Discover. Achieve. Succeed. #BeHere Location: US:WI:MENOMONEE FALLS at our WOODLAND PRIME 400 facility. This job is REMOTE. FTE: 1.000000 Standard Hours:40.00 Shift: Shift 1 8:00-430 Monday to Friday Job Summary: The Pre-Authorization Specialist is a member of the Pre-Authorization Department who is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care. The Pre-Authorization Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned. Other information: EXPERIENCE REQUIRED: A minimum of 2 years experience in hospital billing/pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Medicaid, HMO's and PPO's required. EXPERIENCE PREFERRED: Prior experience in a business office position with strong customer service background preferred. EDUCATION REQUIRED: High School diploma or equivalent is required. EDUCATION PREFERRED: None TRAINING REQUIRED: None TRAINING PREFERRED: None SPECIAL SKILLS REQUIRED: Exceptional customer relations skills required. SPECIAL SKILLS PREFERRED: Knowledge of online insurance eligibility systems. Excellent typing and computer skills. Familiarity with Medical Terminology. Demonstrated ability to efficiently organize work and maintain a high level of accuracy and productivity. LICENSURE REQUIRED: None LICENSURE PREFERRED: None Perks & Benefits at Froedtert Health Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following: - Paid time off - Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities - Academic Partnership with the Medical College of Wisconsin - Referral bonuses - Retirement plan - 403b - Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics - Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation. We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.

• Investigating and settling transportation first party claims and third-party claims • Evaluate coverage and make appropriate policy decisions • Evaluate and negotiate settlements of collision, specified perils, property damage, and transportation losses • Manage and oversee the work of outside adjusters, appraisers and experts • Develop a basic understanding of liability and coverage principles • Recognize state specific laws and claims regulations throughout the United States • Complete research to determine market value on automobiles and heavy equipment • Summarize and make recommendations for disposition of claims in excess of the individual settlement authority • Respond to time sensitive material including intercompany arbitration hearings • Manage a diary system to systematically review and resolve claims • Handle small claim suits as needed

• Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; • manages claims through well-developed action plans to an appropriate and timely resolution. • Assesses liability and resolves claims within evaluation. • Negotiates settlement of claims within designated authority. • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level. • Prepares necessary state fillings within statutory limits. • Manages the litigation process; ensures timely and cost effective claims resolution. • 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.

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make. The Senior Claims Adjuster will play a critical role in delivering quality claim file management and an industry-leading customer claims experience., This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers.. How You’ll Do ItClaims Technical Management: - Independently handle all aspects of the workers’ compensation claims from set-up to closure. - Evaluate and handle high dollar, high exposure, complex claims. - Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change. - Mitigate the complex exposure while achieving the best outcome. - Determine timely and accurate compensability decisions within statutory requirements. - Set and adjust timely/accurate reserves within authority limits to ensure reserving activities are consistent with the case facts and company best practices. - Ability to present claims to senior management, internal and external stakeholders. - Timely administration of statutory medical and indemnity benefits throughout the life of the claim. - Comply with all applicable statutory guidelines, rules, and regulations. - Control legal activity with defense counsel through the litigation process while managing legal fees and costs. - Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement. Claims Customer Service: - Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations. - Assist as necessary in providing claim status to agents and insureds, coverage verification and loss run reports, etc. - Provide excellent customer service to internal and external customers and business partners. - Advocate to ensure that Pie has a leading claims customer experience. - Work to continuously improve our claims operations and look at opportunities and gaps in claim service, handling SOPs, protocols and processes. The Right Stuff - High School Diploma or equivalent is required. - Bachelor's Degree or equivalent experience with some college coursework is preferred. - Minimum of 5-years workers’ compensation claim adjusting experience is required (carrier background, preferred). - Claims experience working in at least two of these states is preferred: Alabama, Arkansas, Colorado, Connecticut, Delaware, DC, Indiana, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Nebraska, New Hampshire, Rhode Island, Vermont, West Virginia, Wisconsin. - Ability to evaluate and identify high dollar, high exposure, complex claims. - Requires active licensing in applicable states Strong communication (written and verbal) skills, to deliver more complex information effectively. - Strong problem-solving skills to be able to manage complex tasks and work through to solutions with little guidance and direction. - Awareness of your own tasks and how it impacts the team and deliverables. - Experience using G-Suite Tools and collaboration tools like Slack is preferred. - Advanced knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements. - Advanced knowledge and experience in claim adjudication, medical, and litigation management. - Advanced ability to analyze and take necessary action in multiple focus areas based on several data points. - Ability to make claim decisions to mitigate exposure while achieving the best outcome. - Ability to use skills to overcome conflict and reach beneficial outcomes. - Ability to mentor junior adjusters. The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process. Base Compensation Range $85,000—$110,000 USD Compensation & Benefits - Competitive cash compensation - A piece of the pie (in the form of equity) - Comprehensive health plans - Generous PTO - Future focused 401k match - Generous parental and caregiver leave - Our core values are more than just a poster on the wall; they’re tangibly reflected in our work Our goal is to make all aspects of working with us as easy as pie. That includes our offer process. When we’ve identified a talented individual who we’d like to be a Pie-oneer , we work hard to present an equitable and fair offer. We look at the candidate’s knowledge, skills, and experience, along with their compensation expectations and align that with our company equity processes to determine our offer ranges. Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members. Location Information Unless otherwise specified, this role is remote. Remote team members must live and work in the United States (territories excluded) and have access to reliable, high-speed internet. Additional InformationPie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic. Pie Insurance participates in the E-Verify program. Please click here, here and here for more information. Pie Insurance is committed to protecting your personal data. Please review our Privacy Policy. Safety First: Pie Insurance is committed to your security during the recruitment process. We will never ask you for credit card information or ask you to purchase any equipment during our interview or onboarding process. Pie Named to 2025 America's Best Startup Employers Pie Insurance 2025 State of Workplace Safety Report #LI-REMOTE #BI-REMOTE