Workers Compensation, Associate Specialist - Job ID: 6442 - Job Family: Legal Organization - Location: Rosemead, CA, US - Pay: $29.86 – $44.81 Job Description: Join the Clean Energy Revolution Become a Workers Compensation, Associate Specialist at Southern California Edison (SCE) and build a better tomorrow. In this job, you'll be a part of a team dedicated to supporting injured employees through expert advocacy. The role primarily assists workers' compensation advisors by managing a range of administrative duties and prioritizing effective customer service as well as timely benefit administration. As a Workers Compensation, Associate Specialist, your work will help power our planet, reduce carbon emissions and create cleaner air for everyone. Are you ready to take on the challenge to help us build the future? Responsibilities - Answers incoming calls and routes communications with professionalism and discretion, ensuring timely response and follow-up. - Processes incoming mail, print jobs, and claim-related documents, maintaining accurate records and supporting team workflows. - Assists in reviewing incident reports and emergency/non-emergency calls, performing initial triage and escalating cases per established guidelines. - Supports claim intake and documentation by facilitating the reporting of new claims and monitoring Incident Only (IO) cases for potential conversion. - Prepares and organizes subpoenas and litigation-related documents under supervision, ensuring compliance with legal protocols. - Maintains data accuracy by completing basic data entry tasks and supporting quality control efforts across high-volume processes. - Coordinates routine ergonomic equipment orders and accommodation requests, ensuring timely communication with internal contacts. - A material job duty of all positions within the Company is ensuring the protection of all its physical, financial and cybersecurity assets, and properly accessing and managing private customer data, proprietary information, confidential medical records, and other types of highly sensitive information and data with the highest standards of conduct and integrity. Minimum Qualifications - Experience performing thorough administrative support and clerical functions. - Knowledge of computer software, on-line applications, and office equipment. Preferred Qualifications - Three years of experience performing thorough administrative, secretarial, and clerical functions - Knowledge of and experience with Workers' Compensation Laws, Rules and Regulations - Experience working in a multi-task environment taking direction from multiple staff with minimal supervision - Strong verbal and written communication skills - Proficiency in MS Word, Excel, Access, MS Outlook or equivalent applications - Ability to handle a high volume of calls Additional Information - This position's work mode is hybrid. The employee will report to an SCE facility for a set number of days with the option to work remotely on the remaining days.  Unless otherwise noted, employees are required to work and reside in the state of California.  Further details of this work mode will be discussed at the interview stage. The work mode can be changed based on business needs. - Visit our Candidate Resource page to get meaningful information related to benefits, perks, resources, testing information, hiring process, and more! - Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. - Relocation does not apply to this position. About Southern California Edison The people at SCE don't just keep the lights on. Our mission is so much bigger. We're fueling the kind of innovation that's changing an entire industry, and quite possibly the planet. Join us and create a future with cleaner energy, while providing our customers with the safety and reliability they demand. At SCE, you'll have a chance to grow personally and professionally, making a real impact in Southern California and around the world. Southern California Edison is a proud Equal Opportunity Employer, including disability and protected veteran status. We are committed to ensuring that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodations at (833) 343-0727.

Title: Part Time Claims Coordinator Location: Middletown, Connecticut, United States Department: Operations Job Description: Description POSITION SUMMARY: Claims Coordinator Behavioral Health Claims & Managed Care | Part-Time | Hybrid | Middletown, CT – must be a CT resident About ABH ABH has been a cornerstone of Connecticut's behavioral health system partnering with state agencies, providers, and communities to strengthen access and quality of care across the state. As a nonprofit, we're driven by our mission. We manage mental health and substance abuse services, provide customized technology to operate programs efficiently, and participate in research representing best practices in the field. Behind all of it is a dedicated team making sure the operational and financial infrastructure runs the way it should and that's where this role comes in. If you are passionate about making a difference, aligned with our mission, and looking for a part-time opportunity that offers the flexibility to fit your life, we'd love to have you on our team. DUTIES AND RESPONSIBILITIES: - Process and adjust claims for the BHRP-Clinical, BHRP-Basic, Military Support, and Pre-Trial Intervention programs - Conduct weekly claims audits with emphasis on high-dollar submissions and compile audit reports - Manage check runs and eligibility file uploads as needed - Assist with weekly and monthly financial reporting - Support the claims denial review process and special claims projects - Respond to provider and staff inquiries about claims status, eligibility, and benefits - Assist in training new and existing claims staff - Maintain working knowledge of CPT and ICD-10 codes, behavioral health insurance terminology, and HCFA/UB-04 claim form requirements - Uphold confidentiality of all protected health information in accordance with HIPAA policies Work Arrangement CT residence only - This is a part-time, hybrid position offering real flexibility. Much of this role's work can be performed remotely, and we support work-from-home when responsibilities and workflows allow for it. Why Join ABH - Part-time schedule with genuine work-life flexibility - Hybrid work arrangement with meaningful WFH opportunity - Contribute to a mission-driven nonprofit that has been a cornerstone of Connecticut's behavioral health system - Collaborative team environment at a stable, established organization - Opportunities for growth across a diverse range of programs and functions ABH is an equal opportunity employer committed to a diverse and inclusive workplace. Requirements EDUCATION AND EXPERIENCE REQUIREMENTS: - Associate’s degree/Bachelor’s preferred in business or related field preferred; - Three years of demonstrated work experience in claims processing or in the behavioral health customer service field; - Attends trainings specific to job duties; - Attends annual Conflict of Interest. KNOWLEDGE/SKILLS/ABILITIES: - In-depth knowledge of ABH’s various utilization management and claims systems created by ABH and used by all the GA staff; - Must be flexible in order to respond quickly and positively to shifting demands; - Strong attention to detail; ability to work on multiple tasks and meet deadlines; - Excellent PC skills with demonstrated experience using Microsoft Office Package (MS Word, Excel, Outlook); - Strong written and verbal communication skills required. - Due to the need for in-person client support across Connecticut, this position requires residency within the state.

