Title: Property Senior Claims Representative - Estimator Location: Westfield Center, OH, United States Work Type: Remote, Full Time Job ID: 11763 Department: Claims Adjusting Job Description: Westfield Property Claims resolves first party personal, commercial, and agriculture property claims, which include structural damage. The Inside Claims Senior Representative serves as a technical estimating expert on first party property claims damages. This role leverages technical estimating software, industry repair standards, and analytical skills to produce accurate, timely, and defensible estimates. The role may also determine applicability of coverage, investigate, establish damages, negotiate, and settle claims. The role delivers quality customer service in a high volume, moderate complex work environment, and mentors less experienced Inside Estimators on the team. Job Responsibilities - Review photos, reports, and other documentation from the inspection, to assess damage and prepare accurate estimates. - Utilize industry-standard estimating platform Xactimate, to produce detailed repair scopes. - Determine appropriate repair vs. replacement decisions based on best practices, jurisdictional code requirements, and policy coverage. - Validate the accuracy of insured and/or contractor submitted estimates and to negotiate discrepancies when necessary. - Apply current industry repair standards, materials pricing, labor rates, and construction methodologies. - Provide technical expertise to frontline claims staff. - Communicate clearly with customers, contractors, and vendors to explain scope and estimate decisions as/is necessary. - Document all file activity in accordance with company and regulatory requirements. - Support supplemental estimate reviews. - Ensure all estimates comply with company guidelines, state regulations, and industry’s best practices. - Maintain high levels of accuracy, productivity, and cycle time performance. - Provides support in negotiation of settlements with insureds, attorneys, and other insurance companies. - Manages approved vendors and counsel utilized as necessary in the claim process, including approval of investigation plans and budgets. - Monitors, reviews, and issues payments to vendors and counsel in accordance with guidelines and standards. - Establishes proper reserves for each claim based upon thorough investigation, evaluation, and experience. - Refers claims exceeding authority to appropriate manager or complex claims specialist with recommendations. - Meets established goals & objectives, arranges for salvage disposition and other recovery proceedings as necessary, participates in claim file reviews and audits with customer and broker. - Formulates sound recommendations for claims file handling, subsequent transactions, and renewal processing. - Contribute to continuous improvement efforts, guideline updates, and internal training initiatives. Job Qualifications - 4+ years of Claims Estimating experience. - Bachelor’s degree in Insurance, Business, Communications, Construction Management, or a related field and/or commensurate work experience. - Proficiency with Xactimate Licenses and Certifications - Associate in Claims (AIC) (preferred) - Xactimate Level 1–3 Certification - HAAG Residential & Commercial Inspector and/or Reviewer Certification Skills & Competencies - Strong attention to detail and technical accuracy. - Excellent written and verbal communication skills. - Ability to multitask in a fast-paced claims environment. - Customer-focused with strong problem-solving ability. - Negotiation and conflict-resolution skills. - Ability to work independently and make sound decisions. This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team. In this Role the candidate will be responsible for: • Processing of Professional claim forms files by provider• Reviewing the policies and benefits • Comply with company regulations regarding HIPAA, confidentiality, and PHI • Abide with the timelines to complete compliance training of NTT Data/Client • Work independently to research, review and act on the claims • Prioritize work and adjudicate claims as per turnaround time/SLAs • Ensure claims are adjudicated as per clients defined workflows, guidelines • Sustaining and meeting the client productivity/quality targets to avoid penalties • Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. • Timely response and resolution of claims received via emails as priority work • Correctly calculate claims payable amount using applicable methodology/ fee schedule Requirements: • 3 year(s) hands-on experience in Healthcare Claims Processing • 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools• High school diploma or GED. • Previously performing – in P&Q work environment; work from queue; remotely • Key board skills and computer familiarity – o Toggling back and forth between screens/can you navigate multiple systems. o Working knowledge of MS office products – Outlook, MS Word and MS-Excel. Preferred Skills & Experiences: • Amisys • Ability to communicate (oral/written) effectively in a professional office setting• Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities • Time management with the ability to cope in a complex, changing environment

