JOB SUMMARY The Insurance Verification Specialist 1, under general supervision, provides patients, physicians and internal hospital personnel with insurance benefit information. This position ensures timely verification of insurance benefits and financial clearance which has a direct impact to the organization's reimbursement from payers for patient accounts that are scheduled and unscheduled. ESSENTIAL FUNCTIONS OF THE ROLE Performs financial clearance of patient accounts by verifying insurance eligibility and benefits and ensuring all notifications and authorizations are completed within the required timeframe. Completes appropriate payor forms related to notification and authorization. Coordinates the submission of clinical documentation from physicians to payers for authorization needs. Calculates accurate patient financial responsibility. Communicates timely with Utilization Review, and collaborates effectively with physician and facility staff to ensure financial clearance of the patients account prior to scheduled or unscheduled service during the patient’s hospital stay. Interprets complex payer coverage information including, but not limited to, network participation status with provider, limited plan coverage and inactive benefits. Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement. KEY SUCCESS FACTORS 1 year of healthcare or customer service experience preferred. Must have the ability to consistently meet performance standards of production, accuracy, completeness and quality. Ability to understand and adhere to payer guidelines by plan and service type. Requires good listening, interpersonal and communication skills, and professional, pleasant and respectful telephone etiquette. Ability to maintain a professional demeanor in a highly stressful and emotional environment, behavioral health and/or suffering patients in addition to life or death situations. Must be able to exhibit a high level of empathy with the ability to effectively communicate with patients and family members during traumatic events, while demonstrating exceptional customer service skills. Demonstrates ability to manage multiple, changing priorities in an effective and organized manner. Excellent data entry, numeric, typing and computer navigational skills. Basic computer skills and Microsoft Office. BENEFITS Our competitive benefits package includes the following - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level QUALIFICATIONS - EDUCATION - H.S. Diploma/GED Equivalent - EXPERIENCE - Less than 1 Year of Experience

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Ombudsman Services Specialist supports members by evaluating and resolving concerns related to benefits administered by ETF. This includes health insurance, life insurance, income continuation insurance, disability programs, and Wisconsin Retirement System (WRS) benefits. The role requires independent decision-making, strong analytical skills, and the ability to interpret complex benefit policies and regulations. - Review, investigate, and resolve benefit-related complaints and inquiries from WRS participants. - Negotiate changes in benefit interpretations, policies, or practices with insurance plans and administrators. - Advise participants on grievance, appeals, and dispute-resolution options when issues remain unresolved. - Research and interpret applicable state and federal regulations, including Medicare and Medicare supplement rules. - Prepare written summaries, reports, letters, and educational materials. - Conduct interviews, gather data, and analyze information relevant to participant concerns. - Deliver training and educational support on benefit programs when needed. - Collaborate with internal ETF teams to address systemic issues or recurring participant concerns. Qualifications - Knowledge of health insurance, life insurance, income continuation insurance, and WRS benefit programs. - Understanding of state and federal laws, rules, and regulations governing Medicare and Medicare supplement programs. - Ability to independently prioritize workload and make sound decisions after training. - Proficient use of computer applications for letters, spreadsheets, and reports. - Effective written and verbal communication skills. - Strong human relations skills and professional customer service aptitude. - Knowledge of public relations and public speaking fundamentals. - Skill in negotiation, advocacy, and complaint-resolution techniques. - Knowledge of interviewing, investigation, research, and data analysis methods. - Ability to gather, track, and interpret statistical information. - Understanding of information systems, data processing, and quality improvement methodologies. - Ability to design and deliver educational materials and training sessions. - Familiarity with health care delivery systems and benefit plan grievance/appeal processes. Requirements - Must currently reside within the state of Wisconsin. - Position is primarily remote with optional onsite availability. Benefits - Compensation varies depending on a wide array of factors including office location, role, skill set, and level of experience. - SSO provides a range of benefits for this role.

• Demonstrate deep expertise across core SICS Life modules, including Treaty Management, Policy Administration, Claims, Accounting, and Technical Reserves. • Configure system parameters, business rules, and calculation engines based on business and technical requirements. • Utilize SICS UI features, batch controls, and platform-specific administrative tools to support operational and project needs. • Maintain strong command of SICS Life data structures. • Interpret data lineage and dependencies across modules to ensure accuracy and consistency. • Work with SICS APIs, inbound/outbound interfaces, and ETL pipelines to support system integrations. • Analyze SICS database tables, troubleshoot discrepancies, and trace records across multi-step processing flows. • Review database schemas, job logs, and error logs to resolve failures and correct posting issues. • Perform advanced troubleshooting using deep understanding of SICS table structures and schema architecture. • Investigate and resolve data processing issues, incorrect transactions, or failed job executions. • Collaborate with technical teams to diagnose system behavior and propose corrective or preventive solutions. • Manage and optimize SICS batch cycles, including job sequencing, dependencies, and runtime controls. • Partner with system engineers to enhance performance, reliability, and scheduling efficiency for end-to-end batch operations.

• Impact the business: By driving results aligned with stated goals for performance metrics, telephony metrics, utilization, productivity, attendance and attrition. • Manage administrative responsibilities: Such as attendance tracking, queue administration, and corrective delivery. • Influence on the lives of others: Develop, train, and manage team members. • Strengthen relationships: Establish and maintain communication with clients and/or team members; understand needs, resolve issues, and meet expectations. • Keep morale high: Ensure motivational programs are in place and encourage frequent recognition. • Impact the bottom line: Produce solid and effective strategies based on accurate and meaningful data reports and analysis and/or keen observations. • Define Sutherland’s reputation: Oversee and manage performance and service quality to guarantee customer satisfaction. • Keep leaders informed: Relay important information in the form of timely and accurate reports.