Title: Credit Balance Specialist - Healthcare Hospital Claims Location: San Antonio United States Job Description: time type Full time job requisition id 39373 Job Family: Patient Account Representative, PFS Billing, PFS General Travel Required: None Clearance Required: None What You Will Do: The Credit Balance Specialist (Hospital Claims) will manage credit balance workloads of patients and respond/follow-up on external and internal inquires in a timely manner. This person should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Individuals must be able to work an eight hour shift between the hours of 8:30 AM CT - 5:30 PM CT, with no remote work initially BUT an opportunity for some hybrid (in office/remote) schedules after training. We will consider individuals open to relocation to San Antonio! Additionally, the Credit Balance Specialist will: - Research and resolve patient credit balance accounts resulting from overpayments, duplicate payments, financial assistance adjustments, or insurance reprocessing. - Analyze overpayments, duplicate payments, coordination of benefits (COB), retro eligibility, and contractual adjustment discrepancies. - Collaborate with billing, cash posting, denial management, and patient access teams to resolve account discrepancies. - Process patient refunds accurately and timely in accordance with client policies and regulatory requirements. - Communicate with patients regarding refund status, account balances, and payment discrepancies professionally and compassionately. - Maintain accurate, clear, concise and complete account notes and other relevant information. - Resolve unidentified payments through research. - Aim to have patient accounts balance to zero prior to accounts being forwarded to an outside agency for collections. - Assist with internal and external audits related to credit balance processes and refund activity. What You Will Need: - High School Diploma / GED. - 1+ years of working with credit balance accounts (refund, overpayment, underpayment, accounts resolution, etc.) - Working knowledge of the following: health insurance claims, medical billing, medical coding, credit finance, accounting or customer service-related responsibilities What Would Be Nice To Have: - Credit balance experience within a hospital background - Experience working within Epic, Meditech or other hospital patient accounting systems. - Ability to interpret UB-04 claims, payer correspondence, and contractual agreements. - Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance - PC skills in a Windows environment. - Knowledge and utilization of desktop applications to include Word and Excel. - Ability to initiate and follow through on projects and work independently with minimal supervision. #IndeedSponsored #LI-DNI What We Offer: Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include: - Medical, Rx, Dental & Vision Insurance - Personal and Family Sick Time & Company Paid Holidays - Position may be eligible for a discretionary variable incentive bonus - Parental Leave - 401(k) Retirement Plan - Basic Life & Supplemental Life - Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts - Short-Term & Long-Term Disability - Tuition Reimbursement, Personal Development & Learning Opportunities - Skills Development & Certifications - Employee Referral Program - Corporate Sponsored Events & Community Outreach - Emergency Back-Up Childcare Program About Guidehouse Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting via email. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process. If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Role Description The Sr Adjuster Field Service Claims is responsible for independently managing moderate to complex and high-value field property claims. This role requires advanced investigation, evaluation, and negotiation skills to resolve field property claims. It involves thorough analysis, collaboration with internal teams and external experts, and will require travel on short notice. Strong technical expertise and the ability to manage claims in accordance with policy provisions, regulations, and best practices are essential to delivering high-quality service and outcomes. In this role, you will: - Independently manage field property claims, including those requiring outside field investigations and catastrophe (CAT) response. - Lead thorough investigations, assess coverage, and issue appropriate documentation including reservation of rights and coverage letters. Escalate issues as needed. - Identify and proactively pursue opportunities to transfer risk to the appropriate entities for the benefit of insureds and business partners. - Maintain comprehensive and detailed claim records, ensuring proper documentation and compliance with jurisdictional requirements. - Identify and assign subrogation potential appropriately; set up files to support successful recovery efforts. - Ensure all claims activities comply with regulatory and company standards. Execute jurisdictional compliance requirements and support others in understanding regulatory obligations. - Investigate and manage suspicious claims using advanced techniques and tools; refer to the Special Investigation Unit (SIU) as needed. Maintain awareness of fraud indicators and regulatory reporting obligations. - Set reserves, authorize payments, and make financial decisions within authority and contribute to reserving accuracy and efficiency. - Coordinate with internal and external stakeholders including legal, underwriting, vendors, and agents. Lead cross-functional meetings and communicate complex information clearly to diverse audiences. - Use advanced tools and analytics to identify trends, correct inconsistencies, and improve claims handling efficiency. Ensure proper data ingestion, labeling, and protection of personally identifiable information (PII). - Maintain comprehensive factual and organized claim records and prepare detailed reports summarizing findings and recommendations. - Serve as a mentor to junior adjusters, providing guidance on complex claims, compliance, and litigation processes. Support training initiatives and contribute to the development of best practices and educational materials. - Deliver empathetic, clear communication throughout the claims process. Educate claimants and stakeholders, affirm next steps, and ensure a positive customer experience. - May represent the company in