• Day-to-day processing of claims for accounts: • Responsible for processing of claims (medical, dental, vision, and mental health claims) • Claims processing and adjudication. • Claims research where applicable. • Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic). • Investigation and overpayment administration: • Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. • Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading.

Role Description MediDrive is seeking a Claims Specialist to support the accurate and timely processing of transportation claims within the Non-Emergency Medical Transportation (NEMT) program. This role is responsible for reviewing, validating, and processing claims in accordance with MediDrive policies, state Medicaid requirements, and client-specific guidelines. The Claims Specialist plays a critical role in ensuring financial accuracy, resolving claim discrepancies, and supporting transportation providers with claims-related inquiries. Key Responsibilities - Review and process transportation claims, ensuring accuracy of mileage, level of service, eligibility, and required documentation. - Validate claims against trip data, authorizations, and system records to ensure compliance with billing requirements. - Identify discrepancies, missing information, or errors and take appropriate action to resolve prior to adjudication. - Research and resolve denied, rejected, or pended claims by identifying root causes and coordinating with internal teams or transportation providers. - Respond to transportation provider inquiries related to claims status, payments, and documentation requirements. - Support the resolution of claims disputes through detailed review of system data and supporting documentation. - Assist in validating claims prior to payment and ensure accurate explanation of payment (EOP) documentation. - Maintain accurate and complete claims records to support audit readiness and reporting requirements. - Ensure proper documentation is retained in accordance with MediDrive policies and regulatory standards. - Ensure all claims processing activities comply with Medicaid regulations, HIPAA requirements, and client-specific contractual obligations. - Identify potential fraud, waste, and abuse (FWA) indicators and escalate concerns as appropriate. - Maintain a high level of accuracy and productivity to meet established performance standards and turnaround times. - Track and support reporting on claims metrics such as processing volume, turnaround time, and denial trends. - Identify recurring issues and recommend process improvements to enhance efficiency and reduce errors. - Collaborate with Operations, Customer Service, and Finance teams to improve claims workflows and outcomes. - Participate in special projects and perform other duties as assigned. Qualifications - High school diploma or equivalent required; associate or bachelor’s degree preferred. - 2–4 years of experience in healthcare claims processing, billing, or related field. - Working knowledge of HCPCS, ICD-9/ICD-10, and condition codes preferred. - Experience in NEMT, Medicaid transportation, or healthcare operations preferred. Core Competencies - Strong attention to detail and accuracy. - Analytical thinking and problem-solving skills. - Effective communication and interpersonal skills. - Ability to manage multiple tasks and meet deadlines. - Customer-focused mindset with strong provider engagement skills. - Ability to work independently and within a team environment. - Proficient in Microsoft Office Suite (Excel, Word, Outlook). - Typing speed of 35+ words per minute. You Are - Detail-oriented and accountable, with a strong focus on accuracy. - A proactive problem-solver who can identify and resolve issues efficiently. - Comfortable working in a fast-paced, high-volume environment. - A strong communicator who can effectively support transportation providers. - A collaborative team player committed to operational excellence.

Role Description Ready to take your claims career to the next level? Join us as a Senior Claims Examiner – Liability, where you’ll handle high-exposure, complex claims and manage the entire process—from investigation to final resolution. This is your chance to grow in a role where your expertise truly makes an impact! - Lead advanced claim investigations with independence - Review coverage, determine liability, and drive fair outcomes - Set reserves using strong analytical judgment - Collaborate with supervisors and defense attorneys to prepare cases for litigation - Mentor and support the development of new team members If you’re detail-oriented, love solving complex problems, and want a role where your experience truly matters—this opportunity is for you! Benefits - Pay and incentive plans that recognize performance excellence - Benefit programs that empower financial, physical, and mental wellness - Training programs that promote continuous learning and career progression while enhancing job performance - Sustainability programs that give back to the communities in which we live and work - A culture of respect, collaboration, entrepreneurial spirit and inclusion Company Description Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time. At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. When you accept a job with Crawford, you become a part of the One Crawford family.

Role Description 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. Qualifications - High School Diploma. - Minimum of 3 years related claims experience. - Appropriately licensed and/or certified in all states in which claims are being handled. - Knowledge of accepted industry standards and practices. - Computer experience with related claims and business software. Requirements - Jurisdictions: PA, NJ, DE - Licenses: DE - Location: This role is open to remote work - Claims Background: Workers Compensation, Lost-Time Benefits - 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 - 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...