The Grievance Specialist is a member of the Appeals & Grievances (A&G) team at Healthfirst and is responsible for managing and resolving member or authorized representative–initiated grievances and complaints across Healthfirst’s product lines, including Medicare, Medicaid, Child Health Plus (CHPlus), Senior Health Partners (SHP), Commercial Qualified Health Plans (QHP), Essential Plans (EP), and CompleteCare. This is a non-clinical role focused exclusively on grievance and complaint resolution. The Specialist plays a key role in advocating for Healthfirst members by thoroughly investigating their concerns and ensuring timely, accurate, and compliant resolutions in accordance with regulatory requirements. Key Responsibilities: - Independently manage a caseload of grievances through the full case lifecycle, from written acknowledgement to investigation, resolution, and written member resolution letters. - Conduct detailed research by collaborating cross-functionally with internal departments (e.g., Member Services, Provider Operations, Clinical, Enrollment, Pharmacy) to identify root causes and recommend appropriate resolutions. - Partner with external vendors (e.g., DentaQuest, EyeMed, Logisticare vendors) to ensure member issues involving subcontracted services and ancillary benefits are appropriately addressed and resolved. - Draft and issue acknowledgement and resolution letters that are clear, and compliant with regulatory standards and timelines (e.g., NYS DOH, CMS, Medicaid Managed Care Model Contract). - Ensure timely and accurate case documentation in accordance with Healthfirst policies, regulatory requirements, and audit standards. - Participate in department meetings, quality audits, training sessions, in-person quarterly town halls and performance reviews as needed. - Meet department metrics for production and quality. Minimum Qualifications - HS Diploma or GED from an accredited institution. - Understanding of utilization management processes and how service authorizations impact member access to care and claims payment - Proficient in Microsoft Office Suite, including Excel (sort, track and filter trends), Word, PowerPoint, Outlook and case tracking systems. Preferred Qualifications - Bachelor’s degree or equivalent experience in healthcare, public health, or a related field preferred. - 2+ years of experience in managed care, member services, or healthcare grievances or complaints resolution. - Working knowledge of Medicare Advantage, Medicaid Managed Care, Child Health Plus, Essential Plans, and/or Health Insurance Exchange (Marketplace/QHP) programs. - Familiarity with applicable state and federal regulatory requirements, such as CMS regulations, the NYS Department of Health (DOH) Medicaid Managed Care Model Contract, and the Department of Financial Services (DFS). - Experience with or knowledge of claims processing and provider billing workflows. - Exposure to or direct experience with long-term services and supports (LTSS), including Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS). WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: - Greater New York City Area (NY, NJ, CT residents): $58,900 - $80,070 - All Other Locations (within approved locations): $51,000 - $74,880 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

Division or Field Office: Property & Material Damage Div Department of Position: Property Damage Dept Work from: Home within territory listed Salary Range: $59,186.00 - $94,543.00 * salary range is for this level and may vary based on actual level of role hired for *This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location (State) based on ERIE's geographical differences, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment. At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia. Benefits That Go Beyond The Basics We strive to be Above all in Service® to our customers—and to our employees. That’s why Erie Insurance offers you an exceptional benefits package, including: - Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work. - Low contributions to medical and prescription premiums. We currently pay up to 97% of employees’ monthly premium costs. - Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service. - 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension. - Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave. - Career development. Including a tuition reimbursement program for higher education and industry designations. Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year. Position Summary Exercises independent discretion or judgment in handling property claims within designated level of authority. Also responsible for servicing assigned territory and may handle litigated claims. - This is a remote/work from home (within the listed territory) position. - The successful candidate will ideally reside in Syracuse, NY or the close surrounding areas - A company car and equipment to work from home will be provided - The hiring manager will also consider candidates for Property Adjuster II. Level of position offered will be based upon the depth and breadth of selected candidate's experience and qualifications. - Good time management and organization skills preferred - Ability to drive/travel regularly within the assigned territory Duties and Responsibilities - Contacts Policyholders regarding property claims within level of authority. Conducts investigations, interviews insureds and witnesses, inspects damage and prepares estimates. Evaluates and makes recommendations regarding coverage of claims. - Handles property claims within designated