Claims Representative - Remote Location: Remote - USA Category: Customer Service & Claims Job Id: 26007462 Job Description: SUMMARY The claims representative is responsible for manually reviewing and processing medical, supplemental, or dental claims. Claims are processed according to benefits, eligibility, and internal processes, policies, and procedures and may be completed, held for additional information/review, or denied. New claim representatives will be provided with a robust training program, which includes virtual classroom training, on-the-job learning/feedback, and gradually increasing claims per hour/quality requirements over several months. After completion of training, claim representatives must meet specific accuracy/quality, volume/claims per hour, and on production performance metrics. $19/Hour Pay Rate RESPONSIBILITIES · Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines. · Confirm the presence of necessary documents within submitted claims. · Validate the accuracy of medical codes provided in claim submissions. · Assess the eligibility status of claims based on established criteria. · Review and verify other insurance coverage information in submitted claim. · Evaluate authorizations provided in claim submissions for accuracy. · Analyze account benefit plans to ensure claims align with coverage and policies. · Identify discrepancies, errors, or missing information. · Utilize multiple computer applications simultaneously. · Maintain self-discipline, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision. · Meet or exceed quality and productivity goals. · Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows. · Utilize a variety of virtual tools, including Outlook email, Cisco Webex, and similar applications, to effectively collaborate, communicate, and stay connected with colleagues and supervisors. QUALIFICATIONS · High school diploma or equivalent · Ability to quickly learn a variety of computer applications to complete job functions, · Experience sending/receiving emails, scheduling calendar appointments/sending invitations, attaching files in Microsoft Outlook. · Knowledge of basic Microsoft Excel functions, such as filtering/sorting. · Experience in navigating multiple computer applications through the use of shortcut keys and other techniques. · Detail-oriented with experience in applying complex policy/procedure documents. · Strong organizational skills to maximize available work time. Ability to prioritize tasks to ensure job tasks are completed before deadlines. · Proven experience completing work with quality and productivity performance standards. · Experience working independently in a virtual environment preferred. · Experience with medical and insurance terminology in a professional setting preferred. · Knowledge of CPT/ICD-10 codes preferred. · Proven experience in health insurance claims processing or similar field preferred If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 17.75 - 26 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

Title: Claims Specialist - Professional Liability Location: Glastonbury, CT, United States Job ID: 10001008 Job Description: Marketing Statement: Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best. We are looking for a Claims Specialist – Professional Liability to join our team! JOB SUMMARY - Investigate, evaluate and settle more complex first and third-party commercial insurance property claims. JOB RESPONSIBILITIES - Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. - Communicates with all relevant parties and documents communication as well as results of investigation. - Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts. - Travel is required to attend customer service calls, mediations, and other legal proceedings. JOB REQUIREMENTS - High School Diploma; Bachelor's degree from a four-year college or university preferred. - 10 plus years related experience and/or training; or equivalent combination of education and experience. • National Range: $95,000.00 - $105,000.00 • Ultimate salary offered will be based on factors such as applicant experience and geographic location. • We offer a hybrid work model that provides flexibility to work remotely while maintaining meaningful in-office collaboration with your team. • Remote consideration will be given to qualified candidates located outside of the primary geographic region. EEO Statement: Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law. Benefits: We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online. Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives

• Investigate claims and confirm facts of loss. • Evaluate coverage, assess liability and damages, and negotiate claim resolutions. • Identify customer needs and work to meet those needs.

Role Description The Senior Credentialing Specialist oversees and leads the credentialing and privileging processes with a focus on regulatory compliance, quality assurance, and process improvement. This role not only performs credentialing tasks but also: - Develops procedures - Mentors staff - Handles complex or escalated issues - Ensures ongoing compliance with accrediting bodies - Acts as a liaison with leadership - Contributes to audits, policy development, and strategic planning Qualifications - Minimum of 3 years of credentialing or healthcare-related experience - High School diploma or equivalent is preferred Requirements - Proficiency in Microsoft Office Suite and Windows applications - Familiarity with credentialing and terminology - Strong database management skills and understanding of file structures - Excellent verbal and written communication skills - Ability to compose professional documents, including letters and meeting minutes - Strong organizational skills with attention to detail - Ability to handle multiple tasks simultaneously and work independently - Self-motivated, with strong problem-solving skills - Team-oriented with a collaborative focus - Knowledge of state and federal regulations related to hospital credentialing - Knowledge of NCQA standards - Accurate typing skills Benefits Froedtert Health offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following: - Paid time off - Growth opportunity - Career Pathways & Career Tuition Assistance, CEU opportunities - Academic Partnership with the Medical College of Wisconsin - Referral bonuses - Retirement plan - 403b - Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics - Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work-life benefits available