• Responsible for managing complex workers compensation claims • Ensure timely adjudication of claims within company standards and regulatory requirements • Contact with employers, injured workers, and medical providers within designated timelines • Documentation of claims and wage information • Timely completion of claims determinations and payments • Manage legal aspects of claims and assign attorneys • Supervise claims assistants and coordinate assignments • Monitor claims for reporting requirements

Role Description Point C is looking for a detail-oriented and motivated Claims Examiner to join our team. In this role, you’ll be responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations. The ideal candidate is analytical, organized, and experienced in self-funded or third-party administration environments. - Adjudicate new claims and process adjustments, including denials upon receipt of additional information - Review and resolve appeals and subrogation/third-party liability cases - Manage individual inventory to ensure timely turnaround and production goals are met - Ensure claims are processed in accordance with stop loss contract terms - Respond to internal and external inquiries via email and other channels within established timeframes - Follow up on missing or incomplete information to ensure claims can be accurately processed - Maintain minimum production, financial, and procedural accuracy standards on a monthly basis Qualifications - Experience with Third Party Administrator (TPA) or self-funded claims administration preferred - At least 2+ years of experience in insurance claims processing required - Experience reviewing and finalizing claim payments for accuracy in accordance with plan policies - Ability to interpret and apply plan documents to ensure accurate claims adjudication - Demonstrated understanding of both claim review processes and underlying benefit plan design - Experience with HealthPac, El Dorado, Javelina, or VBA systems preferred - Working knowledge of CPT and ICD-10 coding - Basic understanding of medical terminology - Strong communication and customer service skills - Proficiency in Microsoft Office and general computer applications - Ability to maintain confidentiality and comply with all company policies and procedures - Able to work independently with minimal supervision - Ability to prioritize, multitask, and work overtime as needed - Associate Degree Preferred Requirements Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role. Pay Transparency: $19 — $22 USD Benefits - Comprehensive medical, dental, vision, and life insurance coverage - 401(k) retirement plan with employer match - Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) - Paid time off (PTO) and disability leave - Employee Assistance Program (EAP) Company Description At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.

• Efficient claim management and documentation of declaratory judgment new loss assignments • Clear understanding of coverage issues and complex coverage decisions • Develop and enforce litigation management strategy on each claim • Review and analyze file materials, policies, motions, and pleadings • Collaborate with other claim adjusters to evaluate litigated claims • Stay informed on industry trends and utilize AI tools

Title: Team Leader Specialty Claims Location: 100 Barangaroo Avenue, Tower One, International Towers Sydney, Sydney NSW 2000, Australia 727 Collins Street, 1 Collins Square, Docklands, Melbourne VIC 3008, Australia Operations Job IdR_356465 Job Description: We are seeking a talented individual to join our Specialty Claims team in Claims Operations. This role will be based in Australia. This is a hybrid role that has a requirement of working at least three days a week in the office. Team Leader Specialty Claims You will provide operational leadership and technical claims support across the Construction, Marine and Power & Energy portfolios. Working closely with Claims Advocacy, you will help progress complex and large-loss claims, support client communications and improve claims outcomes. The role also has a focus on team leadership, stakeholder engagement and continuous improvement across claims operations. We will count on you to: - Lead day-to-day Specialty claims operations across Australia, ensuring timely and consistent service delivery for complex and high-value matters - Support claims from first notification of loss through to settlement and closure, including policy interpretation, coverage milestones and documentation - Coordinate client, insurer and vendor activity, including market appointments, engineering and legal inputs, meeting preparation, actions tracking and follow-up - Partner with Claims Advocacy, Broker Distribution and other key stakeholders to improve client experience, service quality and retention - Coach and develop team members through goal setting, performance reviews, recruitment, performance management and day-to-day guidance - Drive process improvement, reporting, compliance and effective use of systems and data to support operational performance What you need to have: - At least 7 years’ experience in insurance, banking, financial services or professional services - Demonstrated people leadership experience, including coaching, performance management and recruitment - Experience supporting complex claims or operational case management, with the ability to interpret policy wording and assess issues - Well-developed communication, stakeholder engagement and decision-making skills, with a high level of attention to detail and accuracy What makes you stand out: - Loss adjusting or legal qualification - Experience across Construction, Marine or Power & Energy claims - Experience improving claims processes, reporting or operating models Why join our team: - We help you be your best through professional development opportunities, interesting work and supportive leaders - We foster a vibrant and inclusive culture where you can work with talented colleagues to create new solutions and have impact for colleagues, clients and communities - Our scale enables us to provide a range of career opportunities, as well as benefits and rewards to enhance your well-being About Marsh: Marsh Risk is a business of Marsh (NYSE: MRSH), a global leader in risk, reinsurance and capital, people and investments, and management consulting, advising clients in 130 countries. With annual revenue of over $27 billion and more than 95,000 colleagues, Marsh helps build the confidence to thrive through the power of perspective. Marsh is committed to creating a diverse, inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age, background, disability, ethnic origin, family duties, gender orientation or expression, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, or any other characteristic protected by applicable law. Applications will only be considered from candidates who have the appropriate approval to work in Australia. Successful applicants will be required to complete a Criminal & Bankruptcy check prior to commencing of employment. Marsh is committed to hybrid work, which includes the flexibility of working remotely and the collaboration, connections and professional development benefits of working together in the office. All Marsh colleagues are expected to be in their local office or working onsite with clients at least three days per week. Office-based teams will identify at least one “anchor day” per week on which their full team will be together in person.