• Review insurance denials to determine and take the next appropriate action steps to receive payment from the payor. • Appeal claims that have been denied for no auth, medical necessity, etc. • Verify receipt of claims with insurance plans to ensure timeliness of claims reimbursement. • Assume full responsibility for reducing the accounts receivable of insurance balances by working through outstanding accounts. • Communicating with payors through phone calls, emails, and payor portals. • Process and take action on any written correspondence from insurance payors. • Identify and trend reasons for claim denials. • Resolve claim discrepancies reported by patients and other clinical departments.

• Review insurance denials to determine and take the next appropriate action steps to receive payment from the payor. • Appeal claims that have been denied for no auth, medical necessity, etc. • Verify receipt of claims with insurance plans to ensure timeliness of claims reimbursement. • Assume full responsibility for reducing the accounts receivable of insurance balances by working through outstanding accounts. • Communicating with payors through phone calls, emails, and payor portals. • Process and take action on any written correspondence from insurance payors. • Identify and trend reasons for claim denials. • Resolve claim discrepancies reported by patients and other clinical departments.

• Provide virtual client engagement assistance for key clients across the region. • Use analytical skills to analyze client's financial statements and ensure adherence to financial regulations. • Examine financial and accounting records and other documents such as inventory or plant and equipment. • Communicate with Manager and/or Partner regarding engagement progress, risks, and issues. • Test client organization's internal controls and processes. • Build trust and credibility with clients by understanding their expectations and delivering high quality services. • Take ownership of external file completion and analyze engagement economics.

Role Description The Experienced Homeowner Litigation and Appraisal Adjuster is a senior-level individual contributor role within Openly’s Property Claims organization, responsible for managing complex homeowner property claims in litigation and appraisal from assignment through final resolution. This position demands deep technical claims expertise, strong litigation acumen, and the confidence to drive strategy independently on high-stakes files. - Write and critically review estimates. - Navigate sophisticated coverage questions. - Manage defense counsel and appraisal panels. - Deliver fair, well-reasoned outcomes for all parties. The ideal candidate is a consummate professional who commands every file with proactive ownership and unwavering integrity, bringing urgency and genuine empathy to every interaction. Key Responsibilities - Litigation & Appraisal Management: - Manage end-to-end handling of HO property claims in litigation and appraisal. - Drive litigation development and strategy on the file. - Manage the appraisal process from invocation through award. - Make difficult, independent decisions with confidence and sound judgment. - Claim Investigation & Coverage Analysis: - Conduct thorough investigations including review of policy terms and damages evaluation. - Examine claims for potential subrogation opportunities. - Issue coverage position letters and other formal claim correspondence. - Estimating & File Documentation: - Independently scope and write property damage estimates using Cotality. - Critically review estimates prepared by others. - Prepare and maintain thorough file documentation. - Adhere to reserving best practices and update reserves accurately. - Customer Service & Communication: - Provide superior customer service throughout the claims process. - Discuss and provide updates to all parties involved in the claim. - Maintain proactive control of every file. - Negotiation & Independent Decision-Making: - Apply strong verbal negotiation skills to complex claim situations. - Negotiate settlement of claims with fairness and professionalism. - Vendor & Partner Collaboration: - Manage and collaborate with vendor partners to drive accurate claim outcomes. - Provide feedback on process and performance. - Partner with internal functions to drive aligned claim outcomes. - Support and mentor peers as needed. Qualifications - 5+ years of HO claims experience, handling litigation matters from assignment through resolution. - Proven ability to independently scope and write property estimates in Cotality. - Experience managing the appraisal process from invocation through award. - Strong verbal negotiation skills and collaborative experience with defense partners. - Experience with formal claim handling and related correspondence. - Active adjuster license(s) or eligibility to obtain licenses in required states. - Experience in a remote or hybrid claims environment. - Proficiency in Microsoft and Google productivity tools. - Exceptional written and verbal communication skills. - Strong organization, time management, and multi-tasking abilities. - Tech-savvy with comfort using high-end technology tools for adjusting. - Ability to work independently and manage a complex workload. - Agile and change-ready mindset. Preferred - Experience handling claims in Oklahoma and other West Coast states. - Auto Physical Damage (APD) experience. - Innovative mindset with a track record of process improvement. - Experience with MacBook and Google Suite products in claims handling. - Bachelor’s Degree or equivalent combination of education and experience. - CPCU, AIC, or other relevant professional designation.