• Utilize analytical skills to create a comprehensive estimate of damages for 1st and 3rd party material damage claims leading to the proper disposition • Build relationships with customers across multiple lines • Negotiate settlements and complete documentation of activities on complex files

• Manage an inventory of accounts in a team-based environment for medical payments, third-party liability, and health benefits coverage • New and priority accounts to be worked within client specified protocols, including coverage investigation • Aged and high dollar accounts to be worked as necessary to ensure efficient recovery • Accounts that require substantive review by the coding and utilization departments • Accounts that require lien submissions • Identify and resolve accounts with multiple payers (PIP, Health, TPL) involved • Prepare and submit appeals with required documentation in a timely manner • Use professional notation that is clear, concise and comprehensive throughout the complex account resolution process

• Analyze and evaluate insurance claims to determine coverage and appropriate settlement amounts. • Review insurance policies to accurately interpret coverage terms and conditions. • Negotiate claims settlements effectively, ensuring resolutions are fair, timely, and consistent with company standards. • Maintain comprehensive and precise claim documentation in accordance with company procedures and regulatory requirements. • Process incoming claims, making necessary adjustments and recommendations based on findings. • Communicate professionally with landlords, tenants, internal stakeholders, and other relevant parties, addressing inquiries promptly and clearly. • Support legal processes including document preparation, analysis, and regulatory compliance activities. • Manage workload proactively to meet productivity targets and turnaround time expectations. • Identify opportunities to improve claims workflows, documentation practices, or operational efficiency. • Perform other role-related responsibilities as assigned and aligned with business needs.

Role Description At Centauri Health Solutions, we don’t just process applications; we serve as a lifeline. For many Medicaid members, a single phone call with our team can mean potentially receiving additional monthly cash benefits. We are looking for compassionate and detail-oriented individuals to join our team as Bilingual Disability Specialists. If you find deep satisfaction in solving complex problems and advocating for others, your mission starts here. - Member Champion: Serve as the main point of contact for health plan members, maintaining regular communication, answering questions, and clarifying complex information. - Agency Liaison: Manage positive, professional relationships with medical providers, the Social Security offices, and other government agencies to keep applications on track. - Application Process Mastery: Gather, verify, and submit all necessary signed forms, medical records, and eligibility data, ensuring a complete and accurate application. - Proactive Case Management: Thoughtfully manage accounts, anticipating requirements, and taking all appropriate actions to secure disability benefits until every method is exhausted. - Regulatory Standards: Maintain strict adherence to HIPAA and company information security policies to ensure the safety and confidentiality of all data. - Database Navigation: Concurrently manage multiple software systems and databases to track member progress and documentation. Qualifications - 2+ years in customer service. - Experience in social services, case management, disability/claims processing, using contact center software or working with government agencies is a strong plus. - Fluent in English and Spanish, possessing the ability to speak, read, and write both languages with ease. - Excellent interpersonal and communication skills. - Goal-driven and willing to learn. - Highly proficient with Microsoft Suite and able to navigate multiple platforms and screens smoothly. Requirements - Enjoy a structured, performance-driven environment. - Spend 90% of your day managing inbound and outbound calls. - Manage applications from beginning to end, requiring long-term, detailed follow-up and persistence. - Balance quality member interactions with productivity and performance expectations. Benefits - Comprehensive medical, dental, vision, and prescription coverage. - Wellness program supporting overall well-being. - Company-paid basic life and AD&D insurance. - 401(k) plan with company match. - Tuition reimbursement opportunities. - Paid time off for vacation and illness. - Six paid company holidays. - Floating holiday. - Company-paid training and computer equipment. - Performance-based bonus program. - Paid time off for volunteer activities. - Employee referral bonus program. - Career development and training opportunities, including leadership growth.