Role Description Primary responsibility for managing, investigating, and resolving professional and general liability claims for the Stanford Medicine enterprise. Requires coordination with internal stakeholders and staff, as well as oversight and management of panel counsel. Analyzes complex medical claims and evaluates exposure and liability. Assists in handling other types of exposures as warranted, including cyber/privacy, construction, and property claims. What you will do - Develops action plan for managing litigated claims, evaluates insurance coverage, attends mediation and trial, monitors litigation costs, handles discovery, and provides recommendations for ultimate resolution. - Oversees legal defense strategy, retains outside counsel, coordinates support for investigation, reviews attorney invoices, and monitors counsel’s compliance with litigation management guidelines. - Investigates pre-suit claims, reviews medical records, interviews providers, retains consultants when necessary, communicates with patients and/or families, and directly negotiates settlements when warranted. - Prepares claims reports and settlement evaluations. Presents high-exposure cases to leadership and stakeholders, including reinsurance partners. - Maintains accurate defense and indemnity reserves. - Manages claims files in internal database. Inputs all work product to ensure case information is accurate and entered in a timely manner. - Investigates cyber and privacy claims. Pursues recovery in construction and property claims. Manages associated insurance reporting and communication requirements. - Assists in other matters as assigned. Handles Medical Board and NPDB reporting. Prepares and conducts Risk Management educational presentations. Qualifications - Juris Doctor (JD) required. California license preferred. - Five (5) years of progressively responsible and directly-related claim management experience. Requirements - Strong writing, communication, and presentation skills. - Effective negotiation skills. - Ability to analyze complex legal problems and develop solutions. - Ability to review and evaluate medical records and literature. - Knowledge of laws pertaining to professional and general liability litigation. - Ability to work effectively both as a team player and leader. Benefits - Base Pay Scale: Generally starting at $100.03 - $132.51 per hour. - The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. - This pay scale is not a promise of a particular wage. Company Description Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Role Description Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. Job Description Summary - Review claims to ensure accurate coding, appropriate documentation, and compliance with applicable billing regulations and payer guidelines. - Adjudicate claims to pay, deny, or pend as appropriate in a timely and accurate manner according to company policy and desktop procedure. - Review and research assigned claims by navigating multiple systems and platforms, then accurately capturing the data/information necessary for processing (e.g., verify pricing/fee schedules, contracts, prior authorization, applicable member benefits). - Communicate and collaborate with external departments to resolve claims errors/issues, using clear and concise language to ensure understanding. - Review and adjudicate medical claims submitted by healthcare providers, insurance companies, and patients to identify discrepancies, errors, or potential fraud. - Analyze and validate the assigned diagnosis codes (ICD-10) and procedure codes (CPT) on medical claims to ensure accurate representation of services rendered and compliance with coding standards. - Keep up to date with Desktop Procedures and effectively apply this knowledge in the processing of claims and in providing customer service. - Identify and escalate system issues, configuration issues, pricing issues etc. in a timely manner. - Ensure that the medical claims include complete and accurate documentation supporting the services rendered, including physician notes, test results, and other relevant records. - Meet the performance goals established for the position in areas of productivity, accuracy, and attendance that drives member and provider satisfaction. Qualifications - High School Diploma or Equivalent required - Associate's Degree preferred - Professional Coder (CPC) license preferred - Pharmacy Technician certification and/or a degree in a pharmacy-related field preferred - At least 1-2 years of healthcare billing experience required - At least 2–4 years of experience in healthcare claims processing, billing, or the health insurance industry (e.g., hospital or physician billing) highly preferred - Experience in pharmacy claims processing or adjudication, with a strong working knowledge of pharmacy terminology and National Drug Code (NDC) standards. - Experience with core healthcare claims processing and billing system highly preferred - Strong working knowledge of managed care concepts and medical coding, including ICD-10, CPT, HCPCS, and Revenue Codes highly preferred - Knowledge of Medicaid/ACO claims processing - Knowledge of claim types including professional, facility, DME, outpatient, and inpatient - Ability to prioritize and manage aged claims (e.g., 30+ day inventory) to meet program guidelines and turnaround requirements - Strong attention to detail and accuracy in claim review, submissions, and documentation - Familiarity with insurance plans, government programs, and their billing requirements. - Excellent communication skills, both written and verbal, to interact effectively with insurance companies, patients, and colleagues. - Strong customer service orientation and ability to handle sensitive or difficult situations with empathy and professionalism. Requirements - This is a full-time role with a Monday through Friday, 8:30-5 schedule - This is a remote role that can be done from most US states - Scheduled Weekly Hours: 40 - Employee Type: Regular - Work Shift: Day (United States of America) - Pay Range: $17.71 - $25.28/Hourly - Grade: 2 Benefits - Competitive base pay - Comprehensive benefits - Career advancement opportunities - Differentials, premiums, and bonuses as applicable - Recognition programs designed to celebrate your contributions and support your professional growth EEO Statement Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

Role Description The Surety Claims Trainee is an entry-level professional development role designed to prepare individuals for a career in surety claims handling. Under the guidance of experienced claims professionals, the trainee will learn the investigation, evaluation, and resolution of performance bond, payment bond, commercial bond, and related surety claims. The trainee will assist with: - Claim intake - Document review - Claim file management - Communication with claimants and other stakeholders - Preparation of claim summaries and reports Through structured training and mentorship, the trainee will develop the technical, analytical, and communication skills necessary to progress into a Surety Claims Adjuster role. Essential Duties and Responsibilities - Assist in reviewing claim notices and supporting documentation. - Learn to identify key claim facts, issues, deadlines, and bond obligations. - Review contracts, bond forms, indemnity agreements, invoices, correspondence, and project records. - Assist with preparation of claim chronologies, issue summaries, and investigative reports. - Support the identification of additional information needed to evaluate claims. - Maintain organized and accurate electronic claim files. - Document claim activity, communications, and investigative findings. - Assist in preparing claim status reports and management updates. - Communicate professionally with claimants, principals, obligees, attorneys, consultants, underwriters, and internal business partners. - Assist with tracking claim payments, expenses, recoveries, and reserves. - Complete structured onboarding and training programs. - Obtain and maintain applicable adjuster licensing as required. Qualifications - Bachelor's degree preferred; concentrations in Construction, Law, Business, Finance, Accounting, Construction Management, Risk Management, Insurance, Engineering, or related fields are desirable. - The successful candidate must obtain an adjuster’s license promptly after the start of employment. Requirements - Strong analytical and problem-solving skills. - Excellent written and verbal communication abilities. - Strong attention to detail and accuracy. - Ability to prioritize and manage multiple assignments. - Proficiency in Microsoft Office applications. - Ability to work independently, exercise sound judgment, and manage assignments with appropriate supervision while meeting deadlines and maintaining attention to detail. Preferred Characteristics - Interest in surety, construction, contract law, insurance. - Ability to analyze complex documents and identify key issues. - Strong organizational and time-management skills. - Intellectual curiosity and sound business judgment. - Ability to work effectively in a team-oriented environment. - Self-motivated individual with the ability to work remotely, independently, take ownership of assigned responsibilities, prioritize competing demands, and exercise sound judgment while recognizing when to seek guidance or escalate issues. Compensation & Benefits - The applicable base salary for this opportunity is $60,000.00 - $65,000.00. - The base pay offered will be determined by factors such as experience, skills, training, location, certifications, education, and any applicable minimum wage requirements. - This opportunity may be eligible for performance-based incentives. - We are excited to offer a competitive total rewards package which includes: - Health and welfare benefits - Tuition and professional certification assistance - 401k savings - Elective participation in the Employee Stock Purchase Program - Paid time off - Paid holidays - Child bonding leave - Other employee assistance

• Works closely with veterinary hospitals, and policyholders to evaluate and review a pet’s medical history to determine a baseline of health. • Investigates and processes assigned insurance claims, verifies coverage, and compensation amounts, per insurance policy. • Updates Explanation of Benefits (EOB), pays and closes claim. • May order medical records from providers. • May communicate with clients and providers during treatment. • Performs other duties and responsibilities as assigned.