The job profile for this position is Eligibility Senior Representative, which is a Band 2 Professional 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. Applicants must be located in TX, GA, PA, SC, or VA to be eligible for this role. The Senior Eligibility Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes to successfully liaise with Payers, Pharma, Physicians, and Patients. Rely on experience and knowledge of industry best practices to communicate knowledge of pending referrals that may have an adverse impact on company goals and the patient experience. Acts as a liaison between both internal and external resources to reduce client abrasion and facilitate the timely processing of referrals. This individual can proactively recognize cause and effect trends, identify and clarify patients’ needs, and work towards solutions. RESPONSIBILITIES: - Facilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time. - Independently resolve basic patient claims issues using key subject matter knowledge. - Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations. - Demonstrate technical proficiency in patient access functions. - Effectively collaborate with internal departments to resolve issues or provide any needed information, always using professional communication. - Contact benefit providers to gather policy benefits/limitations. - Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.). - Perform medical /pharmacy benefits verification requiring complex decision skills based on payer and process knowledge. - Provide expert assistance to internal and external clients on patient status. - Handle Escalations with an expert understanding of department policies and procedures. - Use discretion & independent judgment in handling patient or more complex client complaints, escalating as appropriate and when triaging as needed. - Complete other projects and additional duties as assigned. QUALIFICATIONS: - High school diploma or GED required, bachelor’s degree preferred. - 3+ years of relevant working experience. - 2 years of Health care experience with medical insurance knowledge and terminology and experience in patient access preferred. - Intermediate data entry skills and working knowledge of Microsoft Office, and Patient Access knowledge. - Pharmacy or healthcare industry experience is highly preferred, with prior exposure to Express Scripts (ESI) considered a strong advantage. - Experienced training and coaching less experienced staff with patience to explain details and processes repeatedly. - Excellent phone presentation and communication skills. - Demonstrated ability to handle challenging customers in a professional manner. - Ability to adapt to a dynamic work environment and make decisions with minimal supervision. - Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions. ABOUT THE DEPARTMENT Through our range of health care products and services offered, Accredo team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis and growth hormone deficiency. In addition to health care products, we provide comprehensive management services – including outcomes measurement, counseling, clinical care management programs, social services, and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to make a positive impact on their patients’ lives. 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. 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.

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, Sustainability initiatives and inclusive corporate culture. Our Workers Comp Lost Time Claims department is seeking a Casualty Claims Consultant for the Southeast team, covering Kentucky, Arkansas, Tennessee, North Carolina, South Carolina, Louisiana, Alabama, Georgia, and Florida. This is a remote Full-time/Exempt role with field investigations. POSITION OVERVIEW: The Consultant Casualty Claims is responsible for managing a caseload of moderate complexity claims from start to finish. This includes conducting thorough investigations, assessing liability, negotiating settlements within defined authority limits, and maintaining clear communication with claimants, third parties, and legal representatives. The role requires strong analytical skills, sound judgment, and adherence to company policies and regulatory standards throughout the claims process. IN THIS ROLE, YOU WILL: - Manage a caseload of moderately complex casualty claims from intake through resolution. - Conduct thorough investigations, assess liability, and evaluate damages using established procedures. - Collaborate with underwriting, legal, and internal/external stakeholders as needed to ensure comprehensive claim evaluation. - Identify and refer potentially suspicious claims to the Special Investigations Unit. - Apply comparative negligence laws and state-specific regulations to claim assessments. - Set reserves, authorize payments, and demonstrate financial acumen within scope of authority. - Utilize technology and data tools to enhance claims processing efficiency and accuracy. - Communicate directly with claimants, legal representatives, and third parties to negotiate fair resolutions. - Maintain detailed and compliant documentation of claim activities and communications. - Participate in team collaboration, problem-solving discussions, and cross-functional coordination. - Support subrogation efforts and risk transfer opportunities to benefit insureds and business partners. - Handle sensitive communications professionally and translate complex information for diverse audiences. - Mentor entry-level claim handlers and share best practices learned through training and experience. - Attend ongoing training and education to maintain licensing and stay current on industry standards. - Independently manage indemnity, medical, and basic arbitration or mediation components of claims with supervisory support. WHAT YOU NEED