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make. The Claims Adjuster will play a vital role in delivering quality claim file management and an industry-leading customer claims experience. This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers. How You’ll Do ItClaims Technical Management: - Independently handle all aspects of the workers’ compensation claims from set-up to closure. - Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change. - Mitigate claim exposure while achieving the best outcome. - Determine timely and accurate compensability decisions within statutory requirements. - Set and adjust timely/accurate reserves within authority limits to ensure reserving activities are consistent with the case facts and company best practices. - Timely administration of statutory medical and indemnity benefits throughout the life of the claim. - Comply with all applicable statutory guidelines, rules, and regulations. - Control legal activity with defense counsel through the litigation process while managing legal fees and costs. - Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement. Claims Customer Service: - Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations. - Assist as necessary in providing claim status to agents and insureds, coverage verification and loss run reports, etc. - Provide excellent customer service to internal and external customers and business partners. - Participate in interactions with TPA adjusters and claims partners to drive optimized claims outcomes and top-notch claims experience. - Advocate to ensure that Pie has a leading claims customer experience. - Work to continuously improve our claims operations and look at opportunities and gaps in claim service, handling SOPs, protocols and processes. The Right Stuff - High School Diploma or equivalent is required. - Bachelor's Degree or equivalent experience with some college coursework is preferred. - Minimum of 2-years workers’ compensation claims experience is required. - Claims experience working in CA, AZ, and UT is preferred. - Strong communication (written and verbal) skills, to deliver more complex information effectively. - Strong problem solving skills to be able to manage complex tasks and work through to solutions with little guidance and direction. - Awareness of your own tasks, and how it impacts the team and deliverables. - Experience using G-Suite Tools, and collaboration tools like Slack is preferred. - Knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements. - Demonstrated knowledge and experience in claim adjudication, medical management and litigation management. - Developing ability to analyze and take necessary action in multiple focus areas, based on several data points. - Ability to use skills to overcome conflict and reach beneficial outcomes. - Ability to make claim decisions to mitigate exposure while achieving the best outcome. The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process. Base Compensation Range $85,000—$105,000 USD Compensation & Benefits - Competitive cash compensation - A piece of the pie (in the form of equity) - Comprehensive health plans - Generous PTO - Future focused 401k match - Generous parental and caregiver leave - Our core values are more than just a poster on the wall; they’re tangibly reflected in our work Our goal is to make all aspects of working with us as easy as pie. That includes our offer process. When we’ve identified a talented individual who we’d like to be a Pie-oneer , we work hard to present an equitable and fair offer. We look at the candidate’s knowledge, skills, and experience, along with their compensation expectations and align that with our company equity processes to determine our offer ranges. Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members. Location Information Unless otherwise specified, this role is remote. Remote team members must live and work in the United States (territories excluded) and have access to reliable, high-speed internet. Additional InformationPie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic. Pie Insurance participates in the E-Verify program. Please click here, here and here for more information. Pie Insurance is committed to protecting your personal data. Please review our Privacy Policy. Safety First: Pie Insurance is committed to your security during the recruitment process. We will never ask you for credit card information or ask you to purchase any equipment during our interview or onboarding process. Pie Named to 2025 America's Best Startup Employers Pie Insurance 2025 State of Workplace Safety Report #LI-REMOTE #BI-REMOTE

• Prepares and submits hospital, hospital-based physician and clinic claims to third-party insurance carriers either electronically or by hard copy billing • Secures needed medical documentation required or requested by third party insurances • Follows up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains • Processes rejections by either making accounts private or correcting any billing error and resubmitting claims to third-party insurance carriers • Responsible for consistently meeting production and quality assurance standards • Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer • Updates job knowledge by participating in company offered education opportunities • Protects customer information by keeping all information confidential • Processes miscellaneous paperwork • Ability to work with high profile customers with difficult processes • May regularly be asked to help with team projects • Ensure all claims are submitted daily with a goal of zero errors • Timely follow up on insurance claim status • Reading and interpreting an EOB (Explanation of Benefits) • Respond to inquiries by insurance companies • Denial Management • Meet with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles • Review late charge reports and file corrected claims or write off charges as per client policy • Review reports identifying readmissions or overlapping service dates and ignore, merge, or split-bill according to the payer’s rules and the client’s policy • Review credit reports, resolve credits belonging to a payer when able, and submit a listing of credits to the facility as required by the payer