Role Description Performs medical record and claims review for Medicare, Medicaid, and/or other claims data in order to ensure that proper guidelines have been followed and assesses for potential overpayment, fraud, waste, and abuse with regards to Medicare, Medicaid, and/or other claims. - Reviews beneficiary, provider, and/or pharmacy cases for potential overpayment, fraud, waste, and abuse. - Completes desk review or field audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud. - Consults with benefit integrity investigation experts and pharmacists for advice and clarification. - Completes case summaries and provides results to investigators to support the investigative process. - Provides case specific or plan specific data entry and reporting. - Participates in internal and external focus groups, as required. - Participates in provider onsite visits and beneficiary interviews, as required, for field audits/investigations. - Testifies at various legal proceedings, as necessary. - Provides job-specific orientation and training, as needed. Helps develop training content, resources, and programs specific to job functions. Qualifications - Minimum Bachelor's Degree required (can be substituted for experience). - 2 - 4 years of experience required; 5 - 7 years preferred. - Medical Review or Utilization Management experience preferred. - Medicare/Medicaid experience preferred. Requirements - Current, active and non-restricted RN licensure required. - Coding certification preferred. Benefits - Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities. - Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.

Role Description As an Auto Claims Specialist at Revecore, you will make high-volume, outbound calls to investigate, bill, and maximize payments on medical claims to insurance companies, on behalf of our clients (hospitals and medical providers). - Investigate and research details of an auto accident to determine the payer. - Make a high volume of outbound calls to patients, insurance company representatives, and attorneys. - Submit bills and proper documentation to the insurance company, ensuring maximized payments to our clients. - Determine follow-up steps and resubmit bills for additional payment if bills aren't paid correctly. - Contribute to your team with various denial reports, audits, and overall support. Qualifications - Working knowledge of Microsoft Office (Word, Excel, Outlook). - Technical proficiency to work on multiple computer screens and software applications simultaneously. - Ability to maintain strong performance in a fast-paced, high outbound call center environment with productivity metrics. - Organizational skills while multi-tasking. - Critical thinking and problem-solving skills to find effective and efficient solutions. - Clear communication skills, both verbally and in writing. - Experience with Coordination of Benefits and a general understanding of insurance billing (a plus, but not required). Requirements - A private, distraction-free environment to work from in your home. - On-Camera Presence: Being on camera is essential for building trust, supporting collaboration, and strengthening team connections. - A secure internet connection. - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. - Workspace must accommodate all workstation equipment (laptop, monitor, keyboard, mouse, docking station, and headset). - Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check. Benefits - Paid training and incentive plans. - Medical, dental, vision, and life insurance benefits available on day 1. - Excellent work/life balance. - Employee Resource Groups build community and foster a culture of belonging and inclusion. - 401(k) contributions matched. - Career growth opportunities. - 12 paid holidays and generous paid time off.

Role Description As a Health Claims Specialist at Revecore, you will: - Bill and investigate health insurance claims to ensure maximum payment from insurance companies on behalf of our clients (hospitals and medical providers). - Investigate and research health insurance claims. - Follow up on unresolved claims to facilitate payment for commercial health, Medicare, and Medicaid. - Contribute to your team with various denial reports, audits, and overall support. Qualifications - Has experience researching and resolving claims for commercial health, Medicare, and Medicaid. - Knows how to file correct UB04's and 1500 HCFA's with subrogation information to payers for payment. - Familiarity with billing health insurance as part of auto accidents. - Conducts timely follow-up activities to determine claim status and collect and/or provide information to resolve the claim. - Experience working in EPIC. - Working knowledge of Microsoft Office (Word, Excel, Outlook). - Possess technical proficiency to work on multiple computer screens and software applications simultaneously. - Can maintain strong performance in a fast-paced environment with productivity metrics. Requirements - A private, distraction-free environment to work within your home. - On-Camera Presence: Being on camera is an essential part of our culture. - A secure internet connection. - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. - Workspace area must accommodate all workstation equipment (laptop, monitor, keyboard, mouse, docking station, and headset). - Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check. - Must reside in the United States within one of the specified states. Benefits - Paid training and incentive plans. - Medical, dental, vision, and life insurance benefits available on day 1. - Excellent work/life balance. - Employee Resource Groups build community and foster a culture of belonging and inclusion. - 401(k) contributions matched. - Career growth opportunities. - 12 paid holidays and generous paid time off.

Role Description As a Property Claims Representative II, you will be responsible for the investigation, negotiation, and resolution of complex property, farm, and commercial claims. You will contribute to our client service culture through daily interactions with clients and by implementing innovative, client-centric solutions. - Investigating, interpreting coverage, negotiating, and making decisions autonomously to resolve complex property, farm, and commercial claims. - Evaluating damage and preparing estimates on property losses, including attending the scene of the loss. - Collaborating with vendors and government officials to facilitate settlement of the loss. - Coaching, training, and providing technical support to the claims team. - Providing exceptional client service in accordance with our claims service and quality standards, with the view of enabling the organization to be the industry leader in client engagement. Qualifications - Three to five years of field property claims experience or related field. - Post-secondary degree or diploma. - Chartered Insurance Professional (CIP) designation or working towards it. - Provincial adjuster license(s) depending on the province of work. Requirements - Regular travel is required. - This role involves direct contact with clients and/or service providers in their environment. - Extended work hours, including evenings and weekends, will be required during peak periods and major events. - Background check as a condition of employment for the successful candidate. Benefits - Training and development opportunities to grow your career. - Flexible work options and paid time off to support personal and family needs. - A holistic approach to well-being, with physical and mental health programs and a supportive workplace culture. - Paid volunteer days to give back to your community. - Comprehensive total rewards package including group retirement savings plans, pension, and benefits (e.g., health and wellness, dental, disability, and life coverage), mental health support, and an employee assistance program. Salary Information Expected salary range: $60,574 to $100,956. The salary amount for the successful candidate is determined by Co-operators in its discretion and will vary depending on several criteria including but not limited to: local market conditions, geography, and relevant job-related factors such as knowledge, skills, qualifications, experience, and education. Employees may also have the opportunity to participate in incentive programs and earn additional compensation tied to individual and/or business performance, or other business metrics.