Job Description: Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently—empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. We are looking to add a Workers’ Compensation Claims Specialist to join our team. Experience handling claims in Louisiana and Mississippi is required. Essential Responsibilities: - Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. - Investigates, evaluates, and resolves lost time Workers’ Compensation claims, including litigated claims. - Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage issues. - Enters and maintains accurate information on a computer system during the claim process, to include final settlement information. - Generates checks for indemnity and medical payments daily. - Develops and monitors consistency in procedural matters of claims handling process within CRS. - Willingness to become licensed if required in jurisdiction where claims are handled. Qualifications: - Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. - Experience: 3-5 years claims experience with strong background in Workers’ Compensation claims handling. Prior experience handling Louisiana and Mississippi claims is required. - Licensing: Active Mississippi, Louisiana, and/or Texas Workers Compensation License required or the ability to acquire license within three months of hire. - Skills: An ideal candidate will have proficient knowledge of Workers’ Compensation insurance coverage and claims processing procedures. They will possess the ability to adjudicate lost time claims across multiple jurisdictions and demonstrate the capacity to quickly learn and adapt to various software programs. - Technical Competencies: An ideal candidate will have a strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements. They will prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience. Here’s a little bit about us: Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: - Paid Parental Leave and supportive New Parent Benefits — We know being a working parent is hard, and we want to support our employees in this journey! - Company paid continuing Education & Tuition Reimbursement — We support those who want to develop and grow. - 401k Profit Sharing — Each year, Holmes Murphy makes a lump sum contribution to every full-time employee’s 401k. This means, even if you’re not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. - Generous time off practices in addition to paid holidays — Yes, we actually encourage employees to use their time off, and they do. After all, you can’t be at your best for our clients if you’re not at your best for yourself first. - Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you — Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. - DE&I programs — Holmes Murphy is committed to celebrating every employee’s unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! - Consistent merit increase and promotion opportunities — Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important — not only with your financial wellbeing, but also your career wellbeing. - Discretionary bonus opportunity — Yes, there is an annual opportunity to make more money. Who doesn’t love that?! Holmes Murphy & Associates is an Equal Opportunity Employer. #LI-SM1

Job Description: Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently—empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. We are looking to add a Workers’ Compensation Claims Specialist to join our team. Experience handling claims in Louisiana and Mississippi is required. Essential Responsibilities: - Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. - Investigates, evaluates, and resolves lost time Workers’ Compensation claims, including litigated claims. - Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage issues. - Enters and maintains accurate information on a computer system during the claim process, to include final settlement information. - Generates checks for indemnity and medical payments daily. - Develops and monitors consistency in procedural matters of claims handling process within CRS. - Willingness to become licensed if required in jurisdiction where claims are handled. Qualifications: - Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. - Experience: 3-5 years claims experience with strong background in Workers’ Compensation claims handling. Prior experience handling Louisiana and Mississippi claims is required. - Licensing: Active Mississippi, Louisiana, and/or Texas Workers Compensation License required or the ability to acquire license within three months of hire. - Skills: An ideal candidate will have proficient knowledge of Workers’ Compensation insurance coverage and claims processing procedures. They will possess the ability to adjudicate lost time claims across multiple jurisdictions and demonstrate the capacity to quickly learn and adapt to various software programs. - Technical Competencies: An ideal candidate will have a strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements. They will prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience. Here’s a little bit about us: Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: - Paid Parental Leave and supportive New Parent Benefits — We know being a working parent is hard, and we want to support our employees in this journey! - Company paid continuing Education & Tuition Reimbursement — We support those who want to develop and grow. - 401k Profit Sharing — Each year, Holmes Murphy makes a lump sum contribution to every full-time employee’s 401k. This means, even if you’re not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. - Generous time off practices in addition to paid holidays — Yes, we actually encourage employees to use their time off, and they do. After all, you can’t be at your best for our clients if you’re not at your best for yourself first. - Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you — Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. - DE&I programs — Holmes Murphy is committed to celebrating every employee’s unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! - Consistent merit increase and promotion opportunities — Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important — not only with your financial wellbeing, but also your career wellbeing. - Discretionary bonus opportunity — Yes, there is an annual opportunity to make more money. Who doesn’t love that?! Holmes Murphy & Associates is an Equal Opportunity Employer. #LI-SM1

