Role Description This position is responsible for the review of policy benefit eligibility in accordance with policy, company, state, and federal guidelines. This position is for Long Term Care Insurance Plans administered by Prudential. Supervisory Responsibilities - None Duties/Responsibilities - Responsible for accurate/timely daily review of Long-Term Care benefit eligibility in accordance with policy provisions to determine appropriate eligibility approval or denial. - Responsible for accurate/timely determination of benefits and additional benefits applicable under policy provisions such as Wavier of Premium, Inflation Protection Options, Guaranteed Purchase Options, and other applicable rider/policy benefits. - Responsible for interpreting policy provisions to accurately determine claim benefits in accordance with policy benefits. - Responsible for timely request of claimant’s assessment and follow-up request of any/all required additional information, i.e., medical records, appropriate forms, statements, and certificates needed for proper eligibility determination. - Ensure systems and documents are updated on all follow-ups and status throughout the eligibility process. - Review and work other applicable reports and documents pertaining to eligibility determination. - Responsible for sending correspondence timely to claimant about benefit eligibility determination. - Respond appropriately and professionally to all oral and written external and/or internal correspondences received from stakeholders regarding benefits, eligibility, claim payments, denials and/or explanation of benefits. - Ensure appropriate systems are updated timely and clearly regarding eligibility rationale on how determinations were made in accordance with policy provisions and documents received. - Work with management, medical director, and client on review of complex eligibility cases. - Maintain current knowledge of federal, state, and insurance regulations and requirements. - Maintain working knowledge of all company and services pertaining to business segment. - Maintain working knowledge and proficiency in company claims and administrative software systems as well as Microsoft applications. - Maintain client and company quality and production standards. - Maintain knowledge of applicable company policies and procedures. - Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information. - Interact professionally with other business units to gather and analyze data needed to properly adjudicate claims and documentation of claims files. Qualifications - Excellent oral, written and interpersonal communication skills. - Knowledge of Microsoft Office applications and telephone protocol. - Exceptional listening and analytical skills. - Strong knowledge of customer care processes and techniques. - Demonstrated ability to work well in a team environment. - Dedication to providing exceptional customer service. - Proven leadership experience. - Ability to provide and support company goals. Education and Experience - Two years certificate/degree from college or technical school; or 4-7 years related experience and/or training; or equivalent combination of education and experience. Physical Requirements - N/A Company Description At Wellcove, we strive to create an inclusive culture for all. We understand the importance of listening and incorporating various perspectives at every level of service. Our company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability.

Role Description To assure the consistent application of company procedures and practices in commercial, residential, farm property and property damage liability claim handling, so as to have a significant and positive overall effect on the company. To provide quality service to insureds and aid in the retention of business. To make certain that claims are properly investigated, evaluated and resolved within the company's contractual and legal obligations. To ensure timely service, while providing appropriate and equitable resolution to insureds, claimants and the company. Responsibilities - Investigate, evaluate and control property and casualty claims under minimal supervision. - Maintain advanced knowledge of various types of buildings, construction, repair cost and methods, repair-estimating system and scoping damages. - Assist in training others on repair estimating system and scoping of damage. - Maintain advanced knowledge of farm machinery, livestock and home furnishings. Qualifications - Bachelor’s degree required with focus on construction trades, agriculture-related studies, business administration or insurance related field preferred, or equivalent experience may be considered. - Minimum five to seven years multi-line or property claims experience required. - Advanced knowledge of insurance contracts written by the companies required. - Advanced knowledge of company and divisional policies and procedures required. - Must possess outstanding listening and superior customer service skills. - Advanced knowledge of estimating systems and construction requirements and methods required. - Must have access to high speed Internet at home if position is field-based. - Must possess a valid driver license with an acceptable driving record. - Designations in INS, AIC and/or similar professional insurance designation required. Requirements - Designation in CPCU preferred. - This is a work from home position primarily covering these Michigan counties: Arenac, Bay, Clinton, Genesee, Gratiot, Huron, Ingham, Ionia, Lapeer, Mecosta, Saginaw, Sanilac, Shiawassee, Tuscola. - This is a field position and candidate must reside in the state of Michigan. - If a candidate is not identified, a Property Claims Representative may be considered based on level of experience. Benefits - Farm Bureau offers a full benefit package including medical, dental, vision, and 401K.

• Play a critical role in optimizing our revenue cycle operations • Monitor claims approaching timely filing limits and alert the RCM team about these claims • Resolve payer claims rejections by researching the root cause, calling the payer, and ultimately get claims accepted • Follow up on claims with no payer response and ensure claims are on file with payers • Identify root cause of issues and work with various teams to obtain updated coverage information • Research root cause of claim denials and appeal them within deadlines • Ensure all EDI related enrollments are in place with payers • Ensure strict adherence to payer regulations and internal policies • Lead workflow optimization initiatives within RCM and manage specific projects • Collaborate extensively with multiple teams to align RCM efforts with business objectives

Role Description Handles verification of injury/claim of all WC patients including auditing medical record for billing accuracy. Responsible for marketing to employers/WC clinics and is the point of contact for adjustors and case managers. Essential Functions - Call adjustors to verify all new and established WC injuries/claims per protocol - Audit WC appointments for comments/authorization/DWC - Prepare claims and documentation for filing - Point of contact for all adjustors and case managers - Facilitate physician’s use and understanding of ODG - Prepare DWC 73’s & 69’s - Authorization of all WC procedures - Timely follow up on appeals for unpaid claims utilizing claims maintenance - Advise physicians on dispute cases including initiating Benefit Review Conferences - Remain up to date on DWC rules – including ODG treatment, RTW, Preauthorization and fee guidelines - AR follow up to ensure claims are paid timely - All other duties as assigned Qualifications - High School Diploma - Three years medical office WC billing experience - Knowledge of Texas Workers’ Comp ODG treatment, RTW and fee guidelines - Excellent computer knowledge and skills - Ability to effectively communicate both orally and written - Adequate visual acuity to read written materials - Ability to sit for long periods of time - Problem solving skills - Attention to detail Physical Demands - Telephone – with or without headset – constantly - Photocopier – frequently - Computer – constantly - Fax machine – frequently Environmental Working Conditions - Indoors with rare conditions of extreme noise - Rare conditions of chemicals/fumes/odors and dust/messiness - Continuously handle multiple tasks simultaneously and work as part of a team - Occasionally perform tedious and exacting work in frustrating conditions