mediations, arbitrations, and trials. - Must have and maintain appropriate state adjuster licenses, continuing education credits, and a valid driver’s license. Qualifications - Bachelor’s degree or equivalent experience with claim handling. Typically requires 5–10 years of adjusting experience. - Strong knowledge of local geography, regulations, and public safety agencies, as well as the ability to build rapport with insureds and navigate the insurance and legal climate. - Strong working knowledge of applicable statutes, regulations, case law, and third-party legal liability concepts. - Skilled in negotiation and developing strategies to influence outcomes. Demonstrates sound judgment and decision-making, including litigation and compliance matters. - Communicates clearly and effectively in both verbal and written formats across a variety of situations. - Highly organized with the ability to manage complex workflows and project work. - Makes informed decisions based on thorough analysis of complex issues. - Ability to collaborate with internal and external experts, including legal, underwriting, and other stakeholders. - Ability to quickly assess customer concerns and anticipate questions, communicate and translate complex and technical terms clearly. - Skilled in using claims systems and Microsoft Office Suite. - Ability to use a personal computer and other standard office equipment. - Ability to sit and/or stand for extended periods. - Required to work on-site as needed. - Ability to travel as necessary. - Ability to work in a fast-paced, changing or stressful environment. - Ability to perform work in a noisy/loud work environment. - May be required to have and maintain sufficient home-based internet connection. - Ability to operate a motor vehicle 4-5 hours per day and to get in and out of the vehicle numerous times during the day. - Ability to load and unload equipment and supplies weighing up to 30 pounds from a motor vehicle as needed to perform field work. - Ability to bend, walk, and climb for several consecutive hours while inspecting damaged buildings. - Ability to use a ladder safely to get on and off roofs and maintain balance while inspecting roofs. - Ability to perform field work in adverse weather. Benefits - Medical, dental, vision, life, and disability insurance - 401K with a company match - Tuition reimbursement - PTO - Company paid holidays - Flexible work arrangements - Cultural Awareness Day in support of IDE - On-site medical/wellness center (Worcester only) Career Development It’s not just a job, it’s a career, and we are here to support you every step of the way. We want you to be successful and fulfilled. Through on-the-job experiences, personalized coaching and our robust learning and development programs, we encourage you – at every level – to grow and develop.

• Researching claims — auditing them for accuracy, compliance, and correct payment • Managing escalated and complex claims issues • Reviewing emails for encounters, outside vendors, and special projects • Creating reports to track trends and quality opportunities • Supporting mass adjustment efforts • Acting as a go-to subject matter expert for tricky claim questions

Role Description Step into a role where your client service expertise makes a meaningful impact. We are looking to add a Liability Claims Specialist to join our Creative Risk Solutions team. 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. - Consult on and confirm coverage for commercial auto and commercial general liability claims. - Adjudication of claims. Investigate bodily injury/liability claims and negotiate settlements when applicable, utilizing our “Best Practices for Claims.” - Enter and maintain accurate loss information on a computer system during the claim process. - Recommend and maintain accurate reserves within reserve authority. - Negotiate and process interim and final settlements, within settlement authority. - Research information for responding to questions and complaints posed by our insured’s, claimants, agency partners and fronting carriers. - Monitor and control claims in litigation, utilizing our “Litigation Management” guidelines. - Ensure suits are answered timely by counsel and the best interests of our insured’s and fronting carriers are protected. - Participate in claim reviews and attend Risk Control Workshops when requested by agency partners or insureds. - Maintain open and ongoing communication with our customers as noted in the “CRS Communication Expectations’ guidelines. - Identify and pursue subrogation when applicable. Identify and report fraud when applicable. - Help train and mentor Claims Specialist I position. - Take part in company committees to help the management team develop new standards when warranted. - Perform special projects and other duties as requested. Qualifications - High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. - Active state specific Life & Health/Property Casualty Insurance agent’s license required or the ability to acquire license within three months of hire. - 3-5 years of adjusting property and casualty claims. Prior agency involvement preferred. - Invests in the understanding and application of claims principles and practices and insurance coverage interpretation as it relates to consulting, evaluating, and resolving claims. - Actively contributes to defined workflows, including related processes, procedures, and deliverables, and utilizing resources to deliver a world class client experience and adhering to compliance requirements. - Actively fosters relationships by seeking to understand appropriate parties, prioritizing problem solving, and collaborating to deliver unique and impactful solutions. Benefits - Paid Parental Leave and supportive New Parent Benefits. - Company paid continuing Education & Tuition Reimbursement. - 401k Profit Sharing. - Generous time off practices in addition to paid holidays. - Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities. - DE&I programs including a paid Diversity Day time off option. - Consistent merit increase and promotion opportunities. - Discretionary bonus opportunity. Company Description At Creative Risk Solutions, you’ll be part of a collaborative, innovative team that values trust, communication, and client focus. We offer competitive compensation, comprehensive benefits, and opportunities for professional growth within the Holmes Murphy family.