The salary range for this job posting is $55,132.00 - $110,642.00 annually + bonus + benefits. Pay Type: Salary The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process. For candidates residing in certain states such as Illinois, the salary range is $59,630 to $119,670 annually + bonus + benefits. Pay Type: Salary While we may prefer candidates who can work remote in Illinois, we will consider candidates who live in any of our listed payroll approved states that have the necessary jurisdictional experience. Lost Time Workers' Compensation claims handling experience in any of the following states Illinois, Wisconsin, Kentucky, Indiana, and Iowa is strongly preferred. The position reports to the Director, Workers' Compensation Claims. We may hire a senior level depending on the candidate's background and experience and the salary range is inclusive of all levels. Are you a Referral? If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team. Unique residence requirements are listed in each job posting, please review closely for details. Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes: Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin. JOB OBJECTIVE: The Lost Time Claims Specialist, Workers’ Compensation primarily manages indemnity claims. The Lost Time Claims Specialist is responsible for the investigation, evaluation, and determination of compensability for work-related injury and disease claims following established guidelines to determine benefit eligibility. The Lost Time Claims Specialist also serves as a resource to Medical Only Claims Specialists and Claims Specialist Trainees. The position’s objective is to provide superior service in a cost-effective manner to achieve best possible outcomes as well as proactively collaborate across the enterprise to ensure alignment of objectives and foster continuous improvement. ESSENTIAL FUNCTIONS: 1. Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims to their most cost- effective conclusion. 2. Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines. 3. Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision. 4. Take recorded statements when necessary. 5. Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels. 6. Utilize proactive reserving behaviors to ensure adequate case reserves which reflect the probable ultimate outcome based on the current known circumstances throughout the life of the claim. 7. Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible. 8. Consults with assigned claim director, return to work specialists, nurse case managers, internal/external medical, and legal on current and/or recommended treatment, litigation or rehabilitation plans to ensure claims outcomes are achievable and appropriate. 9. Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care. 10. Works collaboratively with the injured worker, employer, assigned return to work specialist, and medical providers to facilitate the injured worker’s safe and timely return to work. 11. Manages claims litigation, including expenses, by collaborating and providing direction to panel counsel throughout the life of the claim. 12. Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed. 13. Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome. 14. Presents and summarizes claim details at internal team staffing, participates in discussions, and provides guidance as needed. 15. Consults with assigned claim director if the loss becomes significantly complex or presents significantly increasing financial exposure. 16. Follows established claims best practices related to medical management, litigation, fraud/abuse and recovery. 17. Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics. 18. Develops presentations for special projects such as internal/external meetings and conferences as needed. 19. Along with the claim director, regional vice president and other claims staff, participates in claim reviews, onboardings, etc. for our policyholders and agents. 20. Proactively collaborate with our policyholders to ensure alignment of objectives and foster continuous improvement. OTHER FUNCTIONS: 1. Nonessential function: other duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES: • Bachelor’s Degree from an accredited college or university is preferred. • Three years of experience in the field of workers’ compensation insurance required. • Ability to manage claims through the litigation process. • Internal candidates must demonstrate knowledge of Encova Best Practices guidelines and meet quality standards. • One valid workers’ compensation adjuster license is strongly preferred. Must be eligible to obtain additional licenses as required. • Must pass the claims adjuster license exam(s) as assigned within 90 days of being hired. • Preference may be shown to candidates with multiple state claims management experience. • Experience in workers’ compensation claims practices and laws, court procedures, precedents and state statutes. • Ability to use logic and sound reasoning to identify alternative solutions for problem-solving. • Strong written and verbal communication skills. • Strong analytical skills. • Ability to multitasks and manage time effectively and productively. • Work effectively independently as well as in a team environment. • Develop