Role Description Imagine360 is seeking a Claims Examiner to join the team! This position properly applies plan provisions on self-funded groups and is responsible for claims processing of medical, dental, and vision claims, answering questions in accordance with relevant terms and established procedures. This individual works closely with other departments to proactively research concerns and resolve them to the satisfaction of the client. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility. Position Location: 100% remote Responsibilities include but are not limited to: - Claims Processing - Interprets plan documents. - Reviews, researches, and analyzes information to determine eligibility. - Processes, denies, pends, or allows claims. - Uses thought and reasoning to manage workload that carries an average level of financial risk. - Correspondence - Accurately notes the system of all information received. - Forwards all records. - Group Contacts - Tracks and returns calls and e-mails. - Answers specific plan and claim questions. - Knows each Team Member for each group. - Goes over review issues. - Appeals and Inquiries - Notes system when appeals and inquiries are received. - Records all information on appeals and inquiries in the database. - Notes system if notified that claim is going to outside review or committee. - Customer Service - Acts as a role model in demonstrating the core values in customer service delivery. - Provides timely and thorough follow-up with internal and external customers. - Tracks and returns telephone calls/mail to members and groups answering specific plan/claim questions within 24 hours. - Appropriately escalates difficult issues up the chain of command. - Quality Assurance - Ensures team compliance with service standards. - Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving quality/customer satisfaction. - Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters. - Performs self-quality monitoring in order to develop and execute plans to meet established goals. - Provides ongoing feedback to help optimize quality performance. - Collaborates with others and cross-departmentally to improve or streamline procedures. - Remains current on industry trends and looks for new data sources. - Develops new or improves current internal processes to improve quality. Qualifications - 1+ years' experience in clerical and customer service. - High School Diploma or equivalent. - Associate degree in Medical Billing and Coding or related field preferred. - Claims or Medical Office experience. Knowledge of medical terminology preferred. Requirements - Working knowledge of computers and software including but not limited to Microsoft Office products. - Proficient mathematical, 10-key and typing skills. - Demonstrated organizational skills, problem-solving, analytical skills, and detail-oriented. - Demonstrated ability to remain neutral and maintain confidentiality. - Strong written and oral communication skills. - Demonstrated ability to work independently, prioritize workloads, multi-task, and manage priorities in order to meet deadlines. Benefits - Multiple Health plan options. - Company paid employee premiums for disability and life insurance. - Parental Leave Policy. - 20 days PTO to start / 10 Paid Holidays. - Tuition reimbursement. - 401k Company contribution. - Company paid Short & Long term Disability plus Life Insurance. - Professional development initiatives / continuous learning opportunities. - Opportunities to participate in and support the company's diversity and inclusion initiatives.

