Job Description This Medicare Claims Biller is responsible for providing TruBridge services to a Critical Access Hospital client that is located in Texas. This includes coordinating the day to day activities of a hospital's or clinic’s business office such as patient billing and collection, third-party payer relations, and/or preparation of insurance claims. Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include: - Coordinates business office functions and personnel that may include, but is not limited to patient billing, credit and collections, and data entry. - Recommends new processes and changes in current processes. - Implements controls to ensure appropriate submission, billing and credit and collections are kept in accordance with established procedures - Implements appropriate procedures for follow-up on third party approvals, billing, and collection of overdue accounts - Ensures that accurate and timely billing is being done by staff members in accordance with established procedures and third-party requirements - 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 - Responsible for assisting manager in the management of employees which would include coaching, training and performing necessary disciplinary actions including following up on action plans for their employees. - Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer - Ensures employee compliance with dress code, attendance and other company policies. - Processes miscellaneous paperwork and performs other administrative duties as assigned. - Minimum Requirements: Education/Experience/Certification Requirements - At least 5 years hospital billing experience, can include time outside of TruBridge - Experience processing Medicare Claims, ideally within the state of Texas - Excellent communication (written and oral) and interpersonal skills. - Strong organizational, multi-tasking, and time-management skills. - Must be detail oriented and able to follow through on issues to resolution. - Must be able to act both independently and as a team member. - High School Diploma or equivalent combination of education and relevant experience needed. - Excellent critical thinking, organizational, and time management sills with a strong attention to detail, accuracy, and follow through Why join our team? - Work remotely with a work/life balance approach - Robust benefits offering, including 401(k) - Generous time off allotments - 10 paid holidays annually - Employer-paid short term disability and life insurance - Paid Parental Leave

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 Workers Compensation Claims Associate | CO, UT, WY Jurisdictions | Prior Claims Experience Preferred Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career? - Career development and promotional growth opportunities through increasing responsibilities - A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs PRIMARY PURPOSE OF THE ROLE: To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. ARE YOU AN IDEAL CANDIDATE? We are looking for an enthusiastic candidate to fill a Workers Compensation Associate position. Ideal candidates will thrive in a collaborative team environment, show motivation and drive in their work ethic, are customer-oriented, naturally empathic and solution-focused. Prior Claims experience preferred. ESSENTIAL RESPONSIBILITIES MAY INCLUDE - Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision. - Supports other claims representatives, examiners and leads with larger or more complex claims as necessary. - Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency. - Communicates claim action/processing with claimant, client and appropriate medical contact. - Ensures claim files are properly documented, and claims coding is correct. - May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims. - Maintains professional client relationships QUALIFICATIONS - Education & Licensing: High school diploma or GED required - Skills: Strong oral and written communication, computer literate – including Microsoft Office, organizational skills required - Experience: Clerical or customer service experience or equivalent combination of education and experience preferred Experience One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred. Jurisdictions: CO, UT WY Licensing: not required TAKING CARE OF YOU - Flexible work schedule. - Referral incentive program. - Career development and promotional growth opportunities. - A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($22/hr). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. 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.

SUMMARY: This is the entry level professional claim handler. Handles medical only and indemnity benefits. Exercises some discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. RESPONSIBILITIES/TASKS: - Verifies workers’ compensation coverage of employers and injured employees. - Determines compensability under workers’ compensation by thorough investigation of the claim. - Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. - Facilitates return to work for the injured employee. - Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. - Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies. - Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury. - Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses. - Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition. - Works closely with manager on complex files or files above settlement/reserve authority. - Manages outside vendors to ensure cost containment efforts. - Establishes and maintains effective working relationships with all internal and external customers. - Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS - Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged. - Minimum one-year relevant experience that provides the necessary skills, knowledge and abilities or completion of claims trainee program. Bilingual skills preferred. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: - Ability and proficiency in the use of computers and company standard software specific to position. - Knowledge of medical and legal terminology related to the work. - Knowledge of workers’ compensation laws and regulations, including jurisdictional laws. - Effective oral and written communication skills. - Effective customer service skills. - Ability to negotiate, build consensus and resolve conflict. - Ability to manage multiple priorities and meet established deadlines. - Attention to detail and analytical skills. - Ability to work independently as well as within a team. WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. Minimal travel required. PAY RANGE: “Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $48,200 and $80,750.” We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract. #LI-CH1 #UWIC United Wisconsin Insurance Company

SUMMARY: This is the entry level professional claim handler. Handles medical only and indemnity benefits. Exercises some discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. RESPONSIBILITIES/TASKS: - Verifies workers’ compensation coverage of employers and injured employees. - Determines compensability under workers’ compensation by thorough investigation of the claim. - Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. - Facilitates return to work for the injured employee. - Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. - Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies. - Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury. - Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses. - Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition. - Works closely with manager on complex files or files above settlement/reserve authority. - Manages outside vendors to ensure cost containment efforts. - Establishes and maintains effective working relationships with all internal and external customers. - Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS - Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged. - Minimum one-year relevant experience that provides the necessary skills, knowledge and abilities or completion of claims trainee program. Bilingual skills preferred. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: - Ability and proficiency in the use of computers and company standard software specific to position. - Knowledge of medical and legal terminology related to the work. - Knowledge of workers’ compensation laws and regulations, including jurisdictional laws. - Effective oral and written communication skills. - Effective customer service skills. - Ability to negotiate, build consensus and resolve conflict. - Ability to manage multiple priorities and meet established deadlines. - Attention to detail and analytical skills. - Ability to work independently as well as within a team. WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. Minimal travel required. PAY RANGE: “Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $48,200 and $80,750.” We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract. #LI-CH1 #UWIC United Wisconsin Insurance Company