• Investigates, evaluates, negotiates, and resolves assigned claims • Handles the most complex claims with minimal manager oversight • Establishes and maintains positive relationships with customers • Assists in building business relationships with agents, insureds and partners • Develops and mentors other associates • Assists leadership in training and resources development • Maintains proper reserving through proactive investigation • Assists other departments with investigations as required

• Conduct both virtual and on-site investigations by visiting policyholders’ residences to assess property damage, determine liability, evaluate the extent of loss, and negotiate fair settlements. • Use claims handling software, a company car, and a laptop to determine claims-related damage and write estimates in a paperless environment. • Evaluate and report on potential subrogation opportunities. • Report incidents involving theft, fraud, or arson to appropriate state and industry agencies. • Perform duties independently, with work directly impacting management outcomes. • Act as a company representative in public interactions, maintaining a professional demeanor consistent with management standards. • Engage regularly with a variety of stakeholders, including policyholders, claimants, agents, witnesses, contractors, law enforcement, fraud and arson investigators, attorneys, medical professionals, and other relevant parties. • Use strong customer service skills to negotiate with policyholders to settle the claim. • Perform additional duties as assigned. • Promote safety at all times and comply with safety/ergonomic standards as outlined in relevant company published manuals. • Employees assigned to the Catastrophe team will be required to travel away from their residence for a specified period of time, usually consisting of 2-3 days. Although this is not a CAT-specific role, hires will be expected to commit to 1–3 CAT deployments per year.

Role Description As a BlueCard/ITS Claims Specialist, this role ensures accurate, compliant adjudication across complex BlueCard claims, translates BlueWeb and Association changes into operational action, partners closely with Regence and InterPlan stakeholders, and monitors and improves IPP (InterPlan Program) performance. The Claims Specialist/BlueCard Hybrid serves as an enterprise escalation point, leads cross-functional initiatives, and drives training, quality, and process improvements that safeguard claim outcomes and member experience. What YOU will do: - BlueWeb Review: - Monitor BlueWeb for Association updates and analyze release notes to determine claim, pricing, and training impacts. - Track provider terminations and communicate impacts; coordinate continuity-of-care and disruption analysis. - Serve as SME on BlueCard/ITS claims processing rules and operational program requirements. Coach team members accordingly on guidelines and changes. - Collaboration with Regence: - Coordinate Association projects and rule interpretation with Regence and InterPlan Executives. - Act as key escalation point for Plan-to-Plan issues. - Cascade InterPlan communications to internal teams. - Operational Change Leadership: - Oversee complex ITS/BlueCard workflows; lead system and pricing enhancement projects. - Test and validate system updates; refine ITS/BlueCard policies and procedures. - Conduct root-cause analysis on recurring issues and implement improvements. - IPP Score Monitoring: - Monitor and communicate InterPlan performance metrics (IPP). - Track quality and productivity metrics; lead improvement initiatives. - Claims Adjudication: - Oversee daily ITS claims workflows and ensure timely, accurate adjudication across all claim types. - Serve as the primary escalation point for the most complex, sensitive, or high-impact ITS/BlueCard claim issues. - Partner with leadership to refine ITS policies, update procedures, and support operational strategy. - Act as a liaison with BCBS host/home plans and external partners for escalated claim issues. Qualifications - High school diploma required, Associate’s Degree preferred. - 5-7+ years of claims processing experience within the insurance industry. - 3-5 years of BCBS claims processing experience. - 1+ years of proven leadership experience. - Expert Excel skills with the ability to manipulate data independently. - Expert-level understanding of ITS/BlueCard processing, pricing methodologies, and BCBS national programs. - Strong leadership, communication, and coaching abilities. - Ability to manage competing priorities and support team performance. - High-level analytical skills with the ability to interpret data and drive improvements. Compensation The base salary range for this position in the greater Seattle area is $47.89/hr - $55.76/hr for a level IV and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level I, we may consider level II for highly qualified candidates. Benefits - Seventeen (IC) days paid time off (individual contributors). - Eleven paid holidays. - Two paid personal and one paid volunteer day. - Company-subsidized medical, dental, vision, and prescription insurance. - Company-paid disability, life, and AD&D insurances. - Voluntary insurances. - HSA and FSA pre-tax programs. - 401(k)-retirement plan with company match. - Annual $500 wellness incentive and a $600 wellness reimbursement. - Remote work and continuing education reimbursements. - Discount program. - Parental leave. - Up to $1,000 annual charitable giving match. How we Support your Work, Life, and Wellness Goals At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in-person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party. Company Description HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.

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.