Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. This role supports the quality control of claims entry and processing to identify claims processing errors and remediation prior to payment or denial. Job Summary Responsible for monitoring Quality Control (QC) of Claims Operations and the reporting of all metrics related to such activities. Essential Functions - Responsible for end-to-end pre-pay review of claims adjudicated in QNXT to ensure complete and accurate claims processing in alignment with Medicare regulations, including but not limited to accuracy for paper claim entry, application of benefits and cost-share, CCI/NCCI edits, authorizations, rate of payment, attributes, decision codes, and memos leading to identification of issues which require remediation prior to the weekly check run. -Includes the post-pay review of Explanations of Payments to providers, as well as calculation and accumulation of MOOP, interest, sequestration, etc. -Perform trend analysis and root cause review analysis. -Responsible to ensure claims processing entry and adjudication accuracy -Responsible for identifying potential areas of compliance vulnerability and risk and working with department supervisors/managers to develop and implement remediation plans and/or corrective action as needed and recommend appropriate solutions to enhance current quality assurance programs. -Develop and implement new quality control processes, assist in the business testing process, and participate in projects. -Completion of post-payment Claims Monthly Compliance Monitoring review which is delivered to senior leadership Qualifications Education - Bachelor's Degree preferred Experience - At least 2-3 years of quality control experience within medical claims required - At least 2-3 years of healthcare experience required - At least 2-3 years of Medicare Advantage medical claims processing experience required - At least 2-3 years of MassHealth (Medicaid) medical claims processing experience highly preferred - AAPC certification(s) a plus Knowledge, Skills and Abilities - Experience in monitoring, measuring and reporting on quality and productivity of medical claims processing. - Strong analytical abilities to assess risks, analyze data, and make informed recommendations for improvement. - Excellent written and verbal communication skills to prepare reports, deliver training sessions and collaborate effectively with multifaceted teams across different specialties. - Ability to understand claims processing edits, correct coding edits, medically unlikely edits Additional Job Details (if applicable) Working Conditions - This is a remote role that can be done from most US states - Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment. - This is a Monday through Friday role with a schedule of either 8:00 AM - 4:30 PM EDT or 8:30 AM - 5:00 PM EDT. Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $25.50 - $36.49/Hourly Grade 5 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Division or Field Office: Claims I Division Department of Position: Home & Auto Liability Dept Work from: Remote Salary Range: $56,367.00 - $90,040.00 * salary range is for this level and may vary based on actual level of role hired for *This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location (State) based on ERIE's geographical differences, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment. At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia. Benefits That Go Beyond The Basics We strive to be Above all in Service® to our customers—and to our employees. That’s why Erie Insurance offers you an exceptional benefits package, including: - Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work. - Low contributions to medical and prescription premiums. We currently pay up to 97% of employees’ monthly premium costs. - Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service. - 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension. - Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave. - Career development. Including a tuition reimbursement program for higher education and industry designations. Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year. Position Summary Exercises independent discretion and judgement in claims handling involving complex liability issues, to include coverage issues and minor injury claims. - This is a remote, work from home position handling claims for the State of Illinois. - The ideal candidate will preferably reside in Illinois. Duties and Responsibilities - Conducts investigations, evaluate and make recommendations regarding coverage and liability. - Sets and maintains reserves. Obtains documents to establish the value of claims and negotiates settlement or declines claim. - Documents files and submits final report. - Identifies subrogation opportunities and initiates appropriate action. - Negotiates with all parties, or their representatives, within designated authority. - Completes required training. - Trains and mentors. - Travel for training may be required. The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished. This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident. Capabilities - Values Diversity - Nimble Learning - Self-Development - Collaborates - Customer Focus - Cultivates Innovation - Information Management Skills - Instills Trust - Optimizes Work Processes (IC) - Job-Specific Knowledge - Ensures Accountability - Decision Quality Qualifications Minimum Educational and Experience Requirements - High school diploma or equivalent and two years of claims or customer service experience, preferably with casualty claims, required. - Equivalent educational experience will be considered. - Associate's or Bachelor's degree, preferred. Designations and/or Licenses - Appropriate license as required by state. Physical Requirements - Lifting/Moving 0-20 lbs; Occasional (<20%) - Lifting/Moving 20-50 lbs; Occasional (<20%) - Ability to move over 50 lbs using lifting aide equipment; Occasional (<20%) - Pushing/Pulling/moving objects, equipment with wheels; Occasional (<20%) - Climbing/accessing heights; Rarely - Driving; Occasional (<20%) - Manual Keying/Data Entry/inputting information/computer use; Frequent (50-80%)

