Role Description Responsible for managing patient account balances including accurate claim submission, compliance with all federal/state and third party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of the WVU Medicine hospitals. Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues that arise from customer inquiries. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to achieve best in class revenue cycle operations. Qualifications - High School diploma or equivalent. - One (1) year medical billing/medical office experience (preferred). Requirements - Submits accurate and timely claims to third party payers. - Resolves claim edits and account errors prior to claim submission. - Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. - Gathers statistics, completes reports and performs other duties as scheduled or requested. - Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency. - Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. - Contacts third party payers to resolve unpaid claims. - Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. - Assists Patient Access and Care Management with denials investigation and resolution. - Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth. - Attends department meetings, teleconferences and webcasts as necessary. - Researches and processes mail returns and claims rejected by the payer. - Reconciles billing account transactions to ensure accurate account information according to established procedures. - Processes billing and follow-up transactions in an accurate and timely manner. - Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing. - Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. - Maintains work queue volumes and productivity within established guidelines. - Provides excellent customer service to patients, visitors and employees. - Participates in performance improvement initiatives as requested. - Works with supervisor and manager to develop and exceed annual goals. - Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. - Communicates problems hindering workflow to management in a timely manner. Benefits - Scheduled Weekly Hours: 40 - Shift: Exempt/Non-Exempt - United States of America (Non-Exempt) Company Description - Company: SYSTEM West Virginia University Health System - Cost Center: 544 SYSTEM Patient Financial Services

What’s Under the Hood DriveTime Family of Brands includes SilverRock, which provides quality warranty and ancillary products, and a customer-friendly claims process. SilverRock offers a variety of ancillary products and administrative services encompassing everything from GAP coverage to vehicle theft and GPS tracking to dealership fleet management. Our ancillary product expertise is proven with over 1 million service contracts, products, and warranties, and over $300 million in claims. That’s Nice, But What’s the Job? So What Kind of Folks Are We Looking for? *Must reside in TX, UT, GA, FL, NV, NC, AZ or TN state* Responsibilities of the Job (Or Better Known as, Your Next Destination) Responsible for working with repair facilities to validate, adjudicate, and approve payment for diagnostics and repair recommendations for pre-sale repairs as well as customer vehicles under warranty. - Properly adjudicates claims within approval limit and in accordance with department & industry standards. - Accurately notates all actions taken and interactions with shops and customers within internal systems ensuring proper documentation of interactions. - Effectively navigates department resources in order ensure adherence to department process flows and policies. - Manages list of assigned pending claims and provides timely follow up with repair facilities to decision claims. - Other duties as assigned Knowledge, Skills and Abilities (The Good Stuff) - Must have a strong understanding of automotive systems and repair procedures, parts pricing, labor guides, and repair shop procedures/practices. - Must have clear and professional verbal and written communication, as well as strong negotiation skills - Is proficient in typing and general computer skills. - Must be comfortable in a high-volume, collaborative environment, and managing multiple priorities - Must be solutions-oriented. Requirements (a.k.a. What You Need to Get the Job Done) - High-school diploma required; Bachelor’s Degree preferred. - 3+ years of experience with current automotive mechanical and diagnostics. So What About the Perks? Perks matter - Work From Home. Feel free to rock the casual wear while still being camera ready. You will be working from your home office (in an approved city & state) and make sure you have a conducive and quiet workspace with no distractions and reliable and secure internet. - Medical, dental, and vision, oh my! DriveTime Family of Brands covers a sizable amount of insurance premiums to ensure our employees receive top-tier healthcare coverage. - But Wait, There’s More. 401(K), Company paid life insurance policy, short and long-term disability coverage to name a few. - Growth Opportunities. You grow, I grow, we all grow! But seriously, DriveTime Family of Brands is committed to providing its employees with every opportunity to grow professionally with roughly over 1,000 employees promoted year over year. - Tuition Reimbursement. We’re as passionate about your professional development as you are. With that, we’ll put our money where our mouth is. - Wellness Program. Health is wealth! This program includes self-guided coaching and journeys, cash incentives and discounts on your medical premiums through engaging in fun activities! - Gratitude is Green. We offer competitive pay across the organization, because, well… money matters! - Consistent Work Schedule. You’ll get a set schedule Monday through Friday, with rotating Saturdays! With that, we do ask for some flexibility and overtime as needed. - Paid Time Off. Not just lip service: we work hard, to play hard! Paid time off includes (for all full-time roles) wellness days, holidays, and good ole' fashioned YOU time! For our Part-timers, don't fear you get some time too...vacation time is available - the more you work, the more you earn! Anything Else? Absolutely. DriveTime Family of Brands is Great Place to Work Certified! And get this: 90% of our rockstar employees say they feel right at home here. We could spend a lot of time having you read about ALL our awards, but we’ll save time (and practice some humility) just naming a few others; Comparably Awards: Best Company for Diversity, Best Company Culture and Best Company Leadership, oh and don’t forget Phoenix Business Journal Healthiest Employers (okay, we’ll stop there)! Hiring is contingent upon successful completion of our background and drug screening process. DriveTime is a drug-free, tobacco-free workplace and an Equal Opportunity Employer. And when it comes to hiring, we don't just look for the right person for the job, we seek out the right person for DriveTime. Buckle up for plenty of opportunities to grow in a professional, fun, and high-energy environment!

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 Examiner - Liability (MUST RESIDE IN LA) 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? - Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. - Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. - 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: To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. - Assesses liability and resolves claims within evaluation. - Negotiates settlement of claims within designated authority. - Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. ADDITIONAL FUNCTIONS and RESPONSIBILITIES - Performs other duties as assigned. - Supports the organization's quality program(s). - Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Experience: Five (5) years of Liability claims management experience or equivalent combination of education and experience required. TAKING CARE OF YOU - Flexible work schedule. - Referral incentive program. - Career development and promotional growth opportunities. - A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. 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. 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.

• To analyze mid- and higher-level workers compensation claims to determine benefits due • to ensure ongoing adjudication of claims within company standards and industry best practices • to identify subrogation of claims and negotiate settlements • Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency • Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract • Manages subrogation of claims and negotiates settlements • Communicates claim action with claimant and client • Ensures claim files are properly documented and claims coding is correct • May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review • Maintains professional client relationships