Role Description Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. Hours - M-F 12pm - 8:30pm EST Essential Job Duties - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Strong claims adjusting experience as well as customer services, problem solving, critical thinking skills and research and resolution skills. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. Qualifications - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. Requirements - Knowledgeable in Systems Utilized: - Salesforce - QNXT - Pega - Claim Shark - Cotiviti Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description We’re looking for a seasoned Claim Specialist IV to take ownership of complex lost time claims while serving as a mentor and subject matter expert within our Claims team. This is a high-visibility role designed for a skilled professional who thrives in a fast-paced environment, exercises sound judgment, and enjoys elevating the capabilities of others. The Claim Specialist IV investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision. This position can be remote, hybrid or in-person. What You’ll Do - Own the full claim lifecycle: - Investigate, evaluate, negotiate, and resolve lost time workers’ compensation claims within designated settlement and reserving authority - Analyze complex exposures: - Assess compensability, medical, legal, and indemnity factors while proactively managing risk and claim cost drivers - Navigate jurisdictional requirements: - Ensure compliance with state-specific WC laws, litigation processes, and regulatory guidelines - Strategically manage claims: - Develop and execute resolution strategies, including collaboration with defense counsel, medical providers, and vendors - Exercise advanced judgment: - Handle a high-exposure, complex caseload with a high degree of autonomy and limited supervision - Develop others: - Design and deliver training sessions, research materials, and technical guidance for less experienced adjusters - Serve as a subject matter expert: - Provide leadership in best practices, reserving, settlement strategy, and claim handling excellence What Sets This Role Apart - Complex, high-impact caseload: - Manage litigated and non-litigated lost time claims requiring deep technical expertise - Expanded authority: - Settlement and reserving authority aligned with your experience and demonstrated capabilities - Influential role: - Shape claim outcomes and elevate team performance through mentorship and knowledge sharing - Cross-functional exposure: - Regular collaboration with legal, medical management, underwriting, and risk partners Qualifications - Proven experience managing lost time claims with increasing complexity - 4 years of WC lost time claim handling required - Strong negotiation and analytical skills with a focus on resolution - Ability to work independently while maintaining high-quality outcomes - Passion for mentoring, training, and knowledge sharing - Demonstrated ability to handle confidential, high-impact situations with professionalism Company Description MEMIC is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, age, disability, genetics, gender identity, veteran's status, sexual orientation, or any other characteristic protected by law. Additionally, we are committed to providing an inclusive and accessible recruitment experience for all candidates. If you need a reasonable accommodation during the interview process, please contact us at hr@memic.com. To ensure an equitable and authentic interview process, candidates should not use AI or chatbot tools during the live interview or phone screen. We welcome any preparation you choose to do beforehand, but all responses shared during the interview must be your own. Note: MEMIC does not offer Stem-OPT EAD Extension for this role. Check out our benefit offerings here! Targeted salary range: ___________

• Analyzes and processes complex or technically difficult medical malpractice claims • Manages claims through well-developed action plans to an appropriate and timely resolution • Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions • Negotiates claim settlement up to designated authority level • Monitors reserve adequacy throughout claim life • Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement • Coordinates legal defense by assigning attorney, coordinating support for investigation, recognizing opportunities to reduce total claim cost • Communicates claim activity and processing with the client • Ensures claim files are properly documented and claims coding is correct • Refers cases as appropriate to supervisor and management • Delegates work and mentors assigned staff

• 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.