Supervisor, Claims Full Time RegularManagement Remote, US Requisition ID: 1830 Salary Range:$75,000.00 To $85,000.00 Annually Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, Health Plans, Inc. is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you. What we do HPI is unique. A respected industry leader that’s been serving customers for over 40 years, we’re known for our innovation and growth. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission. What you’ll do The Claims Supervisor will oversee a dedicated unit of Claim Examiners and Claim Seniors. The Supervisor will oversee the daily team operations and plan for future workflow and scheduling. The Supervisor will mentor Claims Seniors and staff to better coordinate the daily production, turnaround time and work quality of claims processing while meeting company goals. The Supervisor will coordinate new business group implementation and testing on new business. The Supervisor will set policy & procedures and work with the auditing team on audit appeals. The Supervisor will also oversee work setup queues working with the Technical Resource Unit. In this role, you’ll also: - Work with Senior Claims Examiners to create and manage department work schedules - Complete weekly turnaround time reports - Attend new business implementation meetings - Assist in supervisor level phone calls - Review and maintain department policies and procedures - Partner with department manager to identify team inefficiencies and solutions - In conjunction with department manager, hire, train, and manage staff within the claims teams - Monitor employee performance; write and/or deliver annual reviews - Work with department manager regarding staff performance, development and training functions - Advise department manager of issues raised by staff; suggest actions to improve processing or resolve issues - Work with appropriate subject matter experts to provide necessary training within the team - Work with Account Services to implement and test new business and support renewing business within the team - Work with Technical Resource Unit to audit claim system build - Manage relationships with internal and external business associates - Process threshold claims to a maximum dollar level of $100,000 - Process Medicare demand payments - Handle special projects as assigned by the Manager What you bring - High school diploma or equivalent education - Three to five years’ of claims processing experience - Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint Why choose us? - Our space is a reflection of who we are—innovative, open and collaborative. - Love to get creative? We do too. Brainstorm in one of our team break-out rooms. - We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks. - Need to reenergize? Take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms. - We offer our employees flexible work arrangements including remote and hybrid options (depending on the position) - We’re a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities. Benefits We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we offer to our employees: - Medical, Dental and Vision Coverage - Prescription Drug Coverage - Fitness Reimbursement Benefit - Tobacco Cessation Program - Employee Assistance Program - Flexible Spending Account & Health Savings Account - 401(k) and Profit-Sharing Plan - Quarterly Bonuses - Generous Paid-Time Off - Volunteer Days - Education Assistance & Professional Development Opportunities - ….and much much more! So, think you want to join the HPI team? We hope to hear from you!

Experienced Healthcare Claims Processor Fully Remote • Raleigh, GA Job Type Full-time Description Join the new Bakinaw-Karna Joint Venture Team as a Temporary, Full-Time Medical Claims Processor. Become an integral part of a team dedicated to servicing the World Trade Center Health Program. In this role, you will leverage your meticulous attention to detail and commitment to accuracy in processing complex medical claims. If you’re eager to make a positive impact in our community through your administrative skills, we encourage you to apply! *Minimum of 5 years’ experience in medical claims processing, including professional and facility claims as well as complex and high-dollar claims* Job Responsibilities: - Claims Review and Processing: Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. - Critical Analysis: Analyze claims and adjudicate them according to program guidelines, employing critical thinking to navigate complex scenarios. - Timely Processing: Ensure claims are processed promptly to meet client standards and regulatory requirements, employing effective problem-solving skills to address any barriers. - Issue Resolution: Proactively resolve claim discrepancies and issues by collaborating with other departments, utilizing analytical skills to identify root causes and implement solutions. - Confidentiality Maintenance: Uphold the confidentiality of patient records and company information as per HIPAA regulations. - Detailed Record Keeping: Maintain thorough records of claims processed, denied, or requiring further investigation, ensuring transparency and traceability. - Trend Monitoring: Analyze and report on trends in claim issues or irregularities to management, contributing to process improvement initiatives; Assists Team Leads with reporting. - Audit Participation: Engage in audits and compliance reviews to ensure adherence to internal and external regulations, using critical thinking to evaluate processes. - Mentoring: Mentors and trains new claims processors as needed. Requirements - High school diploma or equivalent. - Minimum of 5 years’ experience in medical claims processing, including professional and facility claims as well as complex and high-dollar claims. - Familiarity with ICD-10, CPT, and HCPCS coding systems. - Understanding of medical terminology, healthcare services, and insurance procedures (worker’s compensation experience is a plus). - Strong attention to detail and accuracy. - Ability to interpret and apply insurance program policies and government regulations effectively. - Excellent written and verbal communication skills. - Proficient in Microsoft Office Suite (Word, Excel, Outlook). - Capacity to work independently as well as collaboratively within a team. - Commitment to ongoing education and training in industry standards and technology advancements. - Experience with claim denial resolution and the appeals process. - Ability to efficiently manage a high volume of claims. - Customer service-oriented with strong problem-solving capabilities. - Must be flexible and have the ability to adjust to the needs of the client and changes in the program. PM18 #remote Salary Description $22-25/hour

