• Evaluate the full range of civil engineering plans, calculations, and supporting documents for compliance with local, state, and federal regulations • Assess site development plans, including grading, drainage, stormwater management, utilities, roadway improvements, and erosion control measures • Review floodplain development proposals for compliance with FEMA standards, the National Flood Insurance Program (NFIP), and local floodplain ordinances • Evaluate elevation certificates, no-rise certifications, hydrologic and hydraulic (H&H) studies, and floodplain development permit applications • Verify that plans comply with adopted codes, municipal standards, and accepted engineering practices • Prepare clear, accurate review comments and required corrections through the VertexPlans platform • Coordinate with engineers, developers, contractors, and municipal staff (including floodplain administrators) to resolve review comments • Utilize VertexPlans for project tracking, documentation, communication, and report submission • Consistently meet established turnaround times while maintaining high standards of accuracy and quality

• 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.