Title: California Claims Professional Adjuster - REMOTE Location: Louisville, KY, US Salary Range: $90,000.00 To $95,000.00 Annually Job Description: WORKERS’ COMPENSATION CLAIMS ADJUSTER Midwestern Insurance Alliance (MIA) is seeking a full-time Claims Adjuster to join its worker’s compensation claims processing team. MIA is a national workers’ compensation program administrator offering custom-tailored worker’s compensation insurance programs through its carrier partners. MIA focuses on niche segments such as local and long-haul trucking, parcel and mail delivery, and fuel hauling. MIA’s acquisition by San Diego-based K2 Insurance Services in 2012 has enabled MIA to expand its product offerings and product distribution channels. Claims Adjuster responsibilities include, but are not limited to: - Thoroughly investigating worker’s compensation claims by contacting injured workers, medical providers, and employer representatives. - Determining if claims are valid under applicable worker’s comp statutes. - Communicating with medical providers to develop and authorize appropriate treatment plans. - Reviewing and analyzing medical bills to confirm charges and treatment are worker’s comp injury-related and in accordance with the treatment plan. - Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes. - Calculating and assigning appropriate reserves to claims, and managing reserve adequacy throughout the life of the claim. - Managing claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets. - Preparing required state filings within statutory limits. - Providing information as needed for litigation or settlement negotiations. The ideal Claims Adjuster will have: - Bachelor’s degree preferred, but not required. - At least 2 years’ WC claims adjusting experience that includes experience with California WC claims. - AB1262 California Experienced Examiner designation or currently meet the requirements for designation under AB1262. WCCA or WCCP preferred. - Strong verbal and written communication skills. - Strong organizational skills with attention to details. - Ability to work with little supervision. - Ability to manage multiple tasks in a fast-paced environment. - Proficiency in MS Word, Excel, and Outlook. MIA offers the opportunity to join an established company in growth mode. Our benefits package includes medical, dental, vision, disability, and life insurance and 401(k) with employer match. We also offer a business casual work environment and an 8:00-5:00 Monday-Friday work week. Salary: 90,000-95,000 USD Annually

Title: Medicaid Claims Analyst Location: OR, US, Remote Job Description: Description Here at GOBHI, we understand and support diversity by appreciating it and encouraging it by creating a culture of dignity and respect for our employees. We are honored to be an Equal Opportunity Employer. We have multiple job ads for this position, please only apply to one. GOBHI has an immediate opening for a full-time Medicaid Claims Analyst. This remote position will be based out of the employee’s home located in the state of Oregon or accepted radius. The Medicaid Claims Analyst supports GOBHI’s Non-Emergent Medical Transportation (NEMT) program by reviewing, processing, and reconciling Medicaid claims to ensure accuracy, compliance, and timely reimbursement. This position is responsible for coding, billing, auditing, and reconciliation functions related to NEMT services, serving as a key liaison between transportation providers, internal staff, and state Medicaid offices. This role ensures that all claims activities comply with federal and state regulations while supporting program efficiency, accuracy, and integrity. Essential duties include: - Review, validate, and process NEMT claims in accordance with Medicaid policies, GOBHI program guidelines, and contractual requirements. - Perform accurate billing and coding for NEMT claims using appropriate HCPCS/CPT codes. - Verify member eligibility, trip authorization, and service documentation prior to submission. - Ensure claims are submitted within required timelines and track adjudication through final payment. - Identify and resolve claim errors, discrepancies, and denials in coordination with providers and program staff. - Maintain current knowledge of Medicaid billing codes, guidelines, and NEMT-specific requirements. - Conduct regular audits of NEMT claims to detect and prevent errors, overpayments, or potential fraud. - Support corrective action plans and recommend process improvements to strengthen billing integrity. - Accurately code trips and services in compliance with Medicaid and NEMT guidelines. - Prepare, review and submit billing batches to Medicaid and other payers. - Reconcile claims against payments, identifying variances or unpaid balances. - Collaborate with GOBHI finance staff to support accurate accounting and reporting. - Generate and maintain reports on claims activity, denial rates, and reimbursement trends. - Provide data analysis to identify cost drivers, claim patterns, and areas for improvement. - Serve as a resource for NEMT providers regarding Medicaid billing procedures, documentation, and claim resolution. - Upon supervisor’s approval and direction, update and maintain provider rate contracts. - Provide training and technical assistance to providers on coding, billing, and submission processes. - Other duties as assigned. Requirements What is needed to succeed in this role: - Two years’ experience in Medicaid claims processing, billing, or healthcare reimbursement. - Experience working in transportation claims strongly preferred. - Knowledge of Medicaid billing, HCPCS/CPT coding, and claims submission requirements. - Strong analytical skills and attention to detail. - Excellent problem-solving, communication, and organizational abilities. - Handles highly sensitive and confidential information and complies with HIPAA requirements. - Technology savvy, proficient using MS software and Google Suites. - Experience with claims management systems, billing software, and Microsoft Excel. - Capacity to handle multiple priorities and meet strict deadlines. - Education – Associate’s degree in Business, Accounting, Healthcare Administration, or a related field. Bachelor’s degree preferred. What we offer: - Competitive salary – starting at $27.88 DOE - Medical, dental and vision insurance for you and dependents - 22 paid time off days and 12 paid holidays - EAP - FSA, with a $500 employer contribution - Triple AAA insurance - Mileage reimbursement - Wellness benefits - 401k contribution, including 6.5% employer contributions - Cell phone and internet reimbursements About GOBHI: Founded in 1994, Greater Oregon Behavioral Health, Inc. is an innovative behavioral health organization that serves communities across Oregon. GOBHI is a 501(c)(3) nonprofit corporation that is charged with administering the behavioral health Medicaid benefit, non-emergent medical transportation and community engagement in 12 rural and frontier counties in Oregon.

