Role Description At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose. - Apply claims management experience to execute decision-making to analyze claims exposure, plan the proper course of action, and appropriately resolve claims. - Interact extensively with various parties involved in the claim process to ensure effective communication and resolution. - Provide exceptional customer service to our claimants on behalf of our clients exhibiting empathy through each step of the claims process. - Handle claims consistent with clients' and corporate policies, procedures, and standard methodologies in accordance with statutory, regulatory, and ethics requirements. - Document and communicate claim activity timely and efficiently, supporting the outcome of the claim file. Qualifications - Claims Background: Commercial General Liability and Litigation Management - Jurisdictional Experience: Any - Active Adjusters' licenses: Any Requirements - High School Diploma. - Minimum of 5 years related claims experience. - Appropriately licensed and/or certified in all states in which claims are being handled. - Knowledge of accepted industry standards and practices. - Computer experience with related claims and business software. Benefits - Medical/dental/vision plans, which start from day one! - Life and accident insurance - 401(K) and Roth options - Tax-advantaged accounts (HSA, FSA) - Educational expense reimbursement - Paid parental leave - Digital mental health services (Talkspace) - Flexible work hours (availability varies by office and job function) - Training programs - Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing - Charitable matching gift program - And more...

• To analyze Auto Bodily Injury Litigation claims on behalf of our valued clients to determine benefits due. • Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. • 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.

• 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.

Title: Insurance Claims Specialist HB Location: Home Work - Monongalia County WV (Local) time type Full time job requisition id JR26-35859 Job Description: Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Responsible for managing patient account balances including accurate claim submission, compliance will all federal/state and third party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of the WVU Medicine hospitals. Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues that arise from customer inquiries. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to achieve best in class revenue cycle operations. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. High School diploma or equivalent. PREFERRED QUALIFICATIONS: EXPERIENCE: 1. One (1) year medical billing/medical office experience. CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Submits accurate and timely claims to third party payers. 2. Resolves claim edits and account errors prior to claim submission. 3. Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. 4. Gathers statistics, completes reports and performs other duties as scheduled or requested. 5. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency. 6. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. 7. Contacts third party payers to resolve unpaid claims. 8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. 9. Assists Patient Access and Care Management with denials investigation and resolution. 10. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth. 11. Attends department meetings, teleconferences and webcasts as necessary. 12. Researches and processes mail returns and claims rejected by the payer. 13. Reconciles billing account transactions to ensure accurate account information according to established procedures. 14. Processes billing and follow-up transactions in an accurate and timely manner. 15. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing. 16. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. 17. Maintains work queue volumes and productivity within established guidelines. 18. Provides excellent customer service to patients, visitors and employees. 19. Participates in performance improvement initiatives as requested. 20. Works with supervisor and manager to develop and exceed annual goals. 21. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. 22. Communicates problems hindering workflow to management in a timely manner. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Must be able to sit for extended periods of time. 2. Must have reading and comprehension ability. 3. Visual acuity must be within normal range. 4. Must be able to communicate effectively. 5. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Office type environment. SKILLS AND ABILITIES: 1. Excellent oral and written communication skills. 2. Working knowledge of computers. 3. Knowledge of medical terminology preferred. 4. Knowledge of business math preferred. 5. Knowledge of ICD-10 and CPT coding processes preferred. 6. Excellent customer service and telephone etiquette. 7. Ability to use tact and diplomacy in dealing with others. 8. Maintains knowledge of revenue cycle operations, third party reimbursement and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures. 9. Ability to understand written and oral communication. Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 544 SYSTEM Patient Financial Services