Role Description As a key member of our Disability Claims team, you’ll guide insurance claims from start to finish—making informed decisions that directly affect our customers’ financial well-being. Your experience in STD and LTD claims ensures timely, accurate support and builds trust in our company’s promise to protect. - Short Term Disability Class starts on Monday, May 18th. - Long Term Disability Class starts on Monday, June 1st. - Training hours are from 7:30 a.m. to 4:00 p.m. CST for up to 14 weeks. WHAT YOU'LL DO: - Make decisions in partnership with management based on a comprehensive understanding of claim facts and thorough evaluation of relevant information. - Develop case files that showcase sound decision-making in accordance with documented procedures, using claim facts, policy provisions, and special handling agreements. - Foster effective business relationships through clear communication with claimants, brokers, sales organizations, vendor partners, employers, and internal departments such as underwriting and legal. - Thoroughly document all claim decisions and actions meticulously, maintaining regular and appropriate communication. - 50% of your day will be on the phone with claimants, employers, and medical professionals throughout the entire claims life cycle. - Review and determine ongoing claim liability, involving the evaluation of claim documentation, resolution of queries, and identification of any changes in claim status or benefits. - Collaborate with internal and external partners, including brokers, sales organizations, clinical and physician resources, vocational experts, and financial resources. - Accurately determine financial liability by analyzing salary, other income sources, medical/vocational information, and contract language. - Exercise limited autonomy to approve initial and ongoing payments based on a holistic file evaluation. Qualifications - Demonstrate a foundational ability to analyze, comprehend and apply insurance provisions and contracts to disability claims. - Ability to calculate disability benefits based on contract provisions and offset management to provide fair, equitable and consistent treatment of claims necessary for accurate financial payments and policyholder retention and satisfaction. - Proficient with navigating multiple systems and Microsoft Office Suite. - Provide a solid level of customer service (written and verbal) while displaying empathy to customers. - Promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously, remaining curious in all that you do. - Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico. Requirements - 1 year of disability claim experience in STD or LTD (preferred). - Bilingual Spanish both verbal and written communication (preferred). Benefits - Estimated Wage (Levels have variable responsibilities and qualifications): - Benefit Claim Specialist: $26.00 - $27.00, plus annual bonus opportunity. - Sr Benefit Claim Specialist: $56,000 - $70,000, plus annual bonus opportunity. - 401(k) plan with a 2% company contribution and 6% company match. - Work-life balance with vacation, personal time and paid holidays.

Overview Being good neighbors – helping people, investing in our communities, and making the world a better place – is who we are at State Farm. It is at the core of how we operate and the reason for our success. Come join a #1 team and do some good! Responsibilities As an Auto Estimator, you will collect vehicle information from repair shops or customers and complete initial and supplemental estimates via photos or in person. You may be the first point of contact to meet with our insureds, explain coverage, estimate vehicle damage, and help them through the claims process while providing Remarkable® service. This includes: - Utilizing automated estimating systems to prepare repair estimates - Providing technical support to claim handlers on vehicle repair issues - Applying knowledge of market value and other factors affecting reparability issues - Evaluating bid content and photo documentation, vehicle damage, and causation issues - Answering inbound calls and making outbound calls to customers - Providing exceptional customer service throughout the claims process, addressing inquiries and concerns promptly and professionally - May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions Where You'll Work: This is a Remote-Field position in which you will work from home and utilize a mobile office/vehicle for in-person appointments. This position is located in Stockton, CA. Competitive canddiates should reside within a commutable distance of this territory. The Appraiser Team works remotely but may require travel to auto shops for in-person inspections, and/or State Farm offices as needed. Candidates may be asked to work outside of their assigned territory as business needs dictates. Hours of operation are continually evaluated and may change based on business need. Successful candidates are able and willing to work flexible work shifts and may be asked to work overtime and/or irregular hours. Qualifications Competitive candidates must demonstrate the following: - Auto collision repair, auto damage estimating, and/or auto insurance appraiser experience - Excellent customer service, critical thinking, and decision-making skills - Strong written and verbal communication skills - Ability to multi-task across technical platforms - Accountability and Resourcefulness - Physical agility to allow for stooping, bending, and some physical lifting to adequately evaluate vehicle damage and create repair estimates - A valid driver’s license is required Preferred Skills: - Motor Vehicle Physical Damage Appraiser License - CCC One and/or Mitchell knowledge - I-CAR Platinum Certification Additional Details: - Employees must successfully complete all required training, including applicable licensing exam(s), Motor Vehicle Record (MVR) checks, and background checks required of various state(s). - State Farm recently implemented new pre-employment assessments. Candidates that have previously taken an assessment may be asked to participate in additional testing Our Benefits Because work-life balance is a priority at State Farm, compensation is based on our standard 38:45-hour work week! - Potential starting salary range: $73,824.56 - $102,500.00 annually. - Starting salary will be based on skills, background, and experience - High end of the range limited to applicants with significant relevant experience - Potential yearly incentive pay up to 15% of base salary At State Farm, we offer more than just a paycheck. Check out our suite of benefits designed to give you the flexibility you need to take care of you and your family! - Get Paid! On top of our competitive pay, you are eligible for an annual raise and bonus. - Stay Well! Focus on you and your family’s health with our robust health and wellbeing programs. State Farm pays most of your healthcare premium, and we offer multiple healthcare plan options, including a high deductible plan. All medical plans provide 100% coverage for in-network preventative care, AND you and your family have access to vision, dental, telemedicine, 24/7 mental health professionals, and much more! - Develop and Grow! Take advantage of educational benefits like industry leading training programs, top-notch tuition assistance programs, employee resource groups, and mentoring. - Plan Ahead! Plan for those big moments in life with benefits like fertility/IVF/adoption assistance, college coaching, national discount programs, interactive monthly financial workshops, free financial coaching, and more. You can also start a savings account or consider financing through our State Farm Federal Credit Union! - Take a Little “You” Time! You will have access to our generous time off policies designed so you can plan around holidays, family events, volunteering, or just to take a relaxing day off. With the opportunity to initially earn up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service/education support days, there will be plenty of time for you! - Give Back! We offer several ways to give back through our Matching Gift Program, Good Neighbor Grant Program, and the Employee Assistance Fund. - Finish Strong! Plan for retirement using free financial advisors and a 401(k) plan with company contributions of up to 7% of your salary. Visit our State Farm Careers page for more information on our benefits, locations, and the hiring process of joining the State Farm team!

