Role Description Bring your claims expertise to a remote team committed to service excellence and operational success. - Work Style: Remote - Location Requirement: Gainesville, FL - FTE: Full-Time (1.0 FTE) This position is responsible for coordinating incoming and outgoing payer correspondence, reviewing claim documentation, supporting Epic account updates, and ensuring accurate claim processing and routing. Ideal candidates are detail-oriented, analytical, and thrive in a fast-paced environment while helping drive efficiency and accuracy across the revenue cycle team. Qualifications - High School Diploma/Equivalent Requirements - 2+ years of experience in insurance claims processing and support. - Working knowledge of insurance policies, coverage, and claims adjudication processes. - Experience investigating, analyzing, and resolving claim-related issues. - Strong communication and customer service skills with the ability to interact effectively with claimants and stakeholders. - Demonstrated ability to maintain accurate records and ensure compliance with regulatory and audit requirements.

• Day-to-day processing of claims for accounts: • Responsible for processing of claims (medical, dental, vision, and mental health claims) • Claims processing and adjudication. • Claims research where applicable. • Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic). • Incumbents are expected to meet and/or exceed qualitative and quantitative production standards. • Investigation and overpayment administration: • Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. • Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records. • Utilize systems to track complaints and resolutions. • Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading.

Role Description This position is responsible for the coding and total processing of claims and triaging claim adjustments generated by our providers and subscribers or requested via Customer Service, for all lines of business. Processes claims utilizing established policies and procedures to review and correct error and warning messages. Research claims and ensures proper adjudication. - Codes and enters imaged claims and triages adjustments, submitted by members, providers and vendors. - Reviews and corrects on-line edit errors by interpreting generated warning messages. - Uses appropriate systems to research and accurately process claims. - Researches appropriate reference documents and imaged claims to make coding and payment decisions. - Reviews and processes claims that are in a pended status in accordance with processing procedures, policies and current contract specifications regarding coverage, contract limitations, and exceptions. - May identify and report possible system or Image problems to CPR or Supervisor so that corrective action may be taken. - All other duties and assignments as directed. Qualifications - Ability to communicate effectively and professionally with personnel, in both written and verbal form. - Must possess a strong attention to detail and an interest in preventing errors. - Ability to operate a personal computer (PC) and other office equipment (e.g., copy machine, fax machine, printer, calculator, etc.) as well as possess excellent keyboarding skills. - Demonstrate ability to be dependable and professional. - Demonstrate intrinsic initiative and time management skills. - Must possess a strong commitment to teamwork and an ability to foster an inclusive culture of diversity by working well and collaborating with others as needed. - Ability to accept feedback, learn, and adapt from guidance to be successful. - Ability to adapt to constant changing priorities and keeping daily responsibilities on task. - Ability to manage workload and ensure all tasks are completed within established timeframes. - Must be willing and able to work possible mandatory overtime as needed based on business needs. - Must be able to meet quality, productivity, and behavior expectations. - Must possess basic reading and arithmetic skills (reading and math comprehension). Requirements - Preferred familiarity with provider billing documents (including in/out of state hospitals, doctors, pharmacy, and suppliers) in order to code and enter appropriate data from each bill. - Preferred familiarity with medical terminology in order to correctly code and enter the appropriate ICD-10CM diagnosis code, procedure code, ancillary code, type of service, and qualifier code. - Preferred knowledge of both manual and automated aspects of claims processing and Image systems. - Preferred knowledge of claims payment policies and benefits. - Preferred competency in the use of computer applications, databases, and end user computing tools and programs, including proficiency in various software like Microsoft Windows, Email, Internet browsers, Instant Messenger, and Office (Word, Excel, etc.). Experience - Preferred FACETS claims Coding. - Preferred Facets claims processing. - Preferred WorkDesk Imaging. - Preferred Facets Customer Service Application. Education and Certifications - Must have a high school diploma or GED. Benefits - Comprehensive benefits package including Medical, Dental & Vision coverage. - Retirement Plan. - Generous time off including Paid Time Off, Holidays, and Volunteer time off. - Incentive Plan. - Tuition Reimbursement.