Why Us? With a mantra of Empowering Human Potential, Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products, offering the most advanced O&P solutions, clinically differentiated programs and unsurpassed customer service. Hanger's Patient Care segment is the largest owner and operator of O&P patient care clinics nationwide. Through its Products & Services segment, Hanger distributes branded and private label O&P devices, products and components, and provides rehabilitative solutions to the broader market. With 160 years of clinical excellence and innovation, Hanger's vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value. Collectively, Hanger employees touch thousands of lives each day, helping people achieve new levels of mobility and freedom. Could This Be For You? The Priority Claims Specialist III - Remote will ensure payment for services provided is accurate, timely and fully documented. Provide efficient cash collection through excellent reimbursement practices while ensuring compliance with relevant laws, regulations and established Hanger policies and compliance programs. Provides strict adherence to adjustment, refund and write-off policies/procedures as outlined in Hanger Clinic Standard Operating Procedures. Maintain exceptional support and communication with all partners, internal and external. This is a high-dollar medical collections role operating within a Centralized Revenue Cycle Team. This is a full time, remote opportunity. Schedule will be Monday - Friday, day shift. Your Impact Responsibilities for the role will include: - Maintain a working knowledge and understanding of DMEOPS CPT and ICD-10 codes. - Utilize the company billing and collections system to identify and resolve any claims that have been unpaid, short paid and/or denied. - Review EOB's and other correspondence from insurance companies for correct reimbursement according to rules and regulations and contract terms. - Follow up with insurance companies by online portal, phone, email and/or fax. - Identify billing errors and submitted corrected claims insurance carriers. - Provide timely and accurate follow up on accounts until they are resolved. - File and follow up on appeals and disputes. - Communicate identified AR issues that may cause payment delays or write offs to management. - Document all findings with clear and concise detail. - Research insurance guidelines and manuals for additional information. - Perform adjustments in the system as needed. - Submit medical records upon request. - Resolves outstanding accounts receivable problems. Respond to and resolve inquiries from customers or external collection resources. - Primary focus is on complex denials and appeals. - Review, monitor and resolve assigned encounters and all assigned reports. - Identify issues attributing to account delinquency and discuss them with management as needed. - Provide timely follow-up on all tasks. - Effective communication with Patient Care Clinics related to collection efforts. - Complete, review, and research any deficiency to ensure that any deficiency is properly addressed and resolved. Minimum Qualifications Minimum - High school education or equivalent - 5+ years of related experience to include at least one of the following areas: Insurance reimbursement, medical policy, payor appeal requirements or patient collection laws. - Experience in a medical office. Preferred - Associate’s degree. - Experience with NextGen and/or OnBase. - Licensed Medicare auditor or Certified Medical Audit Specialist Knowledge and Skill: - Attention to detail with the ability to quickly identify trends. - Strong communication and interpersonal skills. - Working knowledge of the Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs), and policy articles. - Working knowledge of medical terminology. - Self-starter / take initiative to proactively resolve problems. - Ability to multi-task. - Strong sense of personal accountability to meet deadlines. - Working knowledge of MS Office suite programs. - Working knowledge of Electronic Health Records (EHR); such as, OPS and NextGen - Demonstrated ability to pull data and migrate into online records management systems such as OnBase; - Demonstrate high ethical standards regarding confidential patient and billing information. Additional Success Factors The ideal candidate will also demonstrate: - Strong interpersonal, oral (including telephone) and written communication skills, including the ability to follow written and verbal directions. - Works well under pressure - Attention to detail with the ability to quickly identify trends. - Resourceful and flexible team player who excels at building trusting relationships with patients, insurance companies and colleagues. - Excellent knowledge and understanding of state, federal, regional collection and reimbursement laws, HIPAA and other medical insurance