Title: Workers Comp Senior Claims Representative Remote-NJ PA MA Location: OH Richfield/ USA Job Description: time type Full time job requisition id R8617 National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you! At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. Since 1989, National Interstate has specialized in serving the insurance needs of the wheels-based transportation industry. Our steadfast focus on developing niche expertise in product design, loss control and claim services has made National Interstate one of the most respected names in commercial transportation insurance today. (https://natl.com/) National Interstate is looking for a Workers Comp Senior Claims Representative to join their team. This individual will either work hybrid from the Richfield, OH office 4 days per week or work fully remote from the USA, if not local to the office. National Interstate’s culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in‑office days are Tuesday–Thursday, with the fourth day determined by business needs. Essential Job Functions and Responsibilities - Manages an inventory of claims to evaluate compensability/liability. - Plans and conducts claim investigations to confirm coverage and to determine liability, compensability and damages. - Determines and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials. - Conveys moderately complex information regarding coverage and settlements to insureds, claimants, and external partners. - Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner. - Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements. - Performs other duties as assigned. Job Requirements Education: Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience. Experience: Generally, a minimum of 5 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC). Prefer PA NJ MA state handling experience Scope of Job/Qualifications: Works within significant limits and authority on assignments of higher technical complexity and coordination. Demonstrates strong analytical, negotiation, and problem-solving skills. Demonstrates knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims. Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion. This job is non-exempt in California and Washington Company: NIIC National Interstate Insurance Company Salary Range: $70,000.00 -$78,000.00 Benefits: We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits. Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers. *Excludes seasonal employees and interns.

Claims Inquiry Representative Location: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Remote Full-time Job Description: The Claims Inquiry Representative is responsible for responding to webform inquiries from providers and plan partners, reviewing Durable Medical Equipment (DME) claims for billing accuracy, investigating root causes, and delivering professional, timely solutions while maintaining compliance with legal, regulatory, and company policies including HIPAA. The role requires documentation maintenance, teamwork, adaptability, and the ability to meet productivity goals. Salary: $19.00/hour JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES - Demonstrate the ability to work effectively with multiple health plan payers and remain adaptable to varying daily assignments. - Perform additional duties as assigned to support team and organizational goals. - Foster a climate of teamwork and collaborative problem-solving within the workgroup. - Ensure a minimum internet bandwidth of 200 Mbps download speed is maintained to support daily job duties effectively. - Remain accountable for achieving daily productivity goals that meet or exceed the current production metrics. - Commit to adding value and making positive contributions to the company and department. - Be flexible and willing to adapt to changes within the work environment. - Meet consistent attendance and punctuality expectations as required. - Follow both written and verbal instructions accurately. - Understand and perform all duties in compliance with State and Federal regulations, as well as the policies and procedures of Integra Partners and its clients. - Be self-motivated and utilize available resources to investigate issues and resolve problems independently. - Respond to provider inquiries in a professional, thorough, and timely manner. - Maintain strong attention to detail in all aspects of the role to ensure accuracy and quality. EDUCATION: High school diploma required EXPERIENCE: - Prior medical billing experience. - Proficient in Microsoft Office (Word, Excel, Outlook) and able to learn new programs. - Knowledge of 1500 claim forms, DMEPOS services, ICD-10, HCPCS, and medical terminology. - Able to accurately review medical documents. - Self-motivated, works independently and effectively in a fast-paced team. - Strong organizational and critical thinking skills - Must be reliable and meet attendance expectations. Benefits Offered - Competitive compensation and annual bonus program - 401(k) retirement program with company match - Company-paid life insurance - Company-paid short term disability coverage (location restrictions may apply) - Medical, Vision, and Dental benefits - Paid Time Off (PTO) - Paid Parental Leave - Sick Time - Paid company holidays and floating holidays - Quarterly company-sponsored events - Health and wellness programs - Career development opportunities Remote Opportunities We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Our Story Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health. With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you. Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.