Title: Workers Compensation Claims Examiner | West Hills, CA (Remote 3 Days) Location: West Hills, CA, United States Job Description: Full time job requisition id R70978 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 Workers Compensation Claims Examiner | West Hills, CA (Remote 3 Days) Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? - Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.  - Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.  - Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.  - Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.  - Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.  - Enjoy flexibility and autonomy in your daily work, your location, and your career path.  - Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.  ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. OFFICE LOCATIONS: West Hills, CA (Agile) 3 days remote PRIMARY PURPOSE OF THE ROLE: To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. ESSENTIAL RESPONSIBLITIES MAY INCLUDE - Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.  - Negotiating settlement of claims within designated authority.  - Communicating claim activity and processing with the claimant and the client.  - Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. QUALIFICATIONS Education & Licensing: 5 years of claims management experience or equivalent combination of education and experience required. - High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.  - Professional certification as applicable to line of business preferred. Licensing / Jurisdiction Knowledge: SIP required or must be obtained within one (1) year of employment; California workers compensation jurisdictional knowledge required. TAKING CARE OF YOU Flexible work schedule.  Referral incentive program.  Career development and promotional growth opportunities.  A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. WORK ENVIRONMENT REQUIREMENTS INCLUDE When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding Auditory/Visual: Hearing, vision and talking As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000 - $98,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #LI-Hybrid #claimsexaminer #hybrid #claims Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Role Description The Claims Examiners provide a service to our policyholders by reviewing claims to determine the validity of the insurance claim filed and identify the need for further investigations. Examiners resolve medical/dental/life/trip cancellation claims; documenting actions; maintaining their imaging queues; maintaining quality audit standards and ensuring their outcomes are following the Certificate of Insurance, Policy and Plan Documents as well as legal and regulatory agencies. Duties and Responsibilities - Determines covered insurance losses by studying provisions of policy or certificate. - Establishes proof of loss by studying proof of claim; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims. - Documents medical claims actions by completing forms, reports, logs, and records. - Resolves claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter. - Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations. - Maintains quality customer services by following core values. Qualifications - At least 1 year of prior medical claims processing experience OR willing to consider at least 2 years of experience with coding, billing, reviewing medical records, claims research, benefits review, medical office, or any other claims related role (i.e. complex claims, LCM claims, BI claims, P&C claims, etc.). - Knowledge of basic medical terminology. - Ability to read and interpret insurance policy/certificate wording. - Ability to research and logically consider details from multiple sources to analyze and make a determination of benefits within a productivity-based environment. - Computer skills and proficiency in operating common office equipment. - Documentation, Data Entry Skills. - High attention to detail with ability to analyze information and Problem-solving skills. - Proficiency with basic math. Preferred Skills - Knowledge of ICD-10. - Knowledge of FDA Health and HIPAA Regulations. Benefits - Comprehensive benefits package including Medical / RX / Dental / Vision / Life insurance. - 401k Plan with company match. - Paid Time Off and Company Paid Holidays. - Free employee parking. - On site fitness center. - Casual dress environment. - Tuition reimbursement plan.

Title: Revenue Cycle Specialist | BAR - Commercial/Managed Care Location: Gainesville United States Job Description: Put your revenue cycle expertise to work ensuring accurate reimbursement, resolving complex billing issues, and supporting the financial health of one of Florida's leading academic health systems. Work Style: Remote Location: Gainesville, FL FTE: Full-Time (1.0 FTE) Schedule: Monday - Friday The Revenue Cycle Specialist - Commercial/Managed Care supports the financial integrity of UF Health Physicians Billing and Accounts Receivable operations by performing billing, follow-up, and reimbursement activities for professional services. This role is responsible for processing claims in accordance with federal, commercial, and managed care guidelines; researching and resolving account issues; verifying insurance coverage and benefits; addressing reimbursement discrepancies; managing credit balances and refunds; and investigating and resolving denied claims. The specialist works closely with payers, providers, and internal stakeholders to ensure timely and accurate reimbursement while maintaining compliance with regulatory and organizational requirements. Responsibilities Knowledge, Skills, and Abilities - Strong communication, organizational, and problem-solving skills. - Ability to discuss financial matters and collect payments from patients and payers in a professional and customer-focused manner. - Ability to multitask, prioritize responsibilities, and manage competing deadlines. - Strong analytical skills with the ability to research and resolve account discrepancies and reimbursement issues. - Ability to work independently and collaboratively within a team environment. Qualifications Minimum Education and Experience Requirements Education - High school diploma or equivalent required. - Associate's degree may substitute for the required work experience. Experience - Minimum of six (6) months of healthcare billing, collections, revenue cycle, or financial experience required; OR - Minimum of one (1) year of experience in a business environment involving finance, accounting, insurance, collections, or accounts receivable functions. Preferred Qualifications - Working knowledge of CPT and ICD-10 coding. - Knowledge of federal, commercial, and managed care billing rules, regulations, and compliance requirements. - Epic system experience preferred.

• Conduct both virtual and on-site investigations by visiting policyholders’ residences to assess property damage, determine liability, evaluate the extent of loss, and negotiate fair settlements • Use claims handling software, a company car, and a laptop to determine claims-related damage and write estimates in a paperless environment • Evaluate and report on potential subrogation opportunities • Reports incidents involving theft, fraud, or arson to appropriate state and industry agencies • Perform duties independently, with work directly impacting management outcomes • Acts as a company representative in public interactions, maintaining a professional demeanor consistent with management standards • Engages regularly with a variety of stakeholders, including policyholders, claimants, agents, witnesses, contractors, law enforcement, fraud and arson investigators, attorneys, medical professionals, and other relevant parties • Use strong customer service skills to negotiate with policyholders to settle the claim • Performs additional duties as assigned • Promotes safety at all times and complies with safety/ergonomic standards as outlined in relevant company published manuals • Employees assigned to the Catastrophe team will be required to travel away from their residence for a specified period of time, usually consisting of 2-3 days • Although this is not a CAT-specific role, hires will be expected to commit to 1–3 CAT deployments per year