Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound calls, creating authorizations via phone, Care Advance Provider Tool, and fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment. Essential Accountabilities: Level I - Facilitates inbound and outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center environment. - Responds to customers in a professional, efficient manner to encourage public acceptance of products, services, and policies. - Perform triage for UM Services. - Serves as the primary contact for providers regarding authorization requests. - Contacts members and providers concerning regulatory requirements relating to Department of Health (DOH) notifications and other regulatory requirements such as the National Committee for Quality Assurance (NCQA) guidelines. - Provides timely response to all research inquiries from other departments and assures the response is thorough, accurate, and within regulatory timeframes. - Processes fax requests from the designated fax and system queues. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. - Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. - Regular and reliable attendance is expected and required. - Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) - Assists and performs tasks associated with project and departmental management. - Backup Team Leads by assisting with questions when needed. - Work on assigned offline projects. - Provides, prepares, and assists with preliminary support to multiple levels of providers and or members (as well as others as needed), including but not limited to physicians, skilled nursing facilities, mid-level providers, members, pharmacies, pharmacists, and support staff. - Provide one-on-one support, coaching, and training to UM Services Reps. - Collaborates with other key departments (Claims, Customer Service, related care management units) to ensure end-to-end process for authorizations, telephonic notifications, and/or care management referrals is accurate and complete. Level III (in addition to Level II Accountabilities) - Assists Team Leads with assigned tasks when necessary (including but not limited to authorizations, claims, care management referrals, monitoring and controlling inventory levels/call queues, timeliness, reporting). - Meet departmental requirements for Facets UM Services workflows and PEGA. - Resolves escalated customer questions and complex concerns. - Assists Medical Directors with scheduling Fair Hearings. - Assists with coordinating Grievance and Appeals requests. - Assist with all Blue Card Claims escalations. - Assist management with the review and creation of desk level procedures, acting as a subject matter expert for UM Services. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels - High School Diploma or GED. - Experience with using a desktop computer in a professional environment, preferably with Microsoft Office Products. - Call center experience preferred, not required. - Strong analytical and problem-solving skills. - Strong written and verbal communication skills and ability to work within a team. - Demonstrated organizational skills to manage multiple projects and priorities. - Self-motivated and able to work independently, as well as on intra- and inter-departmental teams where needed. Level II (in addition to Level I Qualifications) - 2 years’ experience working with managed care or healthcare industry. - Ability to apply in-depth knowledge of complex rules, such as those of the authorization process, regulatory processes/time frames, care management systems and processes, departmental policies and procedures, product lines, and contract benefits. - Advanced skills working between multiple programs and applications simultaneously. - Demonstrates willingness to develop collaborative solutions to achieve a better end-to-end process. - Demonstrates proficiency in basic navigation and utilization of department specific applications. - Demonstrates role-specific competencies as it pertains to their work unit on a consistent basis. - Active demonstration of broad knowledge base and positive work habits as evidenced by ability to train new staff, take on new challenges, flexibility in work assignments, and participation in meetings and projects as assigned. Level III (in addition to Level II Qualifications) - 4 years’ experience working with managed care or healthcare industry. - Demonstrates a thorough knowledge and understanding of sources of information about health plan contracts, riders, policy statements, and procedures to identify eligibility and coverage and assisting other staff and other areas within the company with related inquiries. - Demonstrates operational knowledge of FACETS application and workflow processes - Ability to resolve/respond to customer inquiries across multiple plans with limited assistance. - Ability to collaborate within the organization when issues arise with limited assistance. - Ability to identify potential systemic issues and report as necessary without supervisor assistance. Physical Requirements: - Ability to work prolonged periods sitting at a workstation and working on a computer. - Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. - Ability to work in a home office for continuous periods of time for business continuity. - Ability to travel across the Health Plan service region for meetings and/or trainings as needed. - Manual dexterity including fine finger motion required. - Repetitive motion required. - The ability to hear, understand and speak clearly while using a phone, with or without a headset. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I - Min 18.55 Mid 22.72 Max 26.90 Level II - Min 19.22 Mid 24.99 Max 30.76 Level III - Min 20.02 Mid 26.52 Max 33.03 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Responsible for managing to resolution appeal scenarios for all products, which contain multiple issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from standard processes to complete. Act as a subject matter expert by providing training, coaching, or responding to complex issues. May have contact with outside plan sponsors or regulators. • Research and resolves incoming electronic appeals as appropriate as a “single-point-of-contact” based on type of appeal. • Can identify and reroute inappropriate work items that do not meet complaint/appeal criteria as well as identify trends in misrouted work. • Assemble all data used in making denial determinations and can act as subject matter expert with regards to unit workflows, fiduciary responsibility and appeals processes and procedures. • Research standard plan design, certification of coverage and potential contractual deviations to determine the accuracy and appropriateness of a benefit/administrative denial. • Can review a clinical determination and understand rationale for decision. • Able to