• Provide exceptional customer support for incoming and outgoing Provider Claims processing • Review, research, and process claims • Refer claims to appropriate department and prepare RTP forms • Maintain accurate workload tracking and communicate status updates

Role Description The Credentialing Specialist performs primary source verification, enters verification information into a data repository, and makes available verification information to the facilities for processing and acceptance in accordance with the facility's applicable Bylaws, Rules, Regulations, and Policies. - Under minimal supervision, follows procedures for appointment and clinical privileges as outlined in the ECU Health Policies and Procedures. - Independently performs primary source verifications of documentation required for initial credentialing and reappointment applications through sources such as: - National Practitioner Data Bank (NPDB) - Federation of State Medical Boards (FSMB) - American Board of Medical Specialties (ABMS) - Applicable Medical Boards - Obtains verifications through publication review, electronic access, telephone calls, or written correspondence to appropriate agencies, universities, and hospitals. - Communicates the status of credentialing applications and enrollment to all constituents in a timely manner. - Processes applications to complete the credentialing and reappointment process, accurately enters provider data in the CVO database according to established departmental processes, and provides feedback to other entities of the applicant's status. - Identifies red flags and potential issues or processing delays related to provider credentialing applications, communicates issues with the appropriate parties, and obtains clearance from legal and/or the entity representatives as appropriate. - Obtains and reviews provider immunization history to determine compliance with ECU Health's Medical Staff Occupational Health requirements. - Completes an initial assessment of assigned files within 48-72 hours of receipt and enters documentation of missing and incomplete items three times weekly into the CVO Database until the file is released to the entity. - Determines additional supporting documentation required from the applicant and the applicable provider representative, ensuring the accuracy of applications and supporting documents. - Communicates professionally in both verbal and written form to applicants, corporate staff, and external agencies. - Performs timely follow-up on required information (expired licenses, board certifications, insurance, DEA registrations, and other documents). - Prepares credentialing files for quality audits performed by the CVO Quality Assurance Coordinator or Controller. - Manages time, prioritizes assignments, and coordinates functions effectively while maintaining confidentiality of all information related to credentialing and re-credentialing. - Performs other duties and responsibilities as assigned with minimal supervision and within the specified time-frame. - Participates in departmental functions: - Works in harmony and unison with all personnel within the department and throughout ECU Health. - Promotes and assists in the smooth and efficient delivery of departmental services to providers, other ECU Health departments, and outside agencies. - Performs needed departmental projects. - Participates in performance improvement activities. - Attends all required educational offerings annually. - Demonstrates departmental and professional growth. - Operates personal computer, copy machine, and fax machine. - It is the responsibility of each employee to ensure a safe and productive work environment. Qualifications - Zero to two years related experience. - Business or Healthcare related education. - Knowledge of The Joint Commission (TJC) and NCQA (National Committee for Quality Assurance) guidelines, state regulations, and proficiency with Visual Cactus. - Ability to take direction, organize and professionally manage demanding workload, even during high stress situations and peak workloads. - Excellent verbal and written communication skills with editing and proofing experience. - Must have the ability to problem-solve, make decisions, and implement same with minimal supervision. - Must have demonstrated ability to handle phone, email, and personal interactions in an efficient and professional manner. - High School or Equivalent (GED) or higher. Requirements - Pay Range: $21.53 - $31.38/hr - Remote role (based out of Greenville, NC) - Monday - Friday full-time day shift: 8:00 a.m. - 5:00 p.m. Benefits - Great Benefits Company Description ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals, and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education, and research.

Role Description Join Us as a Claims Resolution Champion. At Health Advocate, we’re on a mission to simplify healthcare and empower our members to navigate their benefits confidently. If you’re ready to make a meaningful impact by resolving complex claims and advocating for those who need support, this is your chance to transform lives. As a Claims Specialist, you’ll go beyond solving billing issues—you’ll serve as an advocate, educator, and problem-solver for our members. By leveraging your expertise in claims, benefits, and coordination of care, you’ll ensure timely resolutions that ease stress and deliver value. In this role, you’ll join a team that values collaboration, precision, and compassion. What You’ll Do: Advocate, Resolve, Educate - Resolve Complex Claims Issues: Investigate billing discrepancies, identify errors, and coordinate resolutions among members, carriers, and providers for timely claim processing. - Coordinate Benefits Across Carriers: Manage cases involving Medicaid, Medicare, motor vehicle claims, and other benefit programs, ensuring proper coordination. - Educate and Empower Members: Help members understand their benefit plans, educate them on coverage details, and guide them through challenging claims scenarios. - Ensure Accuracy: Adhere to internal policies, procedures, and federal regulations to process claims in a precise and timely manner. - Collaborate and Escalate: Partner with team members and escalate unresolved issues to supervisors or carriers when necessary. - Support Team Growth: Mentor new team members, share best practices, and contribute to continuous process improvements. Qualifications - At least 2 years of experience in healthcare, customer service, or claims. - Strong listening skills and the ability to guide members with care and patience. - Familiarity with plan documents, ACA guidelines, Medicare, COBRA, and benefits such as dental, vision, and behavioral health is a plus. - Proficient in MS Word and Excel and comfortable using internal databases. Requirements - A private, HIPAA-compliant workspace where confidential member information cannot be viewed or overheard by others. - Sufficient desk space to accommodate a dual-monitor workstation and related equipment. - Reliable high-speed internet with a minimum download speed of 200 Mbps. - The ability to work in a professional, distraction-free environment during scheduled work hours. Benefits - Competitive pay starting at $18.00 per hour. - Robust medical, dental, and vision coverage. - 401(k) with company match. - PTO and more. - A culture that values empathy, innovation, and teamwork. Company Description Health Advocate is the nation’s leading provider of health advocacy, navigation, well-being and integrated benefits programs. For 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being.

Role Description If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! This is currently a work-from-home position with claims inspections that will be done virtually. As a Property Contents, Field Claims Specialist, you'll assist with the investigation and evaluation of moderate to severe losses focusing on the contents portion of the loss. You will meet with customers or their representatives to complete an inventory of damaged contents and conduct research to establish pricing for damaged contents. During the claim, you will work with vendors on cleaning, restoring, and replacing damaged contents. Qualifications - 3-5 years of insurance field/property claims handling or adjusting experience - Solid experience with Xactimate - Content Inventory, Pricing and Repair/Mitigation experience - Construction background/experience (Residential, Remodeling, Water mitigation, etc.) - Strong customer service competency - Strong written & verbal communication skills Requirements - Handles all assigned claims, promptly and effectively, with little to no direction and oversight. - Determines proper policy coverages and applies appropriate claims practices to resolve cases in alignment with company guidelines. - Opens, closes and adjusts reserves according to company practices to ensure reserve adequacy. - Maintains current knowledge of insurance and applicable product/services, court decisions which may impact the claims function, current guidelines in the claims function and policy changes and modifications. - Maintains current knowledge of local industry repair procedures and local market pricing. - Submits severe incident reports, reinsurance reports and other information to claims management as needed. - Partners with Special Investigation Unit and Subrogation to identify fraud and subrogation opportunities. - Delivers an outstanding customer service experience to all internal, external, current and prospective Nationwide customers. - Mentors less experienced claims associates and helps with training/presentations as assigned by claims management. - May perform other responsibilities as assigned. Benefits - Medical, Dental, Vision - 401k with company match - Company-paid Pension plan - Paid time off - Life insurance - Short and long term disability coverage - Business casual attire - Minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date - Nine paid holidays - 8 hours of Lifetime paid time off - 8 hours of Unity Day paid time off