• Manage to resolution complaint/appeal scenarios for all products • Ensure timely, customer focused response to complaints/appeals • Identify trends and emerging issues and report and recommend solutions • Review and analyze complex appeals • Facilitate the interpretation policy and coverage guidelines • Coordinate reviews as needed • Draft any & all resolution letters • Assist with the coaching & mentoring of other analysts • Assist with external reviews as needed

• Determines coverage and identifies coverage issues related to various claims • Issues appropriate Reservation of Rights and/or declination letters • Establishes contact and maintains effective professional relationships with insured parties and others involved in the claims process • Reviews claims and claim status with clients and brokers as necessary • Obtains and prepares the necessary documentation associated with the prompt verification of losses and administration of claims • Follows established policies, procedures, and processes in preparing information • Ensures the accuracy of information collected • Reviews, interprets, and evaluates medical bills and/or reports to determine damages • Manages litigation activities and claim outcomes while considering the overall impact to the customer and company • Analyzes contracts and agreements for risk transfer • Participates in special assignments and activities as required

Role Description The Redeterminations Examiner is responsible for examining incoming Medicare Redetermination appeals through a review of documentation to make appeal determinations. This position determines if adjustments within standard systems are in accordance with established guidelines and policies and responds to Medicare appellants ensuring quality administration of Centers for Medicare and Medicaid Services (CMS) regulations and continuous, proactive customer satisfaction. Essential Functions - Conducts redetermination reviews per Medicare rules and regulations. - Responds to incoming appeals from Medicare appellants in a professional, timely, and accurate manner, including letter writing and proofreading with attention to detail following current guidelines. - Researches and identifies claims processing deficiencies and initiates corrective response. - Evaluates all documentation and history needed to determine if it meets outlined policy criteria to ensure accurate and compliant processing in accordance with CMS guidelines. - Submits educational referrals as necessary to decrease redeterminations and allow claims to pay at the lowest level of appeal. - Assists in writing and updating processing guidelines. - Identifies internal/external education and/or training needs, communicates findings, and assists in training if necessary. - Communicates information to appropriate internal and external parties in a timely manner. - Problem solves and researches effectively. - Processes overpayment appeals as needed. - Maintains up-to-date knowledge of working systems, processing instructions, and other relevant resources to ensure efficient and accurate appeal processing. - Maintains knowledge of CMS and Joint Operating Agreement (JOA) requirements. Non-Essential Duties and Functions - Other duties as assigned. - May facilitate trainings and/or meetings. - May provide backup support to the Process Team. Qualifications - High School diploma or GED. - 6 months' work related experience. - General PC knowledge. - Prioritization skills. - Strong communication skills. - Strong analytical skills. - Ability to adapt to changes. Requirements - 1-year redetermination processing experience (preferred). - Knowledge of medical terminology, Claims Processing Timelines (CPT), Healthcare Common Procedure Coding System (HCPCS), and ICD coding (preferred). Benefits - Health, Dental and Vision Insurance. - Voluntary Insurance Plans. - Health Savings and Flexible Spending Accounts. - 401k and Company Match. - Company-paid Life Insurance. - Education Assistance Program. - Paid Sick Leave. - Paid Holidays. - Increasing PTO Accrual Plan. - Medical/Parental/Disability Leave. - Workers Compensation. - Retiree Benefits. - Severance Package. - Employee Assistance Program. - Financial and Health Wellness Benefits. - Casual Dress. - Open Office Setting. - Online Learning System.

Role Description The Intel Sector is currently looking for experienced Chinese Triage Examiners in various languages to perform media exploitation (MEDEX) and triage in support of a customer in the National Capital Region (NCR). Triage Examiners should be experienced in general linguist operations and Document and Media Exploitation (DOMEX) operations, and are expected to leverage language and analytical skills, as well as advanced computer systems aptitude in addressing triage examination projects. Triage Examiners will: - Perform eDiscovery examinations of electronic media for content of interest using a suite of forensic examination tools. - Identify and prioritize items of importance for further processing, in accordance with customer standard operating procedures. - Communicate effectively and provide ad-hoc notification to superiors on task progress and significant findings. - Produce a report of their findings for further dissemination to customer(s). Qualifications - Operational experience within the Chinese language. - Native-level proficiency in English. - Two years of overall experience in Chinese linguist operations (i.e. translation, language analysis). - Two years of experience performing media examination for Document and Media Exploitation projects. - Willingness to perform occasional shift work to meet mission demands. - Achieve a minimum score of a 3/3 in Reading and Listening in Chinese and 3+/3+ for Reading and Listening in English. - BA degree and/or 4 years prior relevant experience in lieu of degree, or Masters with 2 years of prior relevant experience. - Ability to compose summarizations of highly technical and complex subjects that are both succinct and accessible to a general reader. - Outcomes-based problem solving of ill-defined and abstract problems. - Ability to maintain project momentum while working independently with limited oversight over a long period of time. - Ability to quickly scan and process a large amount of material in a foreign language for essential elements of information. - Ability to comprehend customer prioritization requirements and apply them to files under review. - Demonstrated history of working on screening or translation projects and in maintaining the integrity and meaning of the translated material. - Demonstrated ability to communicate in a professional manner (email, spoken, & reports). - Ability to make sound decisions and handle stress, while meeting deadlines and performing in a high-paced environment. - Familiarity with report writing styles for DOD and IC consumers. - Possess a working proficiency in standard computer systems and office programs, with additional experience in media examination tools. - Ability to use or train to proficiency on customer specific software programs and tools. Requirements - Must currently possess at least an active TS/SCI with polygraph clearance. - Current or recent SCI-level access is a significant advantage and preferred. Preferred Qualifications - Native-level proficiency in foreign language. - Graduate of the Defense Language Institute Chinese Course. - An advanced degree in one of the following fields: Engineering, Computer Science, Chemistry, Physics, Legal, Medical, Banking and Financing, Foreign Military, Forensics. - Familiarity with Digital Forensics/eDiscovery/Document and Media Exploitation (DOMEX) processes and specialized tools (i.e. FTK, enCase, or similar). - Past performance as a media examiner in support of DOD or IC customers. Pay Range Pay Range: $73,450.00 - $132,775.00. The Leidos pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.