Role Description Since 2000, Crum & Forster’s Accident & Health division (A&H) has offered a diverse portfolio of specialty insurance and reinsurance products nationwide. We place a strong focus on product development and creative distribution methods, along with excellent client service and support. In addition to our robust domestic portfolio, which spans both special risk and medical solutions, A&H works on an international basis through various partnerships. Our global capabilities provide our partners with even broader flexibility in underwriting solutions. The qualities and capabilities of A&H demonstrate our philosophy of building meaningful, long-term partnerships and our dedication to providing alternative strategies in an ever-changing insurance market. The A&H MBU takes a full-spectrum approach to designing and servicing a robust slate of products tailored to needs in Employer Stop Loss, Excess Medical, Life, and Ancillary and Supplemental benefits. Our diversified business model includes program partnerships as well as direct sales in Employer Stop Loss. At year-end 2025, the MBU recorded $1.02 Billion in gross premium written. This is a unique opportunity to work with a high-quality team of leaders and benefit from the security and stability of a large organization while maintaining a nimble and responsive approach to business. The successful candidate will work as part of a team and be responsible for: - Evaluating claim eligibility - Outlining claim exposure - Processing payments to policyholders - Maintaining appropriate reporting to management - Interacting internally with fellow team members and externally with the division’s business partners The C&F SL team has an objective to write and administer $2 billion in business in the next 5 years. Qualifications - 3+ years medical stop loss claim experience required - Bachelor’s degree or equivalent experience required - Strong working knowledge of both Microsoft Office suite with an aptitude to learn new programs (ESL Office experience preferred) - Ability to establish a good rapport with all stakeholders - Commitment to delivering outstanding customer service and satisfaction - Commitment to exploring and assisting in implementing new processes to increase effectiveness and achieve organizational goals - Exceptional attention to detail and accuracy - Capability to manage multiple priorities in a fast-paced environment - Excellent written and verbal communication skills Requirements - Review all claim submissions for accuracy, completeness, and compliance with various Plan Documents, SPDs, and Policies - Clearly and professionally communicate external requests for information and maintain timely follow-up - Clearly and professionally communicate claim payment and denial decisions - Confirm appropriate disclosure when applicable - Calculate and maintain reserves as needed - Assist with aggregate accommodation activities and aggregate claim submissions - Maintain appropriate reporting and communication with team and management regarding your assigned areas of responsibility - Assist with refining internal claim procedures and recommending improvements to management - Other duties as assigned Benefits - Competitive compensation package - Generous 401K employer match - Employee Stock Purchase plan with employer matching - Generous Paid Time Off - Excellent benefits that go beyond health, dental & vision, focusing on your whole family’s wellness - Tuition reimbursement, industry-related certifications, and professional training - A dynamic, ambitious, fun and exciting work environment - Encouragement of social and community responsibility through matching donation program and volunteer opportunities

Role Description The Claims Specialist will report to the Claims Supervisor in the CDB Operations Department. This role is responsible for driving compassion, confidence and trust while delivering one superior quality experience at a time. This role requires attention to detail to ensure we are processing the claim accurately to ensure a great member experience based on the claim form they’ve submitted for reimbursement. - Provide excellent customer service to every member. - Adapt quickly in a fast-paced and time sensitive environment. - Processes accurate claim data to ensure members receive correct reimbursements. - Goal orientated, sense of urgency to complete tasks. - Ability to organize and prioritize work to meet deadlines. - Utilizes available tools and resources to make informed decisions while processing claims. - Other duties as assigned. Qualifications - Years of Experience: Claims experience preferred - Degree: High School Diploma, GED or college degree - Certification: N/A - Skills & Abilities: - Excellent analytical skills with a proactive nature - Strong organization skills with a drive to meet deadlines - An affinity for accuracy and efficiency - Proficiency in Microsoft Excel, Word (including mail merge) and Outlook - Strong verbal and written communication skills - An aptitude for prioritization and multi-tasking - Strong collaboration skills - A drive to learn and apply new concepts quickly. Requirements - Ability to work overtime in peak season - Prolonged periods of sitting at a desk and working on a computer