The job profile for this position is Case Management Analyst, which is a Band 2 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. The Claims & PR Advocate is a phone queue-based position responsible for servicing inbound claim-related calls from members, providers, and provider office staff. Advocates will handle back-to-back calls throughout the day, with occasional outbound calls required to resolve claim issues. This role demands strong multitasking, technical proficiency, and independent problem-solving skills. Note: This position requires a Bachelor’s degree to qualify. Key Responsibilities: - Answer inbound calls from members and providers regarding claims, contracting, and provider relations. - Work in a structured call queue environment, handling a high volume of calls daily. - Make outbound calls as needed for issue resolution or follow-up. - Use multiple applications during calls to research and resolve inquiries. Call topics may include: - Claim status inquiries and explanations - Requests for claim reprocessing or adjustments - Provider contract questions and demographic updates - Authorization corrections to ensure proper claim payment - Requests for duplicate EOBs or check reissuance - Escalated issue handling via Advocate Handoff/Help Request (AHHR) - Complaint submissions on behalf of members or providers - Emailing resources and documentation to callers Required Skills: - Proven customer service experience - Prior experience in Evernorth Behavioral Care Specialist/Advocacy role preferred - Experience handling behavioral health claims and provider relations calls is a plus - Ability to thrive in a virtual team environment - Strong interpersonal and communication skills - Effective listening and organizational abilities - Technical aptitude with multiple systems and applications - Independent problem-solving and time management skills - Proficient typing and PC skills Training Schedule: - Monday through Friday, 8:30 AM – 5:00 PM CT Work Schedule: - After training, shifts are Monday through Friday between 7:00 AM – 7:00 PM CT - The recruiter will provide specific shift options Education Requirement: - Bachelor’s degree is required 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. For this position, we anticipate offering an hourly rate of 24 - 37 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead - Workers Compensation - Must Reside in Nevada Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? - Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. - Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. - Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. - Enjoy flexibility and autonomy in your daily work, your location, and your career path. - Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. PRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. * Candidates must reside in NEVADA * ESSENTIAL RESPONSIBILITIES MAY INCLUDE: - Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit. - Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office. - Provides technical/jurisdictional direction to examiner reports on claims adjudication. - Compiles reviews and analyzes management reports and takes appropriate action. - Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards. - Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal. - Reviews reserve amounts on high-cost claims and claims over the authority of the individual examiner. - Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client. - Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client. - Assures that direct reports are properly licensed in the jurisdictions serviced. - Ensures claims files are coded correctly, and adequate documentation is made by claims examiners. - Performs other duties as assigned. - Supports the organization's quality program(s). - Travel as required. QUALIFICATIONS Education & Licensing - Bachelor's degree from an accredited college or university preferred. - Nevada Staff Adjusters License obtained within 3 months of hire. Experience Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience. Licensing / Jurisdiction Knowledge: Nevada TAKING CARE OF YOU - Flexible Work Schedule - Referral Incentive Program - Opportunity to work from home - Career development and promotional growth opportunities - A diverse and comprehensive benefits offering including medical, dental vision, 401K on day 1 As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($73,000 - $90,000). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

• Process and manage large amount of incoming and current claims. • Communicate with customers regarding open claims. • Discuss claims & file claims with the shipping companies, such as UPS & FedEx. • Answer claims inquiries via email, live chat, and telephone. • Answer customer support questions. • Scanning documents.

Imagine a career at one of the nation's most advanced health networks. Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work. LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day. Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network. Summary Reviews and identifies overpayments for self-pay and insurance credit balances processing refunds as appropriate. Ensures compliance with hospital policies and procedures. Works to facilitate resolution of refunds through attention to detail, problem solving initiative, and dedication to efficient service for patients and insurance companies. Job Duties - Identifies and resolves credit balances by utilizing the latest software through assigned work queues. - Processes self pay and insurance refunds with the goal of account accuracy by documenting actions taken to initiate refund in account history. - Documents all communications regarding refunds or refund requests in the account history, scanning documentation received to the patient HAR. - Provides assistance to customer or other PFS areas regarding account reconciliation questions and discrepancies. - Reviews refund checks issued and records the refund in account history taking the steps necessary to mail the refund with the appropriate documentation. - Understands all payor contracts to ensure overpayments are refunded to the third party payors validating that patient responsibility is accurately reflected on the HAR. - Reviews checks that are not cashed through the Escheat process, taking the appropriate action required for resolution. Minimum Qualifications - High School Diploma/GED - 3 years physician or hospital billing/insurance follow up experience or - 2 years refunding experience utilizing an automated patient accounting system - Knowledge of insurance companies contracts and regulations. - Mathematical competency to understand debits, credits, adjustments, and reconciliation. - Strong analytical, problem solving, and organizational skills. - Ability to utilize Microsoft Office Suite (Word, Excel, PowerPoint and Outlook). - Successful completion of DOE and Revenue Cycle Education within 3 months of hire. Preferred Qualifications - Associate’s Degree Healthcare Administration, Finance or Business - CPAT - Certified Patient Accounting Technician - State of Pennsylvania Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR. Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require. Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities. https://youtu.be/GD67a9hIXUY Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes. Work Shift: Day Shift Address: 1200 S Cedar Crest Blvd Primary Location: REMOTE IN PENNSYLVANIA Position Type: Remote Union: Not Applicable Work Schedule: Monday-Friday 6am-6pm Department: 1004-13054 CSS-Patient Accounting