• Provide prompt, courteous and high-quality customer service to all policyholders and claimants by responding to customer inquiries, initiating investigations and resolving customer claims. • Gather necessary information from customers to initiate the claim and explain policy, coverage, and appropriate course of action • Manage an inventory of claims, establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim • Coordinate the repair of damaged vehicles and assist with rental reimbursement • Recognize recovery opportunities in regards to subrogation and salvage, as well as total loss • Ensure compliance with specific state regulations, policy provisions, and standard operating procedures • Communicate with involved parties and negotiate appropriate settlements with claimants, insureds, and attorneys within approved payment authority • Provide input for continuous development of claims guidelines, best practices, and process improvements • Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to resolve the claim • Engage in learning opportunities to build knowledge of personal lines claims, court decisions impacting the claims function, current guidelines in claims function, and policy changes and modifications

• You'll provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls, filing claims, and resolving customer requests • Manage an inventory of both litigated and non-litigated cases • Dive into auto insurance claims to identify areas of dispute, investigate and gather all necessary information, evaluate liability and damages, and negotiate settlements with opposing parties or their insurance providers • Ensure compliance with state regulations, policy provisions, and standard operating procedures • You'll handle both non-litigation and litigation cases related to auto claims disputes, communicate with involved parties, attend mediations, arbitrations, and court hearings as necessary, and keep clients, claims adjusters, attorneys, and other stakeholders informed • Collaborate with defense counsel, claims counsel, and litigation claims management for strategic planning while building strong working relationships with approved defense firms and other industry vendors • Review legal documents and ensure compliance with initial suit-handling plan of action • You'll serve as corporate representative for discovery review and depositions, appearing at depositions and trials when needed • Analyze policy language and make appropriate coverage decisions, draft complex coverage correspondence, and proactively manage claim files from inception to closure • Direct and control the activities and costs of outside vendors including defense counsel, coverage counsel, experts and independent adjusters • Maintain adjuster licenses and continuing education requirements.

• Investigate and resolve Homeowners claims of minor to moderate complexity in a timely and efficient manner. Document with photographs, measurements, recorded interviews as needed, write a repair estimate to capture damages, and complete thorough file notes. • Ability to perform field inspections at least 50% of work time. (company car provided) This will involve travelling to our customers’ home to conduct on-site inspections, thoroughly investigate coverage and prepare detailed estimate to efficiently resolve their claims. • Ability to handle virtual claims. Must have ability to use imagery, and advanced video technology to collaborate with onsite vendors and insureds to identify damage and write damage estimates from a virtual setting when needed. • Compare facts gathered during the investigation against the policy to determine coverage of claim; extend or deny coverage as appropriate. • Establishes reserve amounts within prescribed settlement authority limit and negotiates settlement of claims; recommends claims which exceed personal authority limit to supervisor for approval. • Responsible for effectively and timely communicating with insureds and /or their representatives to resolve issues and ensure customer satisfaction. This includes timely response to phone calls, emails, texts, written communication, and adherence to Department of Insurance requirements. • Prioritizes own responsibilities and effectively manages claims workload to regularly monitor progress and expenses to properly resolve inventory to conclusion. • At times may direct, monitor, and review files handled by independent adjusters to conclusion. • Other functions may be assigned

American Specialty Health Incorporated (ASH) is seeking an Examiner I to join our Claims department. The primary purpose of this position is to verify claim information lifted from the CMS 1500 form by Optical Character Recognition and enter data from CMS 1500 Claim Forms into the Claims Processing System, and to process claim edits from electronic claims. This position is responsible for the accurate review, input and adjudication of claims in accordance with regulations, ASH standards and contractual obligations of the organization. Remote Worker Guidelines - Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings. Responsibilities - Processes claims accurately and efficiently. - Reviews all incoming claims to verify necessary information. - Determines that correct member and provider records are chosen and utilized to process claims. - Enters claims data and information into the computerized Claims Processing System. - Maintains all required documentation of claims processed and claims on hand. - Adjudicates claims in accordance with departmental policies, procedures, state and accreditation standards and other applicable rules. - Maintains production standards; for direct data entry claims this includes processing an average of 31 claims per hour, with an accuracy rate of 98.5% over each pay period. - Verifies data of scanned paper claims at stated standards. - Provides backup for other examiners within the department. - Promotes a spirit of cooperation and understanding among all personnel. - Attends organizational meetings as required. - Adheres to organizational policies and procedures. - Maintains confidentiality of all claim files, claims reports, and claims related issues. - Performs other duties as assigned. - Complies with all policies and standards. Qualifications - High School Diploma or GED certificate required. - 6 months data entry experience with 10 key and word processing; minimum 10,000 keystrokes per hour required. - Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred. - Proficient in MS Office. - Ability to work and maintain production in a work-from-home (WFH) environment. - Demonstrated ability to show self-discipline to meet production goals. Core Competencies - Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships. - Ability to display excellent customer service to meet the needs and expectations of both internal and external customers. - Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment. - Ability to effectively organize, prioritize, multi-task and manage time. - Demonstrated accuracy and productivity in a changing environment with constant interruptions. - Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions. - Ability to exercise strict confidentiality in all matters. Mobility - Primarily sedentary, able to sit for long periods of time. Physical Requirements - Ability to see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs. Environmental Conditions - Work-from-home (WFH) environment. American Specialty Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law. Please view Equal Employment Opportunity Posters provided by OFCCP here. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702. ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information. #LI-Remote #Claims #Healthcare #Review #Data #Typing #10key #DataEntry