strong attention to detail, with a commitment to outstanding customer service - Excellent written and verbal communication skills - Ability to juggle multiple tasks efficiently with little supervision - Client-focused, with the ability to deliver results Benefits: - 401(k) – Employer Contribution - Dental Insurance - Employee assistance program - Flexible spending account - Health insurance - Life insurance - Paid time off - Vision insurance Work Location: - Multiple Locations - Remote optional; Travel may be required Job Type: - Full-time Salary: - $55,000.00 - $120,000.00 per year Supplemental pay types: - Bonus pay (Discretionary) Albert & Mackenzie ensures equal opportunity for all applicants regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other legally protected characteristics. Full-time employees receive a competitive compensation package that features discretionary bonus opportunities and a comprehensive benefits program, including medical, vision, short-term and long-term disability, life insurance, a 401(k) retirement plan, paid time off, and optional dental coverage. Notice of E-Verify Participation Notice of Right to Work

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Facilitates the member grievance and appeal process by investigating, documenting and preparing case files to meet all regulatory requirements. - Investigate member grievance and appeal by gathering supporting documentation from internal departments, contracted Provider Organizations (PO), and non-contracted entities as indicated. - Communicate with the members or providers to request and gather pertinent information. Follow up as needed and document accordingly. - Track and monitor movement of assigned cases through SCAN’s functional units and systems, to ensure compliance with designated timelines. - Respond to requests for information from all regulatory agencies within required timeframes. - Respond to and close cases within designated regulatory time requirements as identified by case types. Generate and send appropriate communications. - Understand SCAN benefit structure and maintain current and additional information as it relates to Grievances and Appeals services. - Utilize department desktop procedures, workflows, job aids and training material. Identify barriers to work processes and bring to the attention of the supervisor/manager. - Maintain the member‘s right to privacy and protect SCAN operations by keeping information confidential. - Adhere to all quality, compliance and regulatory standards to achieve HCS and SCAN outcomes. - Contribute to team effort by accomplishing related results as needed. - Actively support the achievement of SCAN’s Vision and Goals. - Other duties as assigned. Qualifications - High School Diploma or equivalent experience - 2+ years in customer service and/or grievance and appeal in healthcare setting - Experience providing professional customer service. - Performs work under minimal supervision. - Handles complex issues and problems, and refers only the most complex issues to higher-level staff. - Possesses comprehensive knowledge of subject matter. - Provides leadership, coaching, and/or mentoring to a subordinate group. - May act as a lead or first-level supervisor Benefits - Base Pay Range: $20.14 - $30.00 per hour - Work Mode: Mostly Remote - An annual employee bonus program - Robust Wellness Program - Generous paid-time-off (PTO) - 11 paid holidays per year, plus 1 additional floating holiday - Excellent 401(k) Retirement Saving Plan with employer match - Robust employee recognition program - Tuition reimbursement - An opportunity to become part of a team that makes a difference to our members and our community every day! Company Description Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The hours of this role will fall between 8am-9pm EST Mon-Fri. Highly technical Customer Service expert with depth of knowledge within a health care setting. This position will require highly analytical, advanced ability to connect with the member, with a depth of knowledge in resolving and navigating within a health care setting. This position supports medical health plan clients with benefit needs and will also have the expanded responsibility of recommending vendor programs and services. Although this position is within a call center, it differs from typical call center roles due to the requirement and ability to independently seek solutions to customer needs. - Responsible for providing high level of service to inbound calls, outbound calls, direct messaging and digital chat customers with more complex medical conditions and/or needs. - Will educate customer on Medical health plan benefit package and vendors to enable optimal health outcomes. - Conducts in-network provider searches and facilitates appointment scheduling. - Provides advanced support with prior authorizations, helping to navigate next steps on denials and/or missing information. - Investigates and resolves escalations, issues, complaints obtaining necessary information from policies, procedures, or practices. - Highly organized with ability to follow-up timely and communicate proactively to customer and other necessary parties. - May serve as primary contact and liaison between customers, health plans, service centers, and/or functional areas. - Must have thorough technical knowledge of assigned products and excellent communication skills. - Understands when to seek support by coaches and leadership for issue resolution. - Requires the delivery of complex business resolution services in customer service via inbound calls, outbound calls and portal messaging to customers. - Responds to inquiries from policy holders where additional information or research is needed. - Must listen intently and have ability to interpret verbal cues from customers. - The position requires high level of compassion and empathy, excellent interpersonal skills, strong communication and comfortability in sharing intricate and/or difficult messages. - Knowledge and understanding of Customer Service and business/operating processes and procedures required. - Must be a champion of change and adapt well to frequent adjustments to procedures or guidance. Qualifications - High School diploma or GED required. - Required experience in US Commercial Medical Call Operations Background: - Proclaim - CCF / CDHP skillset - Medical OneGuide - OneView - Proven ability to listen, understand customers current & future needs, and interpret information from others. - Excellent communication skills in the spoken and written word. - Creative problem-solving and analytical skills. - Proven ability to independently manage day in a fast-paced environment. - Proficiency in Word and Outlook. Requirements - Strong KPI scores over the last 12 months; must be meeting or exceeding current targets. - ≥90% in Quality. - ≥90% in Contact Resolution. - Meeting Overall Agent Survey Result (target varied by team). - 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. Company Description Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.