regulations and terminology (CPT, ICD-9, HCPCS, modifiers, coding, and documentation guidelines) for private payer, state and federal plans including coding, billing and reimbursement protocols. - Proficient computer skills including Windows based office technologies (ex. Word, Excel, PowerPoint), e-mail and automated billing systems. - Excellent organizational skills and the ability to manage multiple tasks (ex. multitasking) with a high degree of detail orientation while working in a fast-paced environment. - Keep the patient at the center of everything that you do, building lifelong trust. - Foster open collaboration and constructive dialogue with everyone around you. - Continuously innovate new solutions, influencing and responding to change. - Focus on superior outcomes and calibrate work processes for outstanding results. #LI-Remote #LI-BH1 Pay range of $20.00 to $25.00 per hour + annual bonus: up to 5% of base pay depending on bonus criteria. This pay range is posted to comply with wage transparency laws. Hanger salary ranges vary based on skill, ability, knowledge, geographic location and other variables. Our Investment in You - Competitive Compensation Packages - 8 Paid National Holidays & 4 additional Floating Holidays - PTO that includes Vacation and Sick time - Medical, Dental, and Vision Benefits - 401k Savings and Retirement Plan - Paid Parental Bonding Leave for New Parents - Flexible Work Schedules and Part-time Opportunities - Generous Employee Referral Bonus Program - Mentorship Programs- Mentor and Mentee - Student Loan Repayment Assistance by Location - Relocation Assistance - Regional & National traveling CPO/CO/CP opportunities - Volunteering for Local and National events such as Hanger’s BAKA Bootcamp and EmpowerFest Hanger, Inc. is committed to providing equal employment opportunity in all aspects of the employer-employee relationship. All conditions and privileges of employment are administered to all employees without discrimination or harassment because of race, religious creed, color, age, sex, sexual orientation, gender identity, national origin, religion, marital status, medical condition, physical or mental disability, military service, pregnancy, childbirth and related medical conditions, special disabled veteran status, or any other classification protected by federal, state, and local laws and ordinances. The company will comply with all applicable state or local fair employment laws that forbid discrimination or harassment on the basis of other protected characteristics. Retaliation against any employee for filing or supporting a complaint of discrimination or harassment is prohibited. #ERF-HRC

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 Folio Specialist shift: Sunday – Thursday 10am-7pm EST PRIMARY PURPOSE: To assist Property Repair Solutions customers (homeowners, contractors, carriers) with any questions or concerns they may have and/or the work being done by the program contractors; to ensure that all customer expectations are met and/or exceeded to the best of our ability. ESSENTIAL FUNCTIONS and RESPONSIBILITIES · Receives, reviews and dispatches new jobs to contractors based on job type and location. · Places outbound calls to sell programs to customers, assigns contractors, makes customer appointments, provides assistance to insurance adjusters, and sets up program expectations. · Monitors pending jobs and makes follow-up calls to homeowners to ensure that the process is going smoothly and answers questions as needed. · Receives inbound calls to answer customer service questions, resolve minor issues, and schedule appointments for customers with contractors or escalate issues to the proper channels. · Attendance during scheduled work hours is required. ADDITIONAL FUNCTIONS and RESPONSIBILITIES · Performs other duties as assigned. · Supports the organization's quality program(s). QUALIFICATIONS Education & Licensing High school diploma or GED required. Experience One (1) year of experience in construction management, restoration and/or insurance claims and customer service required. Chronicle software experience preferred. Skills & Knowledge · Excellent oral and written communication skills · PC literate, including Microsoft Office products · Good problem resolution skills · Good judgment and sound decision making skills · Ability to build a consensus among various parties · Strong relationship building skills · Excellent organizational skills, accuracy, and attention to detail · Initiative and ability to multi-task · Above average speed and accuracy key stroke skills · High level of professionalism · Ability to work under pressure in a fast paced environment and maintain a positive demeanor · Ability to work independently or in a team environment · Ability to meet or exceed Performance Competencies · Bi-lingual English/Spanish a plus. WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. 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 $16-$18/hr. Always accepting applications. 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.