• Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. • Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios. • Ensure prompt claims processing to meet client standards and regulatory requirements. • Identify and resolve any barriers using effective problem-solving strategies. • Collaborate with internal departments to proactively resolve discrepancies and issues. • Use analytical skills to identify root causes and implement solutions. • Uphold confidentiality of patient records and company information in accordance with HIPAA regulations. • Maintain thorough and accurate records of claims processed, denied, or requiring further investigation. • Analyze and report trends in claim issues or irregularities to management. • Assist Team Leads with reporting to contribute to continuous process improvements. • Engage in audits and compliance reviews to ensure adherence to internal and external regulations. • Critically evaluate and recommend process improvements when necessary. • Mentor and train new claims processors as needed.

• Investigate, negotiate, and resolve/settle assigned claims • Oversee vendor and legal activities • Maintain file notes and action plans • Manage loss severity through medical cost management

Title: Prior Authorization Specialist - MRI Location: West Des Moines, Ankeny Iowa, 50266, United States Department: Administrative Support Requisition Number: PATIE002296 Full-Time Job Description: A rare opportunity to assist with obtaining insurance approval for patient MRI scans is available at Des Moines Orthopaedic Surgeons, P.C. We are seeking individuals with prior experience submitting prior authorizations to insurance companies for advanced imaging and/or experience working with insurance company websites. As a Prior Authorization Specialist with our MRI department you will submit prior authorization via insurance company websites, follow up on status, and assist with scheduling MRI scans upon approval. You will work alongside 3 other individuals to assist our patients in a timely fashion. This is a full-time (40-hrs) opportunity, with Monday - Friday Here is What You Can Expect: - Specializing in advanced imaging authorization and appointment scheduling for our MRI department (West Des Moines and Ankeny locations). - Utilizing Office 365 products to organize MRI schedules, insurance prior authorizations and communicating with clinical staff when needed. - Sitting at a desk for extended periods of time that may seem unnatural. - Work from home available after training is complete What We're Looking For: - Professional. Display a high-level of professionalism when interacting with patients and clinical staff members. - Multi-tasker. Ability to handle multiple tasks at one time while staying organized. - Curiosity. You practice the art of listening, asking clarifying questions and avoiding interrupting. - Experience. Prior exposure to patient care coordination. - Dependability. Ensures patients receive timely care, promotes a reliable healthcare environment, and supports the overall efficiency of the team. Why DMOS? - Consistent schedule, no weekend coverage - Friendly, fun and dedicated peers - Outstanding 401(k) with employer match and an annual company profit sharing contribution (even if you don't participate in the employer match) - Health, dental, and vision insurance including 6 paid holidays and a generous PTO accrual program (as a full-time employee you can anticipate to earn up to 22 days per year) Join our team of orthopaedic surgeons and discover how your talents will change lives helping our patients get back to living! DMOS is a privately held medical facility. Candidates who receive a conditional offer of employment at DMOS will be required to complete a criminal background check, federal background checks, education verification, reference checks, and an initial TB test. Qualifications Education Required: H.S. GED or Diploma or better in General. Experience Preferred 1 year: Medical Reception or Coordination

Role Description The Regional General Adjuster Specialized Claims is a senior-level claims position responsible for the full lifecycle management of highly complex and high-value Marine claims. This includes the investigation, evaluation, negotiation, and resolution of claims that represent the company’s largest damage exposures and often involve intricate coverage issues. Claims handled in this role may originate from anywhere in the country and frequently require on-site field consultation and investigation. The position demands a high level of technical expertise, strategic thinking, and collaboration with internal and external stakeholders, including legal teams, engineers, and other subject matter experts. In this role, you will: - Independently lead investigations and manage the full lifecycle of highly complex, sensitive, and specialized claims. - Analyze coverage, liability, and financial exposure; develop tailored resolution strategies and negotiate high-value or contested claims. - Issue reservation of rights and draft coverage letters, including manuscript and ISO/non-ISO forms; interpret and apply commercial coverages and legal principles. - Set activities, reserves, and authorize payments within high authority limits; manage litigation budgets and direct counsel payouts. - Coordinate with internal and external experts (e.g., forensic analysts, underwriters, legal counsel, contractors) to ensure thorough evaluations and resolution. - Identify and pursue risk transfer opportunities; manage suspicious claims and refer to Special Investigation Unit as needed. - Serve as a subject matter expert (SME) for consistent handling of large losses; provide consultation on claim strategies and co-adjust files to support development. - Ensure compliance across jurisdictions including licensing, forms, deadlines, and accounting; maintain accurate and complete claim records. - Protect personally identifiable information (PII) and promote best practices across the team. - Represent the company in litigation, mediations, settlement conferences, and arbitrations; provide large loss and reinsurance reporting to underwriting. - Lead cross-functional meetings and collaborate with underwriting, agents, vendors, and legal teams to drive consensus and resolve claims. - Identify coverage gaps and partner with product management to enhance offerings. - Mentor and support less experienced adjusters; evaluate training programs and recommend improvements. - Lead quality initiatives to streamline workflows; use data tools to analyze trends and correct inconsistencies. - Maintain strong time and desk management skills; prepare reports and contribute to special projects. - Attend industry events and continuing education seminars to stay current on best practices. - Tailor communication strategies for specialized claims and maintain regular updates with leadership. - Build and maintain strong relationships with customers and stakeholders. Qualifications - Bachelor’s degree preferred; equivalent experience accepted. - Typically requires 8+ years of relevant experience. - Industry designations (e.g., CPCU, AIC) strongly preferred. - Extensive experience handling highly complex, high-value claims with significant legal, financial, and reputational exposure. - Recognized authority in negotiation and resolution of complex claims; able to shape best practices and influence outcomes. - Demonstrated expertise in analyzing policy coverage, legal liability, and regulatory frameworks across jurisdictions. - Proven ability to manage litigation strategy, direct counsel, and represent the company in trials, mediations, and arbitrations. - Experience mentoring others and contributing to the development of investigative techniques, compliance protocols, and claims handling standards. - Strong written and verbal communication skills; able to simplify complex information and handle sensitive issues with professionalism. - Skilled in selecting appropriate communication channels and demonstrating empathy across diverse stakeholder groups. - Ability to draft clear, factual, and objective work product without opinion. - Highly organized with proven ability to manage complex workflows, projects, and competing priorities. - Demonstrated time management and organizational skills; able to coach others in these areas. - Deep understanding of insurance principles, coverage interpretation, and jurisdictional requirements. - Strategic thinker with sound judgment; able to make informed decisions independently and assess financial implications. - Expert in identifying and mitigating legal, regulatory, and reputational risks. - Recognized for developing empathetic customer service strategies and delivering exceptional service. - Ability to use a personal computer and other standard office equipment. - Ability to sit and/or stand for extended periods. - Required to work on-site as needed. - Ability to travel as necessary. - Ability to work in a fast paced, changing or stressful environment. - Ability to perform work in a noisy/loud work environment. - May be required to have and maintain sufficient home-based internet connection. Benefits - Medical, dental, vision, life, and disability insurance - 401K with a company match - Tuition reimbursement - PTO - Company paid holidays - Flexible work arrangements - Cultural Awareness Day in support of IDE - On-site medical/wellness center (Worcester only) Career Development It’s not just a job, it’s a career, and we are here to support you every step of the way. We want you to be successful and fulfilled. Through on-the-job experiences, personalized coaching and our robust learning and development programs, we encourage you – at every level – to grow and develop.