• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. • Negotiating settlement of claims within designated authority. • Communicating claim activity and processing with the claimant and the client. • Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

• To analyze complex or technically difficult bodily injury and general liability claims to determine benefits due; • to work with high exposure claims involving litigation and rehabilitation; • to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; • to identify subrogation of claims and negotiate settlements. • Manages mid-level bodily injury and general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.

Role Description Claims Examiner II receives, researches, and reviews allegations of fraud or abuse by beneficiaries and providers. Responsibilities include: - Review and assess incoming appeals, applying relevant policies and guidelines to render accurate approval or denial decisions. - Organize and maintain case files, thoroughly evaluate documentation, and analyze evidence to support informed determinations. - Partner with the RN team to ensure appeals requiring medical documentation are reviewed by qualified personnel and resolved appropriately. - Prepare clear, detailed written decisions that explain the rationale for determinations and reference applicable policies and procedures. - Review incoming Appeals mail to ensure it is being submitted to the appropriate team. - Initiate adjustments, reprocesses and serve as resource for other teams. Qualifications - U.S. citizenship is required for this position due to Department of Defense restrictions. - High school diploma or equivalent. - 2 years or more in claims and customer service-related field working with public. - Ability to learn and apply governing TRICARE regulations, policies, and procedures. Requirements - 2 years or more of post-high school coursework in Accounting, Auditing, or Health Care related curriculum (preferred). - 2 years or more in Accounting, Auditing, or related field, or medical-related field such as Coding or Medical Assistant (preferred). - High speed cable or fiber internet. - Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection. Benefits - Bargaining Unit position. - Remote and hybrid work options available. - Performance bonus and/or merit increase opportunities. - 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately). - Competitive paid time off. - Health insurance, dental insurance, and telehealth services start DAY 1. - Employee Resource Groups. - Professional and Leadership Development Programs.

Role Description The Claims Team Leader is responsible for the supervision, training and development of a team of Claims Specialists. The Claims Team Leader manages the submission of claims data, payments and works with team members and agencies to resolve outstanding claim issues. - Be the point person for questions from your team members. Coordinate answers with agencies and/or internal departments including Operations. - Sign off/approve credit memos and employee receivables. - Assist with administrative accounting procedures per Controller/CFO. - Audit team performance, monitor team metrics and manage claims process. - Train new employees and existing employees in department procedures and agency requirements. - Assist in developing claims procedures for all new agencies prior to transitioning to Claims Specialist. - Prepare A/R reports for your team’s agencies to monitor unpaid claims. Work with team members and agencies to collect outstanding payments. - Communicate with Claims Manager including but not limited to: training issues, agency challenges, unbilled items and A/R issues. - Attend trainings, conferences and staff meetings. - Participate in company continuous improvement processes. - Uphold company values and mission. - Other duties as assigned. Qualifications - High School Diploma or GED required. - Associate degree preferred. - 2 years of experience relevant to the work performed. - Experience with Microsoft Office products is necessary, specifically Microsoft Excel. - Excellent organizational and administrative skills with demonstrated ability to work towards and meet deadlines by planning and organizing. - Experience in working on complex projects with critical thinking and problem solving. - Excellent written and oral communication skills. - Strong attention to detail. - Able to work with numbers and apply basic math skills to daily tasks. - Strong ability to lead and mentor multiple team members. Work Environment Work is performed from a home office setting. Company Description As a family-founded national leader in personal and financial services for individuals who rely on home- and community-based care, GT Independence supports tens of thousands of people across the country as they find and hire their own caregivers or personal assistants. - Our operations team is driven by trust, autonomy, and—yes—fun. - We believe great teams come from people who are intrinsically motivated, empowered, and valued. - We respect each other, we care about the work we do, and we succeed because we work with purpose. - We value excellence, but we won’t micromanage to achieve it. - If you are self‑motivated, we give you the space and support to grow and thrive. - Team members enjoy flexible paid time off, competitive wages & benefits, and meaningful opportunities for professional growth.