• Ensure timely processing of pending medical claims • Verify and update information on the submitted claims • Review work processes to determine reimbursement eligibility • Ensure payments and/or denials are made in accordance with company protocols and procedures • Process first time claims • Apply policy and provider contract provisions to determine if claim is payable • Research and determine status of medical related claims • Maintain records, files, and documentation as appropriate • Meet and maintain department production and quality standards • Successfully complete additional progressive claims training programs as required • Performs other duties as assigned • Complies with all policies and standards

Location: USA- Job Description: Our client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Remote in CA location. Responsibilities: - To analyze complex or technically difficult workers' compensation 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; and to identify subrogation of claims and negotiate settlements. - Primary Purpose: To analyze complex or technically difficult workers' compensation 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; and to identify subrogation of claims and negotiate settlements. - Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. - Negotiates settlement of claims within designated authority. - Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. - Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. - Prepares necessary state fillings within statutory limits. - Manages the litigation process; ensures timely and cost effective claims resolution. - Coordinates vendor referrals for additional investigation and/or litigation management. - Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. - Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. - Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. - Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. - Ensures claim files are properly documented and claims coding is correct. - Refers cases as appropriate to supervisor and management. - Performs other duties as assigned. - Supports the organization's quality program(s). Requirements: - Minimum 3years of relevant CA WC claims experience is mandatory - California WC Claims handling experience - Must have OSIP certificate - Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. - Experience: Five (5) years of claims management experience or equivalent combination of education and experience required. Why Should You Apply? - Health Benefits - Referral Program - Excellent growth and advancement opportunities

Role Description We are seeking a highly motivated Medical Claims Denial & Appeals Specialist to join our Accounts Receivable Resolution team. This job can be performed 100% remotely and out of state candidates will be considered. The Specialist is primarily responsible for resolving all insurance claim denials for assigned departments to enhance revenues for CU Medicine providers. The individual in this position will generate effective written appeals to carriers using well-researched logic. Denial Specialists are independently accountable for the denial resolution for their assigned divisions. - Appeal denials through coding review, contract review, medical record review and carrier interaction. - Demonstrate a high level of expertise in the management of complicated denied claims. - Deploy analytical approach to resolve denials and recognize trends/patterns in order to proactively resolve recurring issues. - Utilize a multitude of resources to ensure correct appeal processes are followed. - Communicate identified denial patterns to management. - Prioritize and process large volume of denials and maintain high quality of work. - Serve as an escalation point for unresolved denial issues. - Inform team members of payer policy changes. - Assist in training new employees as assigned. - Collaborate on special projects as needed. Qualifications - 3-5 years experience in medical practice billing with exposure to working with denials, appeals, insurance collections and related follow-up. - Bachelor’s degree in a related field is strongly preferred. - Must have ICD-10 and CPT coding assessment skills. - CPC certification is preferred. - Intermediate PC software experience required. - Advanced verbal and written communication skills are essential. - Must demonstrate a solid understanding and ability to apply contract language in conjunction with a comprehensive understanding of claims denial appeal logic. Requirements - All applications MUST be submitted via our website. - You may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. - You will not be penalized for redacting or removing this information. Benefits - Generous leave. - Health plans. - Retirement contributions which take your total compensation beyond the number on your paycheck.

• Complete field inspections, reviews and adjustments accurately and efficiently to administer crop insurance policies. • Ensure compliance with insurance statutes and regulations to apply crop policies cost-effectively. • Build and maintain customer relationships through timely and accurate policy service. • Document and process loss information accurately to assess potential damages. • Participate in quality control tasks, audits, risk assessments, and field reviews. • Contribute to a positive work environment by demonstrating cultural expectations and influencing others positively. • Support business objectives through quality control tasks, audits, and risk assessments.