and maintain strong, effective internal and external relationships. • Work effectively in a paperless environment. • Skilled in the use of laptops, claims management systems, and other typical business-related programs such as Microsoft Office suite. This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons. Ready to join our team? At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating, and financially rewarding opportunities. Join us to discover a work experience where you can learn and grow to your fullest potential. What you can expect from us In addition to a competitive compensation package, we offer a comprehensive benefits package designed to support the well-being and growth of our associates. Available benefits (subject to any policy or plan changes) include, but are not limited to: - Health, Dental & Vision Insurance - Company-provided life and income protection plans - Eligibility to participate in a company incentive bonus program - 401(k) Retirement Plan - 100% company match up to 7% on annual salary - Paid Time Off, Paid Holidays, and Floating Holidays - Flexible Work Arrangements - Hybrid and remote depending on the role We believe that happy, healthy associates are the foundation of great work. Join us and thrive both professionally and personally. Encova Insurance is an EOE/E-Verify employer. #LI-Remote#LI-MF1

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Responsible for managing patient account balances including accurate claim submission, compliance will all federal/state and third party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of the WVU Medicine hospitals. Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues that arise from customer inquiries. Serves as a resource for co-worker process questions and concerns. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to achieve best in class revenue cycle operations. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. High School Graduate or equivalent. 2. Certified Revenue Cycle Representative (CRCR) Certification through the Healthcare Financial Management Association (HFMA) OR Certified Revenue Cycle Specialist through the American Association of Healthcare Administrative Management (AAHAM) within 90 days of hire. EXPERIENCE: 1. Three (3) years medical billing/medical office experience. To be completed as established by department: (Administered at Department level)  1. Completes eight hours of revenue cycle continuing education required annually. PREFERRED QUALIFICATIONS: EXPERIENCE: 1. Three (3) years medical billing/medical office experience, preferably related to claims billing and insurance follow-up. CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Submits accurate and timely claims to third party payers. 2. Resolves claim edits and account errors prior to claim submission. 3. Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. 4. Gathers statistics, completes reports and performs other duties as scheduled or requested. 5. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency. 6. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. 7. Contacts third party payers to resolve unpaid claims. 8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. 9. Assists Patient Access and Care Management with denials investigation and resolution. 10. Accesses and utilizes all necessary computer software, applications and equipment to perform job role. 11. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth. 12. Attends department meetings, teleconferences and webcasts as necessary. 13. Researches and processes mail returns and claims rejected by the payer. 14. Reconciles billing account transactions to ensure accurate account information according to established procedures. 15. Processes billing and follow-up transactions in an accurate and timely manner. 16. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing. 17. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. 18. Maintains work queue volumes and productivity within established guidelines. 19. Provides excellent customer service to patients, visitors and employees. 20. Participates in performance improvement initiatives as requested. 21. Works with supervisor and manager to develop and exceed annual goals. 22. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. 23. Communicates problems hindering workflow to management in a timely manner. 24. Serves as a resource for co-worker process questions and concerns. 25. Works with Hospital Billing Trainer to identify training opportunities for staff. 26. Serves as a Super User for Quadax, FISS, and other PFS software applications. 27. Exceeds productivity measures in like work group as demonstrated by Epic dashboards. 28. Assists in the annual review of departmental policies and procedures and provides feedback. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Must be able to sit for extended periods of time. 2. Must have reading and comprehension ability. 4. Visual acuity must be within normal range. 5. Must be able to communicate effectively. 6. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Office type environment. SKILLS AND ABILITIES: 1.Excellent oral and written communication skills. 2. Working knowledge of computers. 3. Knowledge of medical terminology preferred. 4. Knowledge of third party payers required. 5. Knowledge of business math preferred. 6. Knowledge of ICD-10 and CPT coding processes preferred. 7. Excellent customer service and telephone etiquette. 8. Ability to use tact and diplomacy in dealing with others. 9. Maintains current knowledge of third party payer and managed care billing requirements and contracts. Additional Job Description: Scheduled Weekly Hours: 40 Shift: Day (United States of America) Exempt/Non-Exempt: United States of America (Non-Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 544 SYSTEM Patient Financial Services