Work From Home Work From Home Work From Home, Indiana 46544 The PACE Claims Specialist I, is responsible for performing day-to-day claims processing and adjudication tasks while providing support to vendors and internal teams. This role plays an integral part in ensuring PACE medical claims are processed efficiently and in compliance with PACE policies and CMS requirements. The PACE program's vision is to provide individualized and joyful care through exemplary teamwork serving as many seniors as possible with the best quality-of-life in their communities. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. The PACE program’s vision statement is to provide unmatched, individualized, and joyful care through teamwork that is worthy of praise so that seniors experience the best quality-of-life in their communities. PACE offers seniors and their families the care, nutrition, rehabilitation, transportation, and supportive services they need to remain healthy so that they can live in their own home. Franciscan is known for our mission of caring. WHAT YOU CAN EXPECT - Practice Hours: Monday – Friday, 8:00 a.m. – 5:00 p.m. Eastern - No Weekends, Evenings, or Holidays - Serves as point of contact for vendors and participants for concerns related to claims or billing. Performs customer service activities including, but not limited to, support and education to vendors during onboarding phase of partnership, communicating claim statuses to vendors, investigating vendor inquiries, and gathering information related to vendor claim appeals. - Performs duties related to the timely and accurate adjudication of PACE participant medical claims. This includes data entry, processing manual and electronic claims, verifying proper authorizations, and processing claim denials. Ensures claims adhere to CMS rules, Medicare guidelines, and PACE-specific policies. Collaborates with the interdisciplinary team (IDT) to resolve discrepancies in authorizations or documentation. Conducts any necessary follow up with internal and external stakeholders. - Assists with maintaining the vendor and provider network within the claims adjudication software. Builds and modifies vendor profiles as program’s vendor network changes. Ensures accuracy of vendor profiles in relation to reimbursement structure in vendor contracts, provider lists, W-9s, etc. Enters paper claims into claim adjudication software upon receipt. - Supports Claim Specialist II in monthly EDPS reporting and error clearance. This includes, but is not limited to, reporting to regulatory agencies, clearing errors for resubmission of codes, and monthly auditing of EDPS return/output data. Prepares routine claim reports for review by leadership. - Collaborates with PACE intake and eligibility team members to maintain accurate participant eligibility record in claim adjudication software, driving accurate and compliant claim payments. - Assists with tracking vendor 1099s and gathering claims data for reinsurance reporting. Performs administrative tasks related to claims processing such as mailing vendor checks and remittance advice, mailing vendor notification letters, etc. - Works closely with internal stakeholders, including finance, compliance, and clinical teams, to facilitate claims processing workflows. Partners with external stakeholders, such as CMS or third-party vendors, to ensure seamless claims operations. QUALIFICATIONS - Associate's Degree- Finance, Business or Healthcare Administration- Preferred - Certified Medical Reimbursement Specialist- American Medical Billion Association- Preferred - 1 Year- Medical Claim Processing or Medical Claim Support Role Experience- Required TRAVEL IS REQUIRED: Never or Rarely JOB RANGE: PACE Claims Specialist I $20.25 - $26.33 INCENTIVE: Not Applicable EQUAL OPPORTUNITY EMPLOYER It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity. Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

Aperçu du poste Secteur d’activité : Nestlé Purina Soins des animaux familiers Canada Intitulé du poste : Gestionnaire principal de territoire Lieu : Poste sur le terrain en mode télétravail – Ville de Québec Résumé du poste Nous recherchons un gestionnaire principal de territoire qui sera responsable de visiter les cliniques vétérinaires du territoire de la Ville de Québec et de fournir des recommandations vétérinaires sur les produits Purina Pro Plan Veterinary Diets. Ce poste correspond à un poste vacant existant. Une journée dans la vie d’un gestionnaire principal de territoire : Fait la promotion des produits Purina auprès des vétérinaires : • Fait la promotion des produits Purina Pro Plan Veterinary Diets auprès des vétérinaires en tant que produit de référence • Anime des séminaires éducatifs vétérinaires sur la nutrition des animaux et les produits Purina pour la nutrition et le traitement des animaux sains et malades dans les cliniques vétérinaires • Veille à maintenir un niveau élevé