authority. Sets and maintains adequate reserves. Obtains and reviews reports, statements, records and related materials as required. Evaluates information to determine coverage and total value of claim. Determines payments and issues checks or declines payment as required. - Documents claim files and submits final report to file for closure. - Identifies subrogation situations and initiates appropriate action. - Services assigned territory and brings assigned claims to conclusion. - Interacts with Agents and district sales managers on matters of mutual concern. - Handles property claims involving damages or coverage. May handle litigated claims, including negotiating with plaintiff attorney, or coordinates litigation with defense counsel as required. - Develops and applies a working knowledge of estimating practices and procedures relating to the adjustment of property claims. - Attends industry-related training programs and attends other training sessions to stay current on policy changes, interpretation or new legislation. - Successfully completes Technical Learning Center Training within one year of hire date. - Participates on Catastrophe Team when required. Duties and Responsibilities (cont'd if applicable) The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished. This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become clear. Capabilities - Values Diversity - Nimble Learning - Self-Development - Collaborates - Customer Focus - Information Management Skills - Cultivates Innovation - Optimizes Work Processes (IC) - Job-Specific Knowledge - Instills Trust - Ensures Accountability - Decision Quality Qualifications Minimum Educational and Experience Requirements - High School Diploma or GED and two years of claims handling experience, or equivalent required; or - High School Diploma or GED and successful completion of ERIE sponsored formal education; or - Bachelor’s Degree required. Additional Experience - Incumbent must live in territory assigned unless a change is approved by the company. - Position requires incumbent to serve on catastrophe duty, which may include travel on short notice to other locations for periods in excess of two consecutive weeks. Designations and/or Licenses - Willingness to pursue and complete Technical Learning Center Training required. - Successful completion of AIC 33 and AIC 35 preferred. - Willingness to obtain and maintain any required licenses. - Valid driver’s license and good driving record required. Physical Requirements - Use of Personal Protective Equipment (PPE) is required for this role. - Ability to move over 50 lbs using lifting aide equipment; Often (20-50%) - Climbing/accessing heights; Rarely - Driving; Frequent (50-80%) - Lifting/Moving 0-20 lbs; Often (20-50%) - Lifting/Moving 20-50 lbs; Often (20-50%) - Manual Keying/Data Entry/inputting information/computer use; Often (20-50%) - Pushing/Pulling/moving objects, equipment with wheels; Occasional (<20%)

Division or Field Office: Property & Material Damage Div Department of Position: Property Damage Dept Work from: Home within territory listed Salary Range: $56,367.00 - $90,040.00 * salary range is for this level and may vary based on actual level of role hired for *This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location (State) based on ERIE's geographical differences, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment. At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia. Benefits That Go Beyond The Basics We strive to be Above all in Service® to our customers—and to our employees. That’s why Erie Insurance offers you an exceptional benefits package, including: - Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work. - Low contributions to medical and prescription premiums. We currently pay up to 97% of employees’ monthly premium costs. - Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service. - 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension. - Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave. - Career development. Including a tuition reimbursement program for higher education and industry designations. Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year. Position Summary Exercises independent discretion or judgment in handling property claims within designated level of authority. Also responsible for servicing assigned territory and may handle litigated claims. - This is a remote/work from home (within the listed territory) position. - The successful candidate will ideally reside within the Harrisburg Branch territory, which includes the following counties: Adams, Berks, Bradford, Centre, Columbia, Clinton, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Lycoming, Mifflin, Montour, Northumberland, Perry, Potter, Schuylkill, Snyder, Sullivan, Tioga, Union, York or the close surrounding areas - A company car and equipment to work from home will be provided - The hiring manager will also consider candidates for Property Adjuster II. Level of position offered will be based upon the depth and breadth of selected candidate's experience and qualifications. - Good time management and organization skills preferred - Ability to drive/travel regularly within the assigned territory Duties and Responsibilities - Contacts Policyholders regarding property claims within level of authority. Conducts investigations, interviews insureds and witnesses, inspects damage and prepares estimates. Evaluates and makes recommendations regarding coverage of claims. - Handles property claims within designated authority. Sets and maintains adequate reserves. Obtains and