• Reduce outstanding accounts receivable by managing claims inventory • Speak to patients and insurance companies in a professional manner regarding their outstanding balances • Gather information from patients, clients/family members, client clinical areas, government agencies, employers, third party payors and/or medical payment programs to register patients, gather or update information, obtain referrals and pre-authorizations, complete appropriate forms, conduct evaluations, determine benefits and eligibility, determine financial responsibility and/or to identify sources of payment for services • Request, input, verify, and modify patient’s demographic, primary care provider, and payor information • Provide excellent customer service and timely response to questions and issues related to benefits, billing, claims, payments, etc. • Answer questions by phone and provide quotes for services; identify financial resources, etc. • Utilize various databases and specialized computer software for revenue cycle activities including eligibility verifications, pre-authorizations, medical necessity, review/updating of patient accounts • Explain charges, answer questions, and communicate a variety of requirements, policies, and procedures regarding patient financial care services and resources to patients, staff, payors, and agencies • Work with Claims and Collections to assist patients and their families with billing and payment activities

• Reduce outstanding accounts receivable by managing claims inventory • Speak to patients and insurance companies in a professional manner regarding their outstanding balances • Gather information from patients, clients/family members, client clinical areas, government agencies, employers, third party payors and/or medical payment programs, etc. • Request, input, verify, and modify patient’s demographic, primary care provider, and payor information • Provide excellent customer service and timely response to questions and issues related to benefits, billing, claims, payments, etc. • Utilize various databases and specialized computer software for revenue cycle activities • Explain charges, answer questions, and communicate policies regarding patient financial care services

Role Description This is a career for people who want: - Unlimited Income potential. - Ownership of their book of business. - Leadership and team-building opportunities. - A chance to make a real impact for families. - Flexibility. We're directly responsible for handling asset protection and Insurance benefit options for: - Local, regional, and various organizations. - Police departments. - School boards of education officials. - Multiple Government agencies at the local and state level. No Cold Calling. Our ideal candidate will embrace the opportunity to drive sales among existing clients and new clients through a mix of: - Networking. - Referrals. - PR marketing strategies. - Social media platforms. Company Description

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 Hourly Casualty Adjuster PRIMARY PURPOSE: To manage claim caseload of basic to highly complex claims within granted authority level including related financial implications, along with financial implications and to mentor Account Representatives and Account Specialists. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Utilizes special account instructions to obtain individual customer information and adhere to instructions; identifies, initiates, and coordinates various specialized services such as subrogation, fraud evaluation or case management review to resolve claims. - Establishes and maintains effective relationship with internal and external customers and coworkers; communicates effectively and timely. - Mentors/coaches account representatives and account specialists; facilitates round table discussions within the assigned team. - Investigates, evaluates and resolves claims; identifies potential problems/trends in claim files and takes corrective action or makes corrective recommendations; interprets medical reports and state law or jurisdictional law in claim handling. - Applies jurisdictional and medical knowledge to properly assess the indemnity, medical and expense exposure of assigned claims and appropriately interprets and applies insurance coverage. - Reviews client files and collaborates with team to prepare information which includes thorough analysis of file strategies, claims status and emerging trends. - Proactively manages litigation in conjunction with client requirements; works constructively with client and legal representatives to resolve claims. - Ensures compliance and best possible outcomes by minimizing financial liability. - Compiles requirements in order to prevent penalties and fines; utilizes instructions and tools provided to ensure that all state required documentation is issued accurately and in timely manner in accordance with specific jurisdictional timeframes and guidelines. - Monitors reports as assigned and documents compliance with key jurisdictional requirements (i.e. EDI, timeliness of benefit payments, etc.); assists Team Lead in tracking completion of team’s tasks and projects; reviews SAS/SOX documents and submits in timely manner; and assists with takeover and reverse takeover projects ensuring that claim files are transferred and handled appropriately. ADDITIONAL FUNCTIONS and RESPONSIBILITIES - Performs other duties as assigned. - Supports the organization's quality program(s). QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. State adjuster licenses required. Experience Six (6) years of related experience and/or training or equivalent combination of education and experience required. Skills & Knowledge - Thorough legal and jurisdictional knowledge based on line of business - Strong oral and written communication, including presentation skills - PC literate, including Microsoft Office products - Analytical and interpretive skills - Strong organizational skills - Excellent interpersonal skills - Strong customer service skills - Ability to work in a team environment - Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking 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.