research claim processing logic and various systems to verify accuracy of claim payment, member eligibility data, billing/payment status, and prior to initiation of the appeal process. • Serves as point person for newer staff in answering questions associated with claims/customer service systems and products. Educates team mates as well as other areas on all components within member or provider/practitioner complaints/appeals for all products and services. • Coordinates efforts both internally and across departments to successfully resolve claims research, SPD/COC interpretation, letter content, state or federal regulatory language, triaging of complaint/appeal issues, and similar situations requiring a higher level of expertise. • Identifies trends and emerging issues and reports on and gives input on potential solutions. • Delivers internal quality reviews, provides appropriate support in third party audits, customer meetings, regulatory meetings and consultant meetings when required. • Understands and can respond to Executive complaints and appeals, Department of Insurance, Department of Health or Attorney General complaints or appeals on behalf of members or providers as assigned. Required Qualifications: - 1 year experience in reading or researching benefit language in SPDs or COCs - Demonstrated ability to handle multiple assignments competently, accurately and efficiently. - Excellent verbal and written communication skills. - Computer navigation ability and ability to multitask. - Excellent customer service skills. - Strong Leadership skills - Experience documenting workflows and reengineering efforts. Preferred Qualifications: - 1 year of experience in research and analysis of claim processing. - 1-2 years Medicare part C Appeals experience. - Project management skills are preferred. - Strong knowledge of all case types including all specialty case types Education: - High School Diploma Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $35.29 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Role Description The Forfeiture Specialist is responsible for data entry of bail forfeitures, judgments, court communications, court notices etc. into our electronic database and the continual management of bail forfeitures/judgments by communicating with our agent force and/or the courts and updating our databases accordingly. - Accurately and timely enter bail forfeiture/judgment data and documents into the electronic database, for states or regions assigned by management. - Manage, follow up and update bail forfeitures/judgments for the states assigned by management in the electronic databases by contacting and communicating with the agent force via phone calls and emails. - When applicable, utilize the online court websites to obtain additional updates, status’ and discharges of bail forfeitures/judgments. - Work with the Bail Account Management and Bail Accounting teams, to ensure proper and timely payment of forfeitures/judgments and/or court costs. - Process bail exonerations. - Answer company phone when needed. - Other related duties as assigned by management. Qualifications - High school diploma or equivalent required, associate’s degree preferred. - Strong knowledge of Microsoft Office program. - Excellent customer service and time management skills. - Ability to prioritize tasks assigned to meet deadlines. - Ability to multi-task. - Strong written and verbal communication skills. - Ability to learn and use new operational systems. Benefits - Competitive compensation package. - Generous 401K employer match. - Employee Stock Purchase plan with employer matching. - Generous Paid Time Off. - Excellent benefits that go beyond health, dental & vision, focused on your whole family’s wellness, including your physical, mental and financial wellbeing. - A core C&F tenet is owning your career development, providing a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training. - A dynamic, ambitious, fun and exciting work environment. - Encouragement of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program. Company Description Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. - More than 2000 employees in locations throughout the United States. - Recognized as a great place to work, earning several workplace and wellness awards, including the 2025 Great Place to Work® Award. - Part of Fairfax Financial Holdings, a global, billion dollar organization.

Role Description This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. A Medical Claims Analyst (MCA) is responsible for the intake processing and triage of all initial claim documents in a high-volume environment. This includes but is not limited to: - Referral processing - Obtaining required documents - Medical records sorting and processing - Preparing payment calculations - Preparing the claim for a Nurse review - Applying all Nurse findings to the claim - Preparing and sending reports - Preparing and sending provider packets This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm MST. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule. Primary Responsibilities: - Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims - Analyze and identify trends and provide reports as necessary - Consistently meet established productivity, schedule adherence and quality standards This is a challenging role that takes an ability to thoroughly review, analyze and research complex healthcare claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You’ll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will support timely processing of the member's claim. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Qualifications - High School Diploma / GED OR equivalent years of work experience - Must be 18 years of age OR older - 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools - Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications - Experience with Microsoft Word (create correspondence and work within templates) and Microsoft Outlook (email and calendar management) - Intermediate experience with Microsoft Excel (Sorting and filtering data, using formulas, and working with Tables) - Ability to work Monday – Friday, 08:00AM – 05:00PM MST Requirements - Familiarity with UB04’s - 1+ years of experience processing medical, dental, prescription or mental health claims - 1+ year of experience processing insurance claims or billing/collections in a healthcare or commercial setting - Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work Telecommuting Requirements - Ability to keep all company sensitive documents secure (if applicable) - Required to have a dedicated work area established that is separated from other living areas and provides information privacy - Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Soft Skills - Attention to detail Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.