Role Description The Special Utilities Billing Representative is responsible for resolving claims that are pending, unable to be released, denied, or incorrectly paid by insurance carriers. This role requires strong follow-through, attention to detail, and the ability to manage multiple priorities effectively. This role is a remote, work from home position. The Representative will work Monday through Friday, standard business hours, on an Eastern Time schedule. - Review claims that have been put on hold, working to identify causes and address issues causing them to remain on hold. - Address claims that have been identified as paid by locating deposit information. - Complete basic credentialing updates with insurance companies. - Review patient accounts with multiple transports to ensure the system has the correct coordination of benefits. - Handle all correspondence that comes to EMS lockbox (denial EOBs, patient invoices, attorney requests, etc.). - Document all findings and actions in the appropriate systems with accuracy and attention to detail, maintaining full compliance with HIPAA and internal quality standards. - Work with insurance companies over the phone, collecting claim status, deposit information, etc. - Additional job duties as assigned. Qualifications - High School Diploma or equivalent. - Strong ability to multi-task and manage competing priorities with accuracy. - Ability to work independently and remain focused in a remote, deadline-driven environment. - Collaborative team player with the ability to communicate professionally with internal departments and external partners. - Pleasant, professional, and customer-focused demeanor. - Ability to maintain composure and deliver quality work under pressure. - Strong computer literacy, including comfort working with dual monitors and navigating multiple systems simultaneously. - Excellent follow-through, attention to detail, and accuracy in data review. - Strong written communication skills, including grammar and documentation clarity. - Ability to meet strict deadlines while maintaining high-quality work. - Reliable, punctual, and dependable with strong work accountability. - Quick learner who takes clear, organized notes during training. - Comfortable asking questions and seeking clarification when needed. - Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment. Benefits - Competitive salary, commensurate with experience. - Comprehensive benefits package, including 401(k) Plan.

Role Description Responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Specialists are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. The Specialist must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. - Process eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers. - Confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. - Verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. - Identify all payment sources for accurate primary and secondary payer coverage and required authorizations to prevent denials and/or reduction in payment for patients entering the facility for care. - Obtain necessary paper/electronic referrals, authorizations and pre-certifications from Primary Care Physician and/or Specialty Physician when required by payers. - Collect and validate accurate patient demographic and insurance information, verifies insurance, obtains pre-certification/authorization as required and enters all necessary information. - Calculate and communicate patient estimates for hospital services utilizing a deposit matrix or patient payment estimator. - Educate patients on their benefits, offers the patient/family the opportunity to pay their estimated patient responsibility prior to services rendered. - Identify patients in need of financial assistance and provide charity applications and referrals to the business office as necessary. - Screen all self pay patients for potential payer coverage and directs applicable accounts to the advocacy team for further review. - Provide communication concerning change of insurance coverage, prior to billing, from Registration staff and/or Patient Advocate/Billing staff. - Maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations. Qualifications - 1-3 years related experience in billing, insurance or registration. - 1-3 years healthcare experience. Requirements - The individual must be able to work the hours specified. - Must have visual acuity adequate to perform position duties. - Ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. - Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions. Company Description Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to talent@avera.org.

• Set the strategy for Personal Lines technology delivery and core insurance application support. • Lead direct and matrixed teams across application delivery, production support, and service operations. • Develop and communicate technology roadmaps that align with business goals. • Partner with executive leaders to prioritize initiatives, manage risks, and support enterprise objectives. • Build an inclusive, collaborative team culture focused on trust, accountability, learning, and results. • Coach and develop leaders, managers, and individual contributors. • Oversee a portfolio of Personal Lines projects, including core system changes, digital integrations, and financial system integrations. • Ensure projects are aligned to business priorities, delivery timelines, and expected value. • Guide teams using Agile practices to improve planning, delivery, and collaboration. • Define and lead the application support strategy for core insurance platforms. • Oversee 24/7 production support operations for critical applications. • Monitor service performance using service-level measures, key performance indicators, and business partner feedback. • Improve service management practices using ITIL or similar frameworks.

Role Description We are seeking a Senior Director, AI Insurance Solutions Product Leader to shape, build, and scale a portfolio of AI-powered Service-as-Software solutions for the insurance industry. This role reports to the Executive, AI Solutions Product Leader and leads the industry product agenda within the broader AI Solutions Platform portfolio. The leader will: - Translate industry needs into repeatable AI product concepts. - Guide product execution, support commercialization, and partner closely with various teams. - Focus on moving from bespoke services to reusable, platform-led AI products. Qualifications - 12+ years of full-time professional experience in insurance, InsurTech, product leadership, digital transformation, or enterprise solution development. - Demonstrated experience across all three lines of business (Life, Annuities, and P&C). - Proven ownership of 2+ end-to-end product lifecycles. - Delivery of 1+ enterprise-scale initiatives involving AI/GenAI, intelligent automation, data platforms, or cloud technologies. - Experience leading cross-functional efforts across at least 5 business areas. Requirements - Shape the product strategy and roadmap for AI Insurance Solutions. - Identify high-value use cases across Life, Annuities, and Property & Casualty insurance. - Guide MVP definition, product build, launch readiness, adoption, and continuous improvement. - Ensure industry products leverage shared AI platform capabilities. - Support commercialization through product narratives, solution packaging, and sales enablement. - Convert market and client learning into reusable product patterns. Benefits - Medical, dental, and vision insurance with employer contribution. - Flexible spending or health savings account. - Life and AD&D insurance. - Short and long term disability coverage. - Paid time off. - Employee assistance program. - Participation in a 401k program with company match. - Additional voluntary or legally-required benefits.