TO APPLY: - Associate degree required; bachelor's degree preferred or combination of education and experience. - Typically has 1-4 years of relevant claims handling experience. - Must possess or obtain and maintain appropriate state adjuster licenses. - Conduct independent analysis of contractual indemnification. - Independently execute indemnity, medical, litigation/resolution management. - Proficient with basic computer navigation; ability to use basic software systems/applications (Suite of MS Office Products) and use of internet. - Learn and handle negotiations independently within authority, understand common tactics for moderately complex claim resolution. - Use judgement and effectively utilize the most suitable communication channel while displaying empathy towards all stakeholders. - Knowledge of various types of insurance products and processes. - Conduct thorough investigations; identify key issues and gather evidence. - Provide effective empathetic customer service; handle routine inquiries and issues. - Ability to use a personal computer and other standard office equipment. - Able to use all Microsoft office products - Ability to sit and/or stand for extended periods. - Required to work on-site as needed. - Ability to travel as necessary. - Ability to work in a fast paced, changing or stressful environment. - Ability to perform work in a noisy/loud work environment. - May be required to have and maintain sufficient home-based internet connection. This job posting provides cursory examples of some of the job duties associated with this position. The examples provided are not complete, and the position may entail other essential and job-related functions and responsibilities that employees will be required to perform. CAREER DEVELOPMENT: It’s not just a job, it’s a career, and we are here to support you every step of the way. We want you to be successful and fulfilled. Through on-the-job experiences, personalized coaching and our robust learning and development programs, we encourage you – at every level – to grow and develop. BENEFITS: We offer comprehensive benefits to help you be healthy, build financial security, and balance work and home life. At The Hanover, you’ll enjoy what you do and have the support you need to succeed. Benefits include: - Medical, dental, vision, life, and disability insurance - 401K with a company match - Tuition reimbursement - PTO - Company paid holidays - Flexible work arrangements - Cultural Awareness Day in support of IDE - On-site medical/wellness center (Worcester only) - Click here for the full list of Benefits EEO statement: The Hanover values diversity in the workplace and among our customers. The company provides equal opportunity for employment and promotion to all qualified employees and applicants on the basis of experience, training, education, and ability to do the available work without regard to race, religion, color, age, sex/gender, sexual orientation, national origin, gender identity, disability, marital status, veteran status, genetic information, ancestry or any other status protected by law. Furthermore, The Hanover Insurance Group is committed to providing an equal opportunity workplace that is free of discrimination and harassment based on national origin, race, color, religion, gender, ancestry, age, sexual orientation, gender identity, disability, marital status, veteran status, genetic information or any other status protected by law.” As an equal opportunity employer, Hanover does not discriminate against qualified individuals with disabilities. Individuals with disabilities who wish to request a reasonable accommodation to participate in the job application or interview process, or to perform essential job functions, should contact us at:HRServices@hanover.com and include the link of the job posting in which you are interested. Privacy Policy: To view our privacy policy and online privacy statement, click here. Applicants who are California residents: To see the types of information we may collect from applicants and employees and how we use it, please click here. Compensation: The target hiring range for this role may vary based on geographic location and other factors, including merit or performance, demonstrated proficiency, skills for the role, education, travel requirements, and experience. Additional compensation may include an annual bonus (which could take the form of a general bonus, sales incentive, or short-term incentive), long-term incentive or spot recognition awards. The posted range reflects our ability to hire at different position titles and levels depending on background and experience.

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, Sustainability initiatives and inclusive corporate culture. Our Workers Comp Lost Time Claims department is seeking a Casualty Claims Consultant for the Northeast team, covering Maine, Vermont, New Hampshire, Massachusetts, Connecticut, and Rhode Island. This is a remote Full-time/Exempt role with field investigations. POSITION OVERVIEW: The Consultant Casualty Claims is responsible for managing a caseload of moderate complexity claims from start to finish. This includes conducting thorough investigations, assessing liability, negotiating settlements within defined authority limits, and maintaining clear communication with claimants, third parties, and legal representatives. The role requires strong analytical skills, sound judgment, and adherence to company policies and regulatory standards throughout the claims process. IN THIS ROLE, YOU WILL: - Manage a caseload of moderately complex casualty claims from intake through resolution. - Conduct thorough investigations, assess liability, and evaluate damages using established procedures. - Collaborate with underwriting, legal, and internal/external stakeholders as needed to ensure comprehensive claim evaluation. - Identify and refer potentially suspicious claims to the Special Investigations Unit. - Apply comparative negligence laws and state-specific regulations to claim assessments. - Set reserves, authorize payments, and demonstrate financial acumen within scope of authority. - Utilize technology and data tools to enhance claims processing efficiency and accuracy. - Communicate directly with claimants, legal representatives, and third parties to negotiate fair resolutions. - Maintain detailed and compliant documentation of claim activities and communications. - Participate in team collaboration, problem-solving discussions, and cross-functional coordination. - Support subrogation efforts and risk transfer opportunities to benefit insureds and business partners. - Handle sensitive communications professionally and translate complex information for diverse audiences. - Mentor entry-level claim handlers and share best practices learned through training and experience. - Attend ongoing training and education to maintain licensing and stay current on industry standards. - Independently manage indemnity, medical, and basic arbitration or mediation components of claims with supervisory support. WHAT YOU NEED TO APPLY: - Associate degree required; bachelor's degree preferred or combination of education and experience. - Typically has 1-4 years of relevant claims handling experience. - Must possess or obtain and maintain appropriate state adjuster licenses. - Conduct independent analysis of contractual indemnification. - Independently execute indemnity, medical, litigation/resolution management. - Proficient with basic computer navigation; ability to use basic software systems/applications (Suite of MS Office Products) and use of internet. - Learn and handle negotiations independently within authority, understand common tactics for moderately complex claim resolution. - Use judgement and effectively utilize the most suitable communication channel while displaying empathy towards all stakeholders. - Knowledge of various types of insurance products and processes. - Conduct thorough investigations; identify key issues and gather evidence. - Provide effective empathetic customer service; handle routine inquiries and issues. - Ability to use a personal computer and other standard office equipment. - Able to use all Microsoft office products - Ability to sit and/or stand for extended periods. - Required to work on-site as needed. - Ability to travel as necessary. - Ability to work in a fast paced, changing or stressful environment. - Ability to perform work in a noisy/loud work environment. - May be required to have and maintain sufficient home-based internet connection. This job posting provides cursory examples of some of the job duties associated with this position. The examples provided are not complete, and the position may entail other essential and job-related functions and responsibilities that employees will be required to perform. CAREER DEVELOPMENT: It’s not just a job, it’s a career, and we are here to support you every step of the way. We want you to be successful and fulfilled. Through on-the-job experiences, personalized coaching and our robust learning and development programs, we encourage you – at every level – to grow and develop. BENEFITS: We offer comprehensive benefits to help you be healthy, build financial security, and balance work and home life. At The Hanover, you’ll enjoy what you do and have the support you need to succeed. Benefits include: - Medical, dental, vision, life, and disability insurance - 401K with a company match - Tuition reimbursement - PTO - Company paid holidays - Flexible work arrangements - Cultural Awareness Day in support of IDE - On-site medical/wellness center (Worcester only) - Click here for the full list of Benefits EEO statement: The Hanover values diversity in the workplace and among our customers. The company provides equal opportunity for employment and promotion to all qualified employees and applicants on the basis of experience, training, education, and ability to do the available work without regard to race, religion, color, age, sex/gender, sexual orientation, national origin, gender identity, disability, marital status, veteran status, genetic information, ancestry or any other status protected by law. Furthermore, The Hanover Insurance Group is committed to providing an equal opportunity workplace that is free of discrimination and harassment based on national origin, race, color, religion, gender, ancestry, age, sexual orientation, gender identity, disability, marital status, veteran status, genetic information or any other status protected by law.” As an equal opportunity employer, Hanover does not discriminate against qualified individuals with disabilities. Individuals with disabilities who wish to request a reasonable accommodation to participate in the job application or interview process, or to perform essential job functions, should contact us at:HRServices@hanover.com and include the link of the job posting in which you are interested. Privacy Policy: To view our privacy policy and online privacy statement, click here. Applicants who are California residents: To see the types of information we may collect from applicants and employees and how we use it, please click here. Compensation: The target hiring range for this role may vary based on geographic location and other factors, including merit or performance, demonstrated proficiency, skills for the role, education, travel requirements, and experience. Additional compensation may include an annual bonus (which could take the form of a general bonus, sales incentive, or short-term incentive), long-term incentive or spot recognition awards. The posted range reflects our ability to hire at different position titles and levels depending on background and experience.