reviews reports, statements, records and related materials as required. Evaluates information to determine coverage and total value of claim. Determines payments and issues checks or declines payment as required. - Documents claim files and submits final report to file for closure. - Identifies subrogation situations and initiates appropriate action. - Services assigned territory and brings assigned claims to conclusion. - Interacts with Agents and district sales managers on matters of mutual concern. - Handles property claims involving damages or coverage. May handle litigated claims, including negotiating with plaintiff attorney, or coordinates litigation with defense counsel as required. - Develops and applies a working knowledge of estimating practices and procedures relating to the adjustment of property claims. - Attends industry-related training programs and attends other training sessions to stay current on policy changes, interpretation or new legislation. - Successfully completes Technical Learning Center Training within one year of hire date. - Participates on Catastrophe Team when required. Duties and Responsibilities (cont'd if applicable) The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished. This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become clear. Capabilities - Values Diversity - Nimble Learning - Self-Development - Collaborates - Customer Focus - Information Management Skills - Cultivates Innovation - Optimizes Work Processes (IC) - Job-Specific Knowledge - Instills Trust - Ensures Accountability - Decision Quality Qualifications Minimum Educational and Experience Requirements - High School Diploma or GED and two years of claims handling experience, or equivalent required; or - High School Diploma or GED and successful completion of ERIE sponsored formal education; or - Bachelor’s Degree required. Additional Experience - Incumbent must live in territory assigned unless a change is approved by the company. - Position requires incumbent to serve on catastrophe duty, which may include travel on short notice to other locations for periods in excess of two consecutive weeks. Designations and/or Licenses - Willingness to pursue and complete Technical Learning Center Training required. - Successful completion of AIC 33 and AIC 35 preferred. - Willingness to obtain and maintain any required licenses. - Valid driver’s license and good driving record required. Physical Requirements - Use of Personal Protective Equipment (PPE) is required for this role. - Ability to move over 50 lbs using lifting aide equipment; Often (20-50%) - Climbing/accessing heights; Rarely - Driving; Frequent (50-80%) - Lifting/Moving 0-20 lbs; Often (20-50%) - Lifting/Moving 20-50 lbs; Often (20-50%) - Manual Keying/Data Entry/inputting information/computer use; Often (20-50%) - Pushing/Pulling/moving objects, equipment with wheels; Occasional (<20%)

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection. Job Description As a Virtual Assist Auto Adjuster, you will have the flexibility to work from home daily. You will be an integral part of our team, leveraging advanced technology conducting inspections remotely by analyzing photos and live videos to provide exceptional service to customers whose vehicles require repair. You will play a key role in reviewing, writing estimates, creating supplements, and handling total losses for a wide variety of vehicles. In this role, you’ll be expected to communicate clearly and efficiently with all parties involved, ensuring that the customers’ needs are met with the highest level of professionalism and care. Your attention to detail and problem-solving skills will be key to your success, making this a perfect opportunity for someone passionate about delivering outstanding customer service and working with cutting-edge technology. If you're a self-motivated, detail-oriented individual who thrives in a flexible work environment, this is the perfect opportunity for you! This position requires on-camera presence when assisting customers, participating in team meetings, or as otherwise directed Preferred Qualifications: - 18 months+ previous experience in auto Collision estimating using CCC or Mitchell. - Demonstrated expertise in crafting comprehensive cost estimates for paintwork, body, frame restoration and mechanical. - Proficiency in using virtual inspection tools and applications. - Strong analytical skills to assess damages and write accurate estimates. - Excellent communication skills to interact with customers and stakeholders effectively. - Ability to work independently and manage time efficiently in a virtual work environment. - Familiarity with insurance policies and industry regulations related to auto claims. You’ll wear a few hats to fill a few roles throughout your day that all require a level of experience: The Customer Service Expert –you’ll live into Allstate’s Claims Culture by caring, empowering, and restoring, and you will accomplish that by being compassionate, clear, and a committed partner in each auto claim. You lead with empathy, always. The Investigator – you’ll confidently and independently investigate auto claims by performing detailed reviews of damage and interpreting policies to determine coverage. The Effective Communicator – you’ll use phone, emails and sometimes even video chat with customers to help them through a fast, fair, and easy claims process. You’ll also incorporate a specific approach to claim handling to offer the customer their preference of communication to efficiently discuss their claim needs and keep them updated on the claim