Appeals Professional III (APIII) Overview: J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes the employee experience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs at the State, Federal, and Commercial levels. Position Purpose Performs complex (senior-level) work. Provides dissatisfied parties to a Medicare appeal the opportunity to present documentation to demonstrate why an appeal should be allowed. Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines. Works under general supervision, with moderate latitude for the use of initiative and independent judgment. Essential Responsibilities - Reviews medical records/case file, writes a reconsideration decision letter that is clear, concise, and impartial and supports the determination made, and documents review. - Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, and policy. - Responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed. - Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures. - Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision. - Stays abreast of changes in regulations, medical and healthcare practices, policies and procedures. - Participates in case specific verbal discussions. - Conducts reviews of appeals/disputes with multiple beneficiaries/services in one case. - Plans responses to statistical analysis challenges with assistance from statisticians. - Attends meetings and participates in workgroups at the direction of management. - Conducts quality reviews, as needed. - Serves as a subject matter expert. - Mentors and/or trains staff. - May conduct quality reviews and audits. - Participates in special projects and performs other duties as assigned. Minimum Qualifications Education - - Associate's degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for Associate’s degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.) Experience - - Three (3) years of medical dispute resolution or Medicare appeals, medical review, clinical, or related experience in a healthcare setting - Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience - Demonstrated experience writing or making medical necessity decisions - Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred - Resided in the United States for a minimum of three (3) years out of the last five (5) years? (Per Contract Requirement) Knowledge, Skills and Abilities Considerable knowledge of - Research techniques - Medical terminology - Medicare program, including coverage and payment rules - Medicare regulations, claims administration, and medical review processes - Applicable laws, rules and regulations Expert skill in - Preparing correspondence/documents using correct spelling, grammar and punctuation; proofreading and reviewing documents for clarity and consistency - Researching, analyzing and interpreting policies and state and federal laws and regulations Proficient skill in - Prioritizing and organizing work assignments - The use of personal computers and applicable programs, applications and systems Ability to - Multitask and meet deadlines - Exercise logic and reasoning to define problems, establish facts and draw valid conclusions - Make decisions that support business objectives and goals - Identify and resolve problems or refer issues appropriately - Communicate effectively verbally and in writing - Adapt to the needs of internal and external customers - Show integrity and ethical behavior; respect confidentiality, business ethics and organizational standards - Assures compliance with company policies, procedures, and guidelines including cybersecurity, regulatory, contractual and accreditation entities J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.

Ready to grow your claims career faster than the traditional industry allows? We’re looking for a Auto Claims Handler to join ClaimSorted. This role is ideal for: - a Claims Handler who wants to build their career at a company that rewards performance, not tenure - someone with 6+ months of claims experience who is hungry to learn and grow fast We are not looking for tenure for the sake of it. We are looking for people with talent, ambition, work ethic, and the drive to build a real career. If you join us, we will give you the training and support to become the best Claims Handler possible - from people management to performance management, data, quality, and capacity planning. Our goal is to help you become one of the best claims leaders of the future. About ClaimSorted ClaimSorted is a Third-Party Administrator (TPA) that manages insurance claims end to end on behalf of insurers, in a ~$200B industry. We combine a high-performing claims team with an AI-enabled platform to deliver claims up to 3x faster, with better service and better economics for insurers. We’re backed by Y Combinator, Atomico, and Eurazeo, have raised $16M+, and already manage claims for 30+ insurers across more than $200M in insurance premiums. What you’ll do - Handle claims end to end: from first notification of loss through to settlement - Communicate with policyholders throughout the claims journey, ensuring a clear and positive experience - Review documentation, verify coverage, and assess liability accurately - Set appropriate reserves and manage claims within your authority - Identify potential fraud indicators and escalate appropriately - Maintain accurate and thorough claims records for audit and compliance - Contribute to continuous improvement by flagging process inefficiencies What we’re looking for - Based in the United States with work authorisation - 6+ months of auto claims experience (personal or commercial lines) - Strong organisation and ability to prioritise independently - Comfortable using data to make decisions - Team-oriented, hardworking, and ambitious - Experience leading, mentoring, or coaching others is a plus - Startup or high-growth experience is a plus Why join us This is a chance to grow faster than you would at a traditional insurer or claims business. You’ll get real responsibility, real training, and the opportunity to build your career in a high-performance environment that rewards talent and hard work. If you’re ready to step up, work hard, and build a career in claims, we’d love to hear from you. Our Values - Move Fast – Act decisively, iterate quickly, optimise for momentum. - Always Overdeliver – We exceed expectations in everything we do. - Think Customer-First, Always – The customer experience drives every decision. - Challenge the Status Quo – We innovate relentlessly and never settle for ‘good enough.’ - Say It How It Is – Transparency and direct communication build trust. Compensation & Benefits - Competitive salary beyond the industry standard - Quarterly performance bonus: up to 15% of quarterly salary - Equity participation: stock options as an early-stage team member - Medical insurance - 401(k) with 5% company match - Paid time off - Accelerated promotion track in a high-growth environment

