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.

Role Description The Casualty Representative will proactively investigate coverage, liability and damages. They will seek out all medical documentation to evaluate and settle or deny injury claims where appropriate. Adequate reserves will be set and re-evaluated regularly. - Maintain an acceptable quality of work based on objective measurements and evaluated by the manager and regular audits performed by the Department Audit Team. - Individual results by venue will be compared against prior results and current peer results in the same venue. - Representatives will be called upon to help teammates on occasion. - Judged on the average BI/UMBI payments for the Casualty and Litigation Units based on metrics. - Maintain a current, accurate working knowledge of all venues for the states handled. - Bring all requests for BI settlement authority over 10K to Claim Committee. - Expertise and professionalism will be shown through file documentation and preparation of files for discussion with management and/or at Claim Committee. Qualifications - College degree or commensurate work experience required. - Minimum of 2-year handling injury claims. - Must have strong adjusting and negotiation skills. - Excellent organization and problem-solving skills. - Excellent oral and written communication skills to quickly build rapport. - Knowledge of Claims Best Practices, tort laws in the states we do business in and Department of Insurance regulations, particularly each state’s fair claims practice act. - General office skills include faxing, copying and filing. Proficient in typing. Benefits - Opportunity for annual performance bonus. - Benefits include: Health, dental, supplemental cancer, vision insurance, and 401(k) plan. - Paid Time Off Bank to include 3 days PTO available after first 80 hours worked for New Hires. - Short-term and long-term disability. - Flexible Healthcare and Childcare spending accounts for tax savings. - Opportunities for advancement. - Continuous training and support throughout your career. - Flexible work from home options available.

• Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved • Communication via telephone, email, and text with employees, employers, attorneys, and others • Review and interpret medical records, utilizing resources as appropriate • Complete financial calculations • Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication • Apply contract/policy provisions to ensure accurate eligibility and liability decisions • Demonstrate and apply analytical and critical thinking skills • Verify on-going liability and develop strategies for return-to-work opportunities as appropriate • Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication • Leverage a broad spectrum of resources, materials, and tools to render claims decisions • Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards • Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities • Work independently as well as within a team structure

Role Description This position is responsible for reviewing and determining all claim requirements needed for initial and continuation claims. This position assists Care Managers and Care Coordinators, while also providing quality customer service to our policy holders, their representatives and providers. - Reviews internal databases, client guidelines, and policy contract language to determine all claim requirements needed for initial and continuation claims. - Reviews documented claim forms and contacts the insured, insured's representative, or provider to request information needed to process the benefit inquiry. - Keeps clear and concise documentation of all claim intake activity within the required databases. - Meets quality and production metrics as established and communicated by the department. - Processes requests from the client or from other departmental areas within illumifin. - Other duties as assigned. Qualifications - Associates Degree or equivalent formal training program, or 2 years experience in the health or life insurance industry. - 1-3 years work experience in a claims environment preferred. - Intermediate level experience with Microsoft Office products. Requirements - Experience working in a geriatric healthcare environment. - Knowledge of health, long-term care or disability insurance. - Excellent verbal and written communication skills. Benefits - The base pay for this position is starting at $18.50/hour depending on experience and qualifications.