Role Description Advanced Hearing Providers (“AHP”) coordinates hearing healthcare services for employees with workers’ compensation claims. We connect patients with our nationwide network of qualified hearing healthcare providers on behalf of our clients; the payers and third-party administrators of workers’ compensation claims. We are seeking hard-working, self-motivated candidates with a positive attitude who like the idea of being involved in the process of helping people hear better. The position of Claims Specialist (“CS”) I plays a critical role in the operation of the organization. The main function of an AHP CS I is coordinating authorized hearing healthcare for covered employees. AHP staff work as a TEAM – this is crucial! We expect team members to build trust and respect for each other by producing consistent results and going above and beyond, especially to help each other. Even though each CS will be working on their own assigned cases, interaction with other team members, clients, providers, and patients will occur often. Responsibilities - Obtain a complete, thorough understanding of the workers’ compensation claims administration process, fees and participants. - Adhere to customer Service Level Agreements (SLAs) by maintaining contact with clients, providers, and claimants/patients as prescribed to ensure all parties are kept informed of the process status. - Successfully prioritize the workday utilizing our task-based systems, resulting in achieving daily completion of all required tasks (ensuring SLA compliance). - Ensure orders are properly documented in a timely manner. - Demonstrate an understanding of the workers’ compensation referral and RFA process. - Demonstrate an understanding of navigating client/claimant requirements to ensure billable item eligibility is reviewed prior to submitting requests to client. - Perform verification of all HCPC/CPT codes that will be requested, including verifying eligibility and confirming whether NCCI edits and/or a state fee schedule (SFS) is applicable. - Coordinate the completion of necessary documentation to be filed with state agencies when applicable. - Maintain a high degree of detail and accuracy throughout the claim administration process. - Cross utilize phone, email, and fax for communication to ensure efficient processing time. - Assist with phone answering and intake related duties. - Demonstrate basic to intermediate level process understanding and ability to critically think and solution for complex situations that arise. - Other duties as assigned by the manager. Qualifications - Advanced knowledge and experience with computer systems and business software programs, in particular Salesforce, Word, Excel, Outlook, Office 365 Apps and Adobe Acrobat. - Previous workers’ compensation, insurance claims management, and/or hearing healthcare industry experience is preferred. - Bilingual skills will be extremely helpful with some patients. - Excellent grammar and written skills. - Ability to type at a minimum of 40 WPM. - Ability to travel for training and occasional on-site meetings. - Communicate clearly, professionally and in a timely manner. - Manage multiple tasks simultaneously in a proficient manner. - Ability to maintain professional client and provider relationships. - Work collaboratively with colleagues, including regularly providing direct support by completing team members’ tasks for them as needed. - Understand when situational discretion must be employed in the handling and sharing of client, provider, and/or claimant information. - Self-motivated; ability to work independently. - Must have a high attention to detail. - Must be coachable and receptive to feedback. - Must be dependable and consistent. - Ability to take a proactive approach to all situations. - Driven by a focus on reaching a specific objective or accomplishing a given task. - Eagerness to adapt to new methods. - Obtain satisfaction from delivering great customer service. - Willing to try new things/operate outside of your comfort zone. - EDUCATION - HS Diploma or equivalent. Benefits - Medical, dental, prescription, and vision benefits. - 24/7 virtual medical care. - Employee Assistance Program for you and your family. - 401(k) with company match. - Company-paid life insurance. - Supplemental insurance for yourself, your spouse/partner, and your children. - Short-term and long-term disability insurance. - Pre-tax Health Savings Account and Flexible Spending Accounts for Health Care or Dependent Care. - Pet Insurance. - Commuter accounts.

• Handle GEICO's commercial, short-haul and long-haul trucking claims • Conduct investigations to determine coverage and liability for claims • Evaluate, negotiate, and settle claims for damages • Maintain a pending diary of claims for settlement and resolution • Provide support to GEICO insureds involved in lawsuits • Guide insureds through the litigation process • Provide direction to defense counsel • Travel to attend trainings, trials, and other litigation events • Present files to Senior Leadership

Role Description To analyze mid- and higher-level general auto claims to determine scope of damages; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements. - Manages mid-level and higher-level auto commercial and personal lines claims by gathering information to determine exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. - Assesses liability and resolves claims within evaluation. - Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. - Manages subrogation of claims and negotiates settlements. - Communicates claim action with claimant and client. - Ensures claim files are properly documented and claims coding is correct. - Maintains professional client relationships. - Performs other duties as assigned. Qualifications - Education: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. - Experience: Four (4) years of claims management experience or equivalent combination of education and experience required. - Skills & Knowledge: - Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles as applicable to line-of-business. - Excellent oral and written communication skills, including presentation skills. - PC literate, including Microsoft Office products. - Ability to create and complete comprehensive, accurate and constructive written reports. - Ability to work in a team environment. - Ability to meet or exceed Performance Competencies. - Work environment requirements include: - Physical: Computer keyboarding. - Auditory/visual: Hearing, vision and talking. - Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. Company Description By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. - Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies. - Certified as a Great Place to Work®. - Fortune Best Workplaces in Financial Services & Insurance.