Pharmacy Benefit Specialist-2--------------------------------------------------------------- This position is responsible for working with CareOregon members, their providers, and pharmacies to support the pharmacy benefit and prescription needs under the major medical benefit. Core responsibilities include customer service and claims processing, as well as assistance with prior authorizations, formulary exceptions, appeals, grievances, and projects. Estimated Hiring Range: $20.51 - $25.06 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Customer Service and Claims Processing - Communicate in a professional and respectful manner. - Maintain confidentiality within HIPAA regulations and function on “need to know” principles. - Respond to drug coverage inquires in an accurate and timely manner to members, members’ representatives, providers, and CareOregon staff. - Educate members, providers, pharmacies, and CareOregon staff about the CareOregon formularies and pharmacy benefit policies. - Document all customer service activities according to organization requirements. - Follow policies and procedures to answer questions from members, providers and CareOregon staff regarding claims processing as it pertains to the CareOregon pharmacy benefits and coverage of drugs under the major medical benefit. - Follow policies and procedures to determine a resolution to pharmacy claims adjudication issues or triage to other CareOregon staff for assistance. Data Entry and Clerical Support - Sort incoming faxes and distribute according to assignments. - Maintain files according to unit protocols. - Perform data entry into the claims processing system, document management systems, databases and spreadsheets as assigned. - Clerical Assistance for pharmacy projects, including, but not limited to distribution of education materials to members, providers or pharmacies, letters & mailings, and reports. Prior Authorizations (PA) and Formulary Exceptions - Verify member’s plan eligibility and applicable benefit for drug coverage. - Review member’s medication and eligibility history, load authorization in claim adjudication platform(s). - Assist members and providers with the PA, formulary exception and coverage determination process. - Follow policy & procedures to facilitate a resolution for prior authorization, formulary exception and coverage determinations requests. Notify members, providers or providers staff of prior authorization and formulary exception decisions. Appeals and Grievances - Explain pharmacy appeal and grievances provisions and process to members, providers and CareOregon staff. - Assist PBS II and PBS Lead with setting up pharmacy benefit appeals and grievances. Project Coordination - Minimal project participation. Experience and/or Education Required - Minimum 1 year work experience on a pharmacy team (i.e., retail, long-term care, or hospital) or 1 year experience in a health insurance plan Preferred: - Pharmacy Technician experience Knowledge, Skills and Abilities Required Knowledge - General understanding of managed care, Medicare, and Oregon Health Plan concepts Skills and Abilities - Proficient with Microsoft Office Products and general computer literacy - Familiarity with medical and pharmaceutical terminology - Ability to learn and effectively navigate CareOregon and PBM software programs necessary to perform job responsibilities - Ability to follow policies and procedures in performing job responsibilities - Effective listening, verbal, and written communication skills - Ability to exercise professionalism - Growing ability to network and utilize internal and external resources - Ability to focus on and comprehend information - Ability to learn new skills and abilities - Ability to assess a situation and use critical thinking skills and company resources to determine a solution - Ability to accept managerial direction and feedback - Ability to tolerate and manage stress - Results and service oriented - Ability to be flexible and adaptable - Ability to organize, plan, and prioritize daily workflow within time constraints - Ability to work in an environment with diverse individuals and groups - Ability to learn, focus, understand, and evaluate information and determine appropriate actions - Ability to accept direction and feedback, as well as tolerate and manage stress - Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day - Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☐ No ☒ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

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.