Role Description At Vantage, the Senior Claims Specialist, Property plays a critical role on our Property team, providing complete claim management and oversight for assigned claims within the Property and Programs portfolio. This role independently investigates, evaluates, and manages the disposition of Property claims of varying degrees of complexity and severity across multiple product types and markets. Additionally, the role supports the Underwriting Business Unit by: - Liaising with account and broker/agent representatives - Providing frequent, in-depth exposure analysis to Claims Leadership - Participating in marketing efforts at industry events and conferences The mission of the Vantage Claims team is to add creativity to tech-enabled efficiency and robust analytics to address risks others avoid. This role reports to our Head of Property Claims and is a remote opportunity for the appropriate candidate. The base salary expectation for this role is between $115,000 and $140,000. The actual base salary and title for the selected candidate may be higher, commensurate with the candidate's experience and expectations. Additionally, Vantage offers its colleagues: - Performance-based bonus potential - Strong health & welfare benefits - Retirement plans with company match - Competitive time off plans - A highly flexible work environment - Much more Qualifications - A bachelor’s degree is required or equivalent professional experience - Minimum of seven (7) years of Commercial Property claims handling experience, including large/complex loss - Insurance designation preferred – e.g. CPCU, AIC, AINS - Must have active adjuster license(s) and/or be eligible to obtain one as needed within 90 days of joining - Experience in TPA oversight and auditing preferred but not required - Ability to assist during CAT events - Experience in collaborating with internal stakeholders such as legal, operations, underwriting, and actuaries - Demonstrated commitment to continuous improvement — both in personal skill development and in identifying efficiencies within the claims handling process - Strong interpersonal skills and the ability to effectively communicate and work independently are essential - High positivity, integrity, and dependability with a strong sense of urgency and results-driven orientation - Developed problem-solving, analytical, and negotiation skills - Working knowledge of MS Office applications, including Word, Outlook, PowerPoint, and Excel - Ability to process and adapt to change in a rapidly growing company environment Requirements - Proactively manage assigned caseload of first-party Commercial Property claims from intake to resolution, including evaluation, reserving, and coverage analysis - Draft coverage letters and communicate coverage positions to insureds, brokers, and agents - Support TPA oversight and governance, including audits of Vantage's Property programs with findings presented to Claims Leadership - Apply strong negotiation skills and property expertise to drive appropriate outcomes — through direct negotiation or alternative dispute resolution - Build and maintain strong relationships with TPA partners, insureds, brokers, agents, and internal stakeholders - Document claim files thoroughly in line with company policy, best practices, and regulatory requirements - Follow all of Vantage’s reserving, escalation, and reporting protocols - Identify emerging trends across assigned caseload and the broader Property market and share insights with Claims Leadership and business partners - Perform other duties as assigned Benefits - Performance-based bonus potential - Strong health & welfare benefits - Retirement plans with company match - Competitive time off plans - A highly flexible work environment - Much more Company Description Vantage Group Holdings Ltd. (Vantage) was established in late 2020 as a re/insurance partner designed for the future. Driven by relentless curiosity, our team of trusted experts provides a fresh perspective on our clients’ risks. We add creativity to tech-enabled efficiency and robust analytics to address risks others avoid. Vantage provides specialty re/insurance through its operating subsidiaries in Bermuda and the U.S. Vantage has approximately 365 colleagues in both the United States and Bermuda. We have offices in: - Chicago, IL - Norwalk, CT - West Hartford, CT - Washington, D.C. - Boston, MA - New York, NY - Atlanta, GA - Hamilton, Bermuda Additionally, we are a highly geographically diverse workforce with colleagues based in 35 states and counting. We fully support work flexibility including remote and hybrid work arrangements.