Ready to grow your claims career faster than the traditional industry allows? We’re looking for a Property Claims Handler to join ClaimSorted. This role is ideal for: - a Claims Handler who wants to build their career at a company that rewards performance, not tenure - someone with 6+ months of claims experience who is hungry to learn and grow fast We are not looking for tenure for the sake of it. We are looking for people with talent, ambition, work ethic, and the drive to build a real career. If you join us, we will give you the training and support to become the best Claims Handler possible - from people management to performance management, data, quality, and capacity planning. Our goal is to help you become one of the best claims leaders of the future. About ClaimSorted ClaimSorted is a Third-Party Administrator (TPA) that manages insurance claims end to end on behalf of insurers, in a ~$200B industry. We combine a high-performing claims team with an AI-enabled platform to deliver claims up to 3x faster, with better service and better economics for insurers. We’re backed by Y Combinator, Atomico, and Eurazeo, have raised $16M+, and already manage claims for 30+ insurers across more than $200M in insurance premiums. What you’ll do - Handle claims end to end: from first notification of loss through to settlement - Communicate with policyholders throughout the claims journey, ensuring a clear and positive experience - Review documentation, verify coverage, and assess liability accurately - Set appropriate reserves and manage claims within your authority - Identify potential fraud indicators and escalate appropriately - Maintain accurate and thorough claims records for audit and compliance - Contribute to continuous improvement by flagging process inefficiencies What we’re looking for - Based in the United States with work authorisation - 6+ months of property claims experience (buildings, contents, renters, commercial, or personal property) - Strong organisation and ability to prioritise independently - Comfortable using data to make decisions - Team-oriented, hardworking, and ambitious - Experience leading, mentoring, or coaching others is a plus - Startup or high-growth experience is a plus Why join us This is a chance to grow faster than you would at a traditional insurer or claims business. You’ll get real responsibility, real training, and the opportunity to build your career in a high-performance environment that rewards talent and hard work. If you’re ready to step up, work hard, and build a career in claims, we’d love to hear from you. Our Values - Move Fast – Act decisively, iterate quickly, optimise for momentum. - Always Overdeliver – We exceed expectations in everything we do. - Think Customer-First, Always – The customer experience drives every decision. - Challenge the Status Quo – We innovate relentlessly and never settle for ‘good enough.’ - Say It How It Is – Transparency and direct communication build trust. Compensation & Benefits - Competitive salary beyond the industry standard - Quarterly performance bonus: up to 15% of quarterly salary - Equity participation: stock options as an early-stage team member - Medical insurance - 401(k) with 5% company match - Paid time off - Accelerated promotion track in a high-growth environment

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries. Job title: Claims Representative -Work From Home (Healthcare) Job Description: Sagility, a global leader in business process management, is dedicated to enhancing the member and patient experience. By combining cutting-edge technology with decades of healthcare expertise, we deliver exceptional results for our clients. If you are detail-oriented, analytical, and thrive in a structured environment, this is your opportunity to build a career in healthcare operations. Sagility is actively building a pipeline of qualified Claims Representatives to support upcoming classes. Early applicants will be prioritized for interview scheduling and for consideration of offers. As a Claims Representative, you will review and process medical, dental, or supplemental insurance claims according to eligibility guidelines, benefits, and internal policies. Our structured training program prepares you for success through instructor-led virtual sessions, hands-on learning, and progressive performance goals. Once training is complete, you will be responsible for meeting established quality, productivity, and accuracy standards. If you are motivated, reliable, and ready to grow your career in healthcare, we encourage you to apply as soon as possible. Become Part of a Team That S.O.A.R,s! - S Spark Curiosity - O One Team, One Direction - A Action for Results - R Right by Right Purpose Benefits You Will Enjoy - Competitive pay: $18.00/hour - Performance-based incentives - Paid training in a cutting-edge virtual training environment - Comprehensive health coverage (available after 90 days) - Employee wellness and engagement programs. - Career advancement opportunities: 90% of our leaders started as Customer Service Representatives What You Will Do • Review and process insurance claims accurately using internal guidelines and benefit plans • Research and navigate multiple systems and documents to validate claim details • Confirm required documentation is included and identify missing information • Verify accuracy of medical coding (CPT/ICD-10 preferred) • Evaluate eligibility, coverage, authorizations, and coordination of benefits • Identify discrepancies and resolve errors using established procedures • Maintain productivity and quality standards in a fast-paced environment • Work independently while collaborating with supervisors, coaches, and trainers • Use multiple computer applications and virtual tools such as Outlook, Webex, and internal systems • Continuously improve efficiency through feedback and training support What You Bring • High school diploma or equivalent • Ability to quickly learn new systems and processes • Experience using Microsoft Outlook (email, calendar invites, attachments) • Basic Microsoft Excel skills (sorting/filtering) • Ability to navigate multiple systems using shortcuts and efficient workflows • Strong attention to detail and ability to follow complex procedures • Excellent time management and organizational skills • Ability to meet productivity and quality performance expectations • Experience working independently in a remote environment preferred • Familiarity with healthcare terminology, insurance claims, CPT or ICD-10 coding preferred • Previous claims processing or related administrative experience preferred Job Requirements • Must be at least 18 years of age • Minimum 1 year of consistent employment history (customer service or administrative experience preferred) • Reliable attendance required, especially during the first 90 days • Typing speed of at least 25 WPM • Hardwired internet connection with minimum speeds of 25 Mbps download and 10 Mbps upload • Secure, private workspace free from distractions • Flexible availability, including weekends as business needs require Benefits & Perks • Daily Pay options available • Medical, Dental, and Vision coverage • Life Insurance • Short-Term and Long-Term Disability options • Flexible Spending Account (FSA) • Employee Assistance Program • 401(k) with employer contribution • Paid Time Off (PTO) • Tuition Reimbursement Sagility is an Equal Opportunity Employer/Veteran/Disability. Alert: Please beware of fraudulent communications from profiles impersonating Sagility or its employees. All official communication from Sagility will come from our verified email domains: “@sagility.com” or “@sagilityhealth.com”. Sagility will never ask for payments for job offers, interviews, or otherwise. Do not respond to suspicious communications, whether via email, WhatsApp, or any social platform. For any concerns, contact us directly through our official website. Location: Work@Home USAUnited States of America