progress. The Negotiator – You will evaluate and negotiate claims settlements with customers, vendors, third party carriers and claimants, in accordance with all legal and business standard methodologies. With negotiations, you will incorporate tactics in handling challenging and complex situations. The Problem Solver –you’ll utilize multiple tools to get the job done in a fast-paced environment, including estimate tools, job aids, and additional settlement platforms, all while using your sharp critical thinking skills. The Recorder – you’ll protect the company financially by executing policies along policy agreements, and you keep a clear record of your work in a claims system that you will be trained on. You’ll accomplish this by ensuring timely and accurate documentation is completed as you work on each claim. “Please note, you may be required to attend 1-week of training that will take place in Wheeling, IL” Work Location: This position is a remote home-based role. Your home office does not need to be near an Allstate office, but it does need to be in the United States. This Position is not available for Washington, California, Alaska, and Hawaii residents. When you work from home full time, you’ll need: - A dedicated workspace in your residence that is private and free from distractions. - A minimum internet bandwidth of 50 MB download speed and 5 MB upload speed. - Appropriate work surface and seating. Work schedule: Candidates are considered based on the time zone they live in. If you selected for this position you need to be willing to work one of the following schedules to be determined by business needs. - 8:30 am - 5:00 pm. PST - 9:00 am - 5:30 pm. MST - 10:00 am - 6:30 pm. EST/CST (Times may vary and will be determined by business needs) “Please note, you are required to attend 2-week of in person training.” What Allstate will provide: - A technology bundle that includes all equipment needed to perform your work from home (laptop, monitor, headset, keyboard, and mouse.) - Connectivity reimbursement of $80 per month to offset some of the cost of internet. Notice of Licensing Requirement: As a condition of employment, your office/area may require you to obtain an adjuster and/or an appraiser license which includes passing an additional background check with the Department of Labor. If applicable, you will be required to secure license(s) within 60 days of hire. If required, the Hiring Manager will work with you along with the Centralized Licensing team to ensure that you are properly licensed. Sign on Bonus: You may be eligible for a $1000 Licensing Sign on Bonus if you have the applicable active licenses needed for this role. This could include Home Resident Property & Casualty License, Designated Home State (DHS) Florida or Texas License, and/or applicable Appraiser License. **Candidates who have previously worked for and are seeking to be rehired at Allstate and its family of companies are not eligible for this sign-on bonus. Allstate Benefits: Allstate cares about you and your wellbeing. We offer a comprehensive total rewards package that includes pay, benefits, and programs to help you balance work with the rest of your life. You can choose whatever benefits are most important you. Here are some of our offerings: - Competitive salary based on experience and qualifications. - Medical, dental, and vision coverage. - Allstate pension plan and 401(k) savings plan. - Ayco financial coaching. - Spring Health mental and emotional wellbeing resources. - Paid parental leave. - Adoption reimbursement. - Paid time off. - Tuition reimbursement. - Wellness incentives. Notes: The preceding description is not designed to be a complete list of all duties and responsibilities. May be required to perform other related duties as assigned. Regular, predictable attendance is an essential function of this job. #LI-RF2 Skills Auto Estimating, CCC ONE, Communication, Computer Literacy, Critical Thinking, Insurance Claims, Mitchell Estimating, Negotiation, Time Management, Total Loss Claims, Working Independently Compensation Compensation offered for this role is 53,500.00 - 84,625.00 annually and is based on experience and qualifications. The candidate(s) offered this position will be required to submit to a background investigation. Joining our team isn’t just a job — it’s an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger – a winning team making a meaningful impact. Allstate generally does not sponsor individuals for employment-based visas for this position. Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component. For jobs in San Francisco, please click “here” for information regarding the San Francisco Fair Chance Ordinance. For jobs in Los Angeles, please click “here” for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance. To view the “EEO Know Your Rights” poster click “here”. This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs. To view the FMLA poster, click “here”. This poster summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint. It is the Company’s policy to employ the best qualified individuals available for all jobs. Therefore, any discriminatory action taken on account of an employee’s ancestry, age, color, disability, genetic information, gender, gender identity, gender expression, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national origin, race (include traits historically associated with race, including, but not limited to, hair texture and protective hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to all aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment.