JOB DESCRIPTION Job Title Insurance Follow-up Specialist FLSA Non-Exempt Reports to Manager Grade D Location Remote Band 1A Summary/Objective Under limited supervision the Insurance Follow-up Specialist reviews and manages the billing and collections for hospitals and physicians. This type of specialist acts as an intermediary between the medical institution, patients, and the insurance agency. They assist in filing insurance claims, determining correct reimbursements/ adjustment/write-offs, and denial management. They also analyze plans to determine which benefits are covered, submit secondary insurance claims, generate patient statements, and follow-up on those submissions. Essential Job Functions - Work with insurance companies on behalf of hospitals and physician practices to resolve outstanding issues. - Analyze claims (denial/non-denial) in practice management systems, internal system and direct toward resolution (Payment, Adjustment & self-pay). - Technical billing and denial follow-up on all assigned payer claims - Call Payer (Insurance/ third parties) to resolve claims (denial/non-denial) after review from PMS, internal system & process toward resolution (Payment, Adjustment & self-pay). - Identify potential process improvements, trends, issues and escalate to Supervisor. - Be part of initial and all ongoing training session to enhance knowledge of RCM processes. - Resolve complex patient account issues requiring investigation of system timeline comments, payer reimbursements and account transactions. - Identify trends/payer issues and escalate complex payer issues to the lead billing specialist, as necessary. - Maintain a working knowledge of client policies and procedures. Follow the Workflow documentation like SOP’s Update tracker, Issue Log and Trend logs. - Maintain quality standards as determined by management. - Assist the Manager or Team Lead in working priority reports promptly, effectively, and efficiently. - Maintain accurate records within a collections database. - Be a mentor to new employees and assist in their training and development. - Performs other duties as directed. - Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance. Key Success Indicators/Attributes - Ability to prioritize and multi-task in a fast-paced, changing environment. - Demonstrate ability to work in all work types and specialties. - Demonstrate ability to self-motivate, set goals, and meet deadlines. - Demonstrate leadership, mentoring, and interpersonal skills. - Demonstrate excellent presentation, verbal and written communication skills. - Ability to develop and maintain relationships with key business partners by building personal credibility and trust. - Maintain courteous and professional working relationships with employees at all levels of the organization. - Work in accordance with corporate and organizational security policies and procedures, understand personal role in safeguarding corporate and client assets, and take appropriate action to prevent and report any compromises of security within scope of position. - Demonstrate excellent analytical, critical thinking and problem-solving skills. - Manage the Individual KRA’s as per the provided metrics. - Understand client requirements and specifications of the project & Ensure targeted collections are met on a daily / monthly basis. - Meet the productivity targets of clients within the stipulated time. Ensure timely follow up on pending claims and to prepare and Maintain individual status reports. - Skill in operating a personal computer and utilizing a variety of software applications is essential. - Knowledge of coding convention and rules established by the AHIMA, American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes is an added advantage. - Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation is an added advantage. Supervisory Responsibility No Work Environment This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. Position Type/Expected Hours of Work This is a full-time position. Schedule is M-F 8am-4pm EST without a lunch, with a lunch it is M-F 8am-430pm EST. This position occasionally requires long hours and weekend work. Travel Minimal travel required; up to 5% Required Education and Experience Knowledge of medical and insurance terminology such as CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible or co-insurance, and full understanding of hospital/physician billing. Minimum 1-2 years’ experience in Medical Billing/Coding and experience with standard office software products. High School diploma or equivalent. Preferred Education and Experience N/A Additional Eligibility Qualifications N/A Security Access Requirements In addition to the specific security access required by the employee’s client engagement, the employee will have access to the Omega set forth in the “Omega Field Employee” profile. AAP/EEO Statement Omega is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status. Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Employee may perform other duties as assigned. Qualifications for Internal Candidates Same Posting Description for Internal and External Candidates Qualifications for Internal Candidates Same Posting Description for Internal and External Candidates

At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers’ expectations while making a real impact for our company through our shared purpose. When you join our company, we want you to feel valued, supported and proud to work here. That’s why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers. Multi-line Adjuster - Houston, TX and surrounding areas. *Starting pay rate varies based upon position and location. Ask your Recruiter for details! Sign on bonus: $1,500 for candidates who hold an adjusters license that is active and in good standing. ** This is a remote position but will have to go into the field and travel as needed ** We are looking for a highly motivated and service-oriented individual to join our Multi-line Damage team as a Multi-line Adjuster! As an ambassador for GEICO's renowned customer service, you will work in a dynamic environment that may include repair shops, salvage yards, a customer's home or in a virtual estimating environment. You will be responsible for inspecting damage, estimating cost of repairs, negotiating settlements, issuing payments, and providing excellent customer service. This position primarily will include servicing boat, motorcycle, RV and other specialty claims. Qualifications & Skills: Valid driver’s license (must meet company underwriting guidelines for at least the past 3 consecutive years) and the ability to maintain applicable state and federal certifications and permits Willingness to be flexible with primary work location – position may require either remote or in-office work Solid computer, mechanical aptitude, and multi-tasking skills Effective attention to detail and decision-making skills Ability to effectively communicate, verbally and in writing, and willingness to expand on these abilities Minimum of high school diploma or equivalent, college degree or currently pursuing preferred Requirements: Experience appraising automobiles - 2 years minimum Preferred experience appraising motorcycles and RV's Strong Customer Service skills - Ability to interact with customers and repair facilities Must be able to obtain Texas all line adjusters license At this time, GEICO will not sponsor a new applicant for employment authorization for this position. The GEICO Pledge: Great Company: At GEICO, we help our customers through life’s twists and turns. Our mission is to protect people when they need it most and we’re constantly evolving to stay ahead of their needs. We’re an iconic brand that thrives on innovation, exceeding our customers’ expectations and enabling our collective success. From day one, you’ll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people’s lives. Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career – and your potential – in mind. You’ll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels. Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose. As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers. Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future. - Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family’s overall well-being. - Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance. - Access to additional benefits like mental healthcare as well as fertility and adoption assistance. - Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year. The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled. GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.

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.