de connaissances nutritionnelles afin d’influencer les ventes en clinique • Élaborer des plans d’affaires avec les cliniques et réalise des revues d’affaires • Gère les retours d’information et le statut des promotions pour établir des évaluations avant et après • Réalise une revue d’assurance qualité pour la clinique en termes de produit, tarification et distribution Assure la couverture des cliniques vétérinaires : • Assure la couverture des cliniques vétérinaires selon la fréquence et la couverture d’appels établies • Vendent les opportunités incrémentales pour Nestlé Purina Canada en tirant parti des initiatives nationales et régionales • Transmet les informations des cliniques directement dans la base de données du système de ventes pour examen, vérification et analyse Gère la formation et le coaching : • Prend en charge la formation des nouveaux gestionnaires de territoire pour un intégration efficace et soutient le développement continu des gestionnaires de territoire actuels • Soutient les gestionnaires de territoire moins expérimentés dans le service des cliniques au besoin Exigences du rôle • Le bilinguisme en anglais et en français est requis, car ce poste nécessite une collaboration avec des parties prenantes à travers le marché canadien • 4+ années d’expérience en vente directe ou expérience commerciale connexe • Une expérience en vente dans l’industrie vétérinaire ou pharmaceutique est considérée comme un atout de taille • Le candidat doit résider dans le territoire et être en mesure de voyager selon les besoins du territoire • Grande motivation personnelle et esprit proactif, avec la capacité de penser stratégiquement pour saisir des opportunités d’affaires incrémentales • Maîtrise des outils informatiques : MS Word, Excel, PowerPoint, Outlook • Excellentes aptitudes à la communication verbale et écrite, avec un historique avéré de présentations efficaces devant des auditoires de toutes tailles Avantages Chez Nestlé Canada, nous nous engageons à la transparence et à l’équité dans nos pratiques de rémunération et d’affichage des postes. Ce poste offre un salaire concurrentiel dans la fourchette indiquée ci‑dessus, en conformité avec les règlements ontariens sur la transparence salariale. • Fourchette de salaire de base : 91 000,00 $ CA à 108 000,00 $ CA • Admissibilité à un bonus • Ensemble complet de rémunération globale incluant des avantages santé et dentaires dès le premier jour d’emploi • Régime de retraite avec contribution de l’entreprise • Quatre semaines de vacances et six jours personnels (jours fériés payés personnels) • Excellents programmes de formation et de développement ainsi que des opportunités d’évolution au sein de l’entreprise • Accès à l’aide aux études et au remboursement des frais de scolarité • Prestations d’affirmation de genre pour assurer l’accès aux soins nécessaires, aux ressources et à la couverture pour les interventions d’affirmation du genre • Couverture médicale pour les services de fertilité et la gestation pour autrui afin de soutenir le projet de parentalité, indépendamment des conditions médicales, du genre ou de l’orientation sexuelle • Prestations d’adoption pour réduire certains des obstacles financiers liés à l’adoption • Jusqu’à 50 % de rabais – machine à café Nespresso, capsules et accessoires • Accès au magasin d’entreprise à prix réduit proposant des produits Nestlé, Nespresso et Purina (situé dans divers bureaux/sites de Nestlé) Ce que vous devez savoir Nous examinerons les candidatures au fur et à mesure de leur réception; n’attendez donc pas pour soumettre la vôtre. Nestlé Canada est un employeur offrant l’égalité des chances. Les principes de diversité, d’équité, d’inclusion et d’accessibilité sont essentiels à notre façon d’opérer. Nous nous efforçons de favoriser un environnement respectueux et bienveillant où chacun se sent valorisé et encouragé à contribuer et à réussir. Si vous êtes invité à participer au processus de recrutement et avez besoin d’un aménagement, veuillez en informer les Ressources humaines. Nestlé collaborera avec vous pour assurer une pleine

Introduction At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose. Overview Role specifics: - Jurisdictions: Any - Licenses: License is preferred such as TX, FL, NY, HI and RI - Location: This role is eligible for fully remote work. How you'll make an impact Supervise: Lead and encourage a liability MCU claims team handling a variety of caseload sizes and complexities to deliver high-quality and efficient service. Promote Best Practices: Guide claims team to handle claims in accordance with GB’s Best Practices. Drive Talent: Take charge of adjuster hiring and training, encouraging a culture of performance and continuous improvement. Manage Workloads: Define team goals, motivate performance, and effectively manage workloads to ensure optimal efficiency. Utilize Technology: Harness the power of Gallagher's technology to