Role Description Seeking an experienced Workers’ Compensation Claims Adjuster to manage a diverse caseload for multiple accounts, including both insurance and self-insured employers. This position requires strong knowledge of Nevada Workers’ Compensation law, as well as experience handling litigated claims. The ideal candidate will possess excellent communication, analytical, and organizational skills, with the ability to manage claims efficiently and deliver superior customer service. - Receive and review claim assignments, confirming policy coverage and directing timely acknowledgments of claims. - Manage a caseload of approximately 100 lost time claims, including 15%–20% litigated files. - Oversee claims through the full life cycle, ensuring timely and accurate handling in accordance with jurisdictional regulations. - Investigate claims, gather supporting documentation, and determine compensability. - Communicate effectively with claimants, employers, medical providers, attorneys, and other stakeholders. - Develop and execute strategies to resolve claims promptly and within authority levels. - Maintain detailed and accurate documentation within the claims management system. - Ensure compliance with all applicable state laws and internal procedures. Qualifications - Minimum of 3 years of Workers’ Compensation lost time claims handling experience. - Active Nevada Adjuster License required. - Must reside in the state of Nevada. - Strong knowledge of Nevada Workers’ Compensation laws and regulations. - Proven experience managing litigated claims. - Excellent customer service and organizational skills. - High school diploma required; bachelor’s degree preferred. Requirements - Compensation: $80K - $93K (depending on experience) + bonus opportunities. Benefits - Competitive benefits package. - 401(k). - Paid time off. - Professional development opportunities. - And more.

Introduction At Gallagher, we help clients face risk with confidence because we believe that when businesses are protected, they’re free to grow, lead, and innovate. You’ll be backed by our digital ecosystem: a client-centric suite of consulting tools making it easier for you to meet your clients where they want to be met. Advanced data and analytics providing a comprehensive overview of the risk landscape is at your fingertips. Here, you’re not just improving clients' risk profiles, you’re building trust. You’ll find a culture grounded in teamwork, guided by integrity, and fueled by a shared commitment to do the right thing. We value curiosity, celebrate new ideas, and empower you to take ownership of your career while making a meaningful impact for the businesses we serve. If you’re ready to bring your unique perspective to a place where your work truly matters; think of Gallagher. Overview The Gallagher National Risk Control Team is now the Gallagher Claims and Risk Consulting Team. This new team is equipped with experts, processes and solutions to help you meet the evolving nature of risk. As risk evolves, so has Gallagher with tools and programs to help you proactively meet these challenges now and in the future. Gallagher's Claims and Risk Consulting team includes more than 100 safety and risk control professionals across the country with in-depth knowledge of current and emerging regulations, safety and health management, and operational exposures. How you'll make an impact - Acts as an advocate for complex clients, providing assistance and coverage advice as well as monitoring of large and complex claims, documenting all pertinent activity as it relates to the claim. - Key responsibilities include: - Consulting with clients and brokers on claims and coverage issues; - Facilitating and attending client meetings and claims reviews; and Negotiating changes in reserves for a positive client outcome as appropriate by line of coverage. - Provides status reports to clients as required by any applicable service plan, reviews action plans and reserves with consideration for client costs. - Actively researches and obtains claims information from both clients, and carriers and timely and accurately communicate with all interested parties. - Reviews all new problematic or complex claims on designated clients and formulates a plan of action to achieve a favorable claim resolution. About You - 5 years of relevant claims experience, with adjuster experience preferred - Advanced proficiency with Microsoft Word, Outlook, Excel, and PowerPoint - Exceptional verbal, written and interpersonal communication skills, including responsiveness - Excellent analytical, time management, and organizational skills, including ability to multi-task, prioritize, and manage large volumes of information #LI-MS1 Compensation and benefits We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve: - Medical/dental/vision plans, which start from day one! - Life and accident insurance - 401(K) and Roth options - Tax-advantaged accounts (HSA, FSA) - Educational expense reimbursement - Paid parental leave Other benefits include: - Digital mental health services (Talkspace) - Flexible work hours (availability varies by office and job function) - Training programs - Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing - Charitable matching gift program - And more... **The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process. We value inclusion and diversity Click Here to review our U.S. Eligibility Requirements Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.