• To analyze complex or technically difficult general liability claims to determine benefits due. • To work with high exposure claims involving litigation and rehabilitation. • To ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements. • To identify subrogation of claims and negotiate settlements. • 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.

Role Description This is not an adjuster role and will not be expected to handle a caseload. The Workers’ Compensation Program Specialist is a professional, fully remote role that reports directly to the Workers’ Compensation Manager. As a member of the (corporate) Safety team, the Workers’ Compensation Program Specialist will: - Provide day-to-day administrative and operational support of the workers’ compensation program. - Assist in the overall coordination of the workers’ compensation claims program. - Ensure local teams report workers’ compensation claims in a timely manner and maintain complete and accurate documentation. - Guide and support local teams with basic information needed in the monitoring and management of ongoing workers’ compensation claims. - Partner with the Workers’ Compensation Manager to collaborate with internal stakeholders (HR, Safety, Operations) and external partners (insurance carriers, third-party administrators) to identify process improvement opportunities and ensure regulatory compliance. - Maintain strict confidentiality of employee medical information and workers’ compensation claim data. - Support the ongoing development, implementation, and enhancement of return-to-work and light-duty programs. - Assist in continuous program improvement opportunities to ensure a best-in-class workers’ compensation program for all associates. - Coordinate and schedule workers’ compensation related meetings and training sessions, as needed. - Develop, prepare, and distribute workers’ compensation reports as directed by the Workers’ Compensation Manager. - Complete additional Safety-related administrative tasks as assigned. Qualifications - Associate’s degree in Human Resources, Risk Management, Occupational Safety, Business Administration, or a related field (or equivalent work experience). - 3–5 years of experience supporting a workers’ compensation program, safety program, HR, risk management, or related function. - Working knowledge of workers’ compensation principles, including incident reporting, claim lifecycle awareness, and return to work concepts. - Experience collaborating with insurance carriers, third party administrators (TPAs), or internal claims partners. - Strong understanding of the importance of timely incident reporting and accurate documentation. - High level of discretion with the ability to maintain confidentiality of medical and claim information. - Proficiency in Microsoft Office (Excel, Word, PowerPoint, Outlook), with the ability to prepare reports and track program metrics. - Excellent written and verbal communication skills, with the ability to explain workers’ compensation processes to non-technical audiences. - Strong organizational and time management skills, with the ability to manage multiple priorities in a remote environment. - Ability to work independently while maintaining strong collaboration with cross-functional teams. Requirements - Experience supporting a multi-state workers’ compensation program. - Familiarity with OSHA recordkeeping basics and the relationship between safety incidents and workers’ compensation claims. - Experience assisting with return to work or light duty programs. - Prior experience in distribution, manufacturing, warehousing, or logistics environments. - Experience preparing monthly or executive level reports related to workers’ compensation or safety performance. - Knowledge of common workers’ compensation systems or incident management platforms (e.g., risk management or TPA portals). - Experience with the handling or oversight of workers' compensation claims in the state of California. - Professional certifications such as: ARM, AIC, WCIS. Benefits - Comprehensive benefits package designed to support your life, health, and future. - Benefits begin 0–90 days after hire and include: - Vacation, Personal, and Sick time - Medical, Dental, Vision, Life Insurance, and Disability coverage - Flexible Spending Accounts - 401(k) plan - Discounts on brand‑name apparel - Fun employee events - Meaningful opportunities for growth and advancement Working Environment The job will be performed remotely. There may be some travel which will be less than 1%, if at all. Equal Opportunity Employer S&S Activewear welcomes people of all backgrounds and experiences and are committed to creating a diverse culture and supporting human growth. We are proud to be an equal opportunity employer and are committed to providing equal opportunity for all employees and applicants.

Overview As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This is not a physical investigator role. Responsibilities - Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse. - Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review. - Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation. - Conducts investigation-related training. - Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. - Negotiates settlement agreements to resolve disputes. - Maintain current knowledge of relevant laws, regulations and standards. - Participates in special projects as required. This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change. Qualifications - Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience. - 5-8 years of related investigative experience. - Advanced level skills in Excel. - Excellent verbal and written communication skills. - Strong listening and observation skills. - Attention to detail and high level of accuracy. - Effective organizational and prioritization skills with multi-tasking ability. - Preferred certifications: - Accredited Healthcare Fraud Investigator (AHFI), - Certified Fraud Specialist (CFS), - Certified Fraud Examiner (CFE), - Certified Forensic Interviewer (CFI), or - Certified in Healthcare Compliance (CHC). Job Demands: - This is a work-at-home position. Access to high-speed internet is required (all other equipment will be provided). - Must be able to sit and use a computer keyboard for extended periods of time. - Travel up to 15%. - Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones. - After hours and/or weekend work is required where necessary for major deliverables/deadlines (not consistent). Mental Requirements: - Communicating with others to exchange information. - Assessing the accuracy, neatness, and thoroughness of the work assigned. Physical Requirements and Working Conditions: - Remaining in a stationary position, often standing or sitting for prolonged periods. - Repeating motions that may include the wrists, hands, and/or fingers. - Must be able to provide a dedicated, secure work area. - Must be able to provide high-speed internet access/connectivity and office setup and maintenance. Base compensation ranges from $70,000 to $90,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page. Date of posting: 3/6/2026 Applications are assessed on a rolling basis. We anticipate that the application window will close on 5/6/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected. #senior #LI-JB1 #LI-Remote

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence Health Plan is calling an Associate Utilization Review Specialist who will: - Be responsible for all core functions in the Prior Authorization (PA) Department - Coordinate and execute the review and research functions required to support the PA Department - Investigate, review, and prepare all requests for prior authorization review for all lines of business (LOB) in multiple applications (Facets, CIM, CareAdvance, etc.) while using multiple resources to support the review (Medical Policies, KMS, Benefit Grids, Handbooks, etc.) - Critically assess and prepare all cases for RN/MD review of coverage (medical necessity, eligibility, network status, regulatory) - Uses appropriate resources and sound judgement to review and approve specific service requests based on deep understanding of medical service requested, CPT/HCPCS codes, and plan design. Authorizes select medical services - Provide research, assessment, and proposed resolution of operational issues as they relate to coverage policy, correct coding (CPT/HCSPCS, Dx), regulations, and other coverage rules - Take incoming phone calls from providers and members regarding operational plan functions with an ability to research and follow-up on unique prior authorization related requests and plan processes for all lines of business - Responsible for ensuring service review requests and inquiries are complete and adjudicated to meet regulatory and compliance requirements, including timeliness - Consult, or triage to, appropriate subject matter experts internally and across departments - Work in a fast-paced environment with strict compliance and turn-around-times for all work metrics (prior authorization requests, customer service inquiries, provider resolutions, etc.) This position offers 100% remote work for candidates residing in Portland, Oregon. Required Qualifications: - Bachelor's Degree in Health related field., or Applicable 2 years work experience may be substituted for some education. - 2 years experience in healthcare related field (or equivalent education) - 1 year experience and proven track record of researching and resolving complex problems which required critical thinking - 2 years experience in fast-paced working environment with a proven record of successful ability to quickly prioritize and resolve issues to meeting timeliness and quality metrics. - 1 year experience in database management and spreadsheets. - 6 months experience with telephony systems, call center phone volumes and multi-line communication systems. Preferred Qualifications: - 3 years experience in healthcare related field (or equivalent education) Why Join Providence Health Plan? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.