enhance your team's efficiency and overall quality of service. Client Communication: Communicate with clients, carriers, and brokers in a professional, positive, and proactive manner. Prioritize and Develop: Effectively manage multiple competing priorities, identify coaching opportunities, and position team members for successful development. About You Ideal candidates for this position will have: • Claims Background: Commercial MCU claims (trucking a plus), significant injury claims & demands or lawsuit (litigation) experience • Prior leadership experience: 7-10 years preferred • Litigation expereince, catastrophic loss, and trucking/transportation preferred REQUIRED QUALIFICATIONS: • High School Diploma • Minimum of 10 years related claims experience • Appropriately licensed and/or certified in all states in which claims are being handled • Knowledge of all team member related functions DESIRED: • Bachelor's Degree #LI-NZ1 #LI-REMOTE Compensation and benefits We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve: - Medical/dental/vision plans, which start from day one! - Life and accident insurance - 401(K) and Roth options - Tax-advantaged accounts (HSA, FSA) - Educational expense reimbursement - Paid parental leave Other benefits include: - Digital mental health services (Talkspace) - Flexible work hours (availability varies by office and job function) - Training programs - Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing - Charitable matching gift program - And more... **The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process. We value inclusion and diversity Click Here to review our U.S. Eligibility Requirements Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

Benefits: - 401(k) matching - Competitive salary - Health insurance - Paid time off - Training & development - Vision insurance About the Role: We are currently seeking a highly organized and detail-oriented Roofing Claims Supplement Specialist to join our national franchise support team. In this role, you will support our franchise owners and help manage the supplements process for insurance restoration projects. You will play a critical role in ensuring that each claim is accurate, fully accounted for, and compliant with building code and carrier requirements. This position is ideal for someone who is both technically skilled and service-oriented — someone who thrives on precision, problem-solving, and providing exceptional support to our growing franchise network. Salary range is $55-75k and will be commensurate with experience. Key Responsibilities: - Review insurance restoration projects, including statements and scopes of work, to identify discrepancies or omissions in the necessary repairs - Use current construction principles, practices, and local building code requirements to prepare detailed and accurate supplemental estimates - Communicate directly with insurance carriers to reconcile estimate differences and justify any potential additions to the estimate - Use Xactimate and/or Symbility to prepare comprehensive estimates in accordance with local building code and construction standards - Respond to incoming communications promptly and professionally, ensuring all documentation is handled with precision and care - Maintain a consistently professional demeanor when working with insurance carriers, franchisees, and internal teams - Provide frequent and consistent updates and follow-up communications to ensure timely resolution of all assigned supplement files - Collaborate with the Director of Supplementing, Supplementing Specialists, and Franchise Business Coaches to support file progress and provide best-in-class service to franchise owners Required Skills & Qualifications: - Minimum 1 year of experience working with roofing insurance claims (both desk and field experience will be taken into consideration) - Experience preparing estimates in Xactimate (required); Symbility experience (a plus) - Solid understanding of general construction standards and residential building codes - Ability to clearly and professionally articulate building practices, and scope justifications - Exceptional attention to detail and documentation accuracy - Proficient arithmetic skills and the ability to calculate estimate values quickly and correctly - Strong critical thinking and problem-solving abilities - Capable of working both independently and collaboratively in a remote team environment - Competence and confidence in written and verbal customer-facing interactions Why Join Storm Guard: At Storm Guard, we lead with values. We act with enthusiasm, do the right thing, innovate and grow, show respect for others, and create exceptional experiences — for our franchisees, customers, and each other. As a growing national brand, we’re looking for people who care about doing meaningful work and making an impact alongside a supportive, purpose-driven team. This is a remote position.