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, Sustainability initiatives and inclusive corporate culture. Our Workers Comp Lost Time Claims department is seeking a Casualty Claims Consultant for the Northeast team, covering Maine, Vermont, New Hampshire, Massachusetts, Connecticut, and Rhode Island. This is a remote Full-time/Exempt role with field investigations. POSITION OVERVIEW: The Consultant Casualty Claims is responsible for managing a caseload of moderate complexity claims from start to finish. This includes conducting thorough investigations, assessing liability, negotiating settlements within defined authority limits, and maintaining clear communication with claimants, third parties, and legal representatives. The role requires strong analytical skills, sound judgment, and adherence to company policies and regulatory standards throughout the claims process. IN THIS ROLE, YOU WILL: - Manage a caseload of moderately complex casualty claims from intake through resolution. - Conduct thorough investigations, assess liability, and evaluate damages using established procedures. - Collaborate with underwriting, legal, and internal/external stakeholders as needed to ensure comprehensive claim evaluation. - Identify and refer potentially suspicious claims to the Special Investigations Unit. - Apply comparative negligence laws and state-specific regulations to claim assessments. - Set reserves, authorize payments, and demonstrate financial acumen within scope of authority. - Utilize technology and data tools to enhance claims processing efficiency and accuracy. - Communicate directly with claimants, legal representatives, and third parties to negotiate fair resolutions. - Maintain detailed and compliant documentation of claim activities and communications. - Participate in team collaboration, problem-solving discussions, and cross-functional coordination. - Support subrogation efforts and risk transfer opportunities to benefit insureds and business partners. - Handle sensitive communications professionally and translate complex information for diverse audiences. - Mentor entry-level claim handlers and share best practices learned through training and experience. - Attend ongoing training and education to maintain licensing and stay current on industry standards. - Independently manage indemnity, medical, and basic arbitration or mediation components of claims with supervisory support. WHAT YOU NEED TO APPLY: - Associate degree required; bachelor's degree preferred or combination of education and experience. - Typically has 1-4 years of relevant claims handling experience. - Must possess or obtain and maintain appropriate state adjuster licenses. - Conduct independent analysis of contractual indemnification. - Independently execute indemnity, medical, litigation/resolution management. - Proficient with basic computer navigation; ability to use basic software systems/applications (Suite of MS Office Products) and use of internet. - Learn and handle negotiations independently within authority, understand common tactics for moderately complex claim resolution. - Use judgement and effectively utilize the most suitable communication channel while displaying empathy towards all stakeholders. - Knowledge of various types of insurance products and processes. - Conduct thorough investigations; identify key issues and gather evidence. - Provide effective empathetic customer service; handle routine inquiries and issues. - Ability to use a personal computer and other standard office equipment. - Able to use all Microsoft office products - Ability to sit and/or stand for extended periods. - Required to work on-site as needed. - Ability to travel as necessary. - Ability to work in a fast paced, changing or stressful environment. - Ability to perform work in a noisy/loud work environment. - May be required to have and maintain sufficient home-based internet connection. This job posting provides cursory examples of some of the job duties associated with this position. The examples provided are not complete, and the position may entail other essential and job-related functions and responsibilities that employees will be required to perform. CAREER DEVELOPMENT: It’s not just a job, it’s a career, and we are here to support you every step of the way. We want you to be successful and fulfilled. Through on-the-job experiences, personalized coaching and our robust learning and development programs, we encourage you – at every level – to grow and develop. BENEFITS: We offer comprehensive benefits to help you be healthy, build financial security, and balance work and home life. At The Hanover, you’ll enjoy what you do and have the support you need to succeed. Benefits include: - Medical, dental, vision, life, and disability insurance - 401K with a company match - Tuition reimbursement - PTO - Company paid holidays - Flexible work arrangements - Cultural Awareness Day in support of IDE - On-site medical/wellness center (Worcester only) - Click here for the full list of Benefits EEO statement: The Hanover values diversity in the workplace and among our customers. The company provides equal opportunity for employment and promotion to all qualified employees and applicants on the basis of experience, training, education, and ability to do the available work without regard to race, religion, color, age, sex/gender, sexual orientation, national origin, gender identity, disability, marital status, veteran status, genetic information, ancestry or any other status protected by law. Furthermore, The Hanover Insurance Group is committed to providing an equal opportunity workplace that is free of discrimination and harassment based on national origin, race, color, religion, gender, ancestry, age, sexual orientation, gender identity, disability, marital status, veteran status, genetic information or any other status protected by law.” As an equal opportunity employer, Hanover does not discriminate against qualified individuals with disabilities. Individuals with disabilities who wish to request a reasonable accommodation to participate in the job application or interview process, or to perform essential job functions, should contact us at:HRServices@hanover.com and include the link of the job posting in which you are interested. Privacy Policy: To view our privacy policy and online privacy statement, click here. Applicants who are California residents: To see the types of information we may collect from applicants and employees and how we use it, please click here. Compensation: The target hiring range for this role may vary based on geographic location and other factors, including merit or performance, demonstrated proficiency, skills for the role, education, travel requirements, and experience. Additional compensation may include an annual bonus (which could take the form of a general bonus, sales incentive, or short-term incentive), long-term incentive or spot recognition awards. The posted range reflects our ability to hire at different position titles and levels depending on background and experience.