• Works closely with veterinary hospitals, and policyholders to evaluate and review a pet’s medical history to determine a baseline of health. • Investigates and processes assigned insurance claims, verifies coverage, and compensation amounts, per insurance policy. • Updates Explanation of Benefits (EOB), pays and closes claim. • May order medical records from providers. • May communicate with clients and providers during treatment. • Performs other duties and responsibilities as assigned.

Role Description - Responsible for updating patient Billing Episodes and crediting account, as appropriate. - Review and resolve prior authorization/precertification/referral issues that are not valid and contact insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial. - Validates all necessary referrals/prior authorizations/pre-certifications for scheduled services are on file and shared with all appropriate staff and are valid for the scheduled services performed. - Ensure all account activity is documented in the appropriate system and shared with all appropriate staff timely and thoroughly. - Manage clinic emails throughout the day, responding in a timely manner. - Identify, correct, and forward potential reimbursement problems to Revenue Cycle Manager. - Proactively interact with Clinics and other appropriate staff sharing benefits, authorizations, and eligibility. - Responsible for billing all patient claims in a timely manner (weekly billing, secondary and out-of-network plans). - Review claims issues, make corrections as needed, and rebill. Utilize claims clearinghouse, EMRs, and payor portals to review and correct claims and to resubmit electronically when available. - Evaluate bill cycles and change/update when necessary. - Print daily billing reports – both electronic and paper claims. Monitor validation percent. - Work daily claims rejection lists including but not limited to; claims rejected due to auto eligibility process during weekly billing and “Rejected” claims due to eligibility, coordination of care and authorization as part of accounts receivable. - Gather and interpret data from the system and understand appropriate courses of action to take and initiate time-sensitive and strategic steps resulting in payment. - Call and status outstanding claims with third party payors. - Review explanation of benefits to ascertain that claim processed and paid correctly. - Document account follow-up where appropriate. - Identify trends and work with the Revenue Cycle Manager for resolution. - Perform other duties as assigned. Qualifications - High school diploma or equivalent; prefer some college or technical school coursework. - 2+ years of healthcare billing/AR experience, preferred. - Healthcare payor claims follow-up or accounts receivable experience. - Healthcare background with payor appeals experience. - Advanced computer skills including Microsoft Office; especially Word, Excel, and PowerPoint. - Knowledge of office administration procedures with the ability to operate most standard office equipment. - Ability to work professionally with sensitive, proprietary data & information while maintaining confidentiality. - Excellent interpersonal skills include the ability to interact effectively and professionally with individuals at all levels; both internal and external. - Exercises sound judgment in responding to inquiries; understands when to route inquiries to the next level. - Self-motivated with strong organizational skills and superior attention to detail. - Must be able to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes. - Capable of working within established policies, procedures and practices prescribed by the organization. - English sufficient to provide and receive instructions/directions. Benefits - Comprehensive Medical, Dental, & Vision insurance - Competitive 401(k) plan with company match - Company paid group term life insurance and short-term disability - Generous PTO: Paid vacation, personal time, sick leave, and extended sick leave - Employee Assistance Program (EAP) offering continued support to employee lifestyle and well-being - Career advancement opportunities across a leading national network

• Investigating and confirming the facts of loss for basic to advanced automobile accidents. • Determining coverage, liability, damages, and adjusting claims within the limit of authority. • Partnering with assigned reps for claims involving fraud or subrogation. • Handling investigation regarding all aspects of auto claims with discretion and independence.

Role Description To supervise the operation of multiple teams of examiners and technical staff for liability claims for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. - Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit. - Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office. - Provides technical/jurisdictional direction to examiner reports on claims adjudication. - Compiles reviews and analyzes management reports and takes appropriate action. - Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards. - Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal. - Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner. - Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client. - Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client. - Assures that direct reports are properly licensed in the jurisdictions serviced. - Ensures claims files are coded correctly and adequate documentation is made by claims examiners. - Performs other duties as assigned. - Supports the organization's quality program(s). Qualifications - Bachelor's degree from an accredited college or university preferred. - Licenses as required. - Professional certifications as applicable to line of business preferred. - Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience. - Thorough knowledge of claims management processes and procedures for multiple product lines. - Excellent oral and written communication, including presentation skills. - PC literate, including Microsoft Office products. - Leadership/management skills. - Analytical and interpretive skills. - Ability to work in a team environment. - Ability to meet or exceed Performance Competencies. Requirements - Work environment requirements include: - Physical: Computer keyboarding. - Auditory/visual: Hearing, vision and talking. - Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. Company Description Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.