• In a remote call center environment, you will review, analyze, and process pharmacy claims with accuracy, timeliness, and adherence to company and regulatory standards. • Identify discrepancies, investigate claim issues, and determine appropriate resolutions. • Communicate effectively with pharmacies, providers, and internal teams to clarify information and resolve errors. • Support audits and quality reviews by maintaining detailed, accurate claim documentation. • Identify trends and share insights that can improve claim accuracy and efficiency. • Uphold confidentiality and compliance with HIPAA and corporate policy standards.

• Investigate, evaluate, negotiate, and resolve property insurance claims • Analyze and manage claims by verifying coverage and gathering pertinent information • Maintain action plans for timely resolution in accordance with policies • Recognize coverage issues, potential fraud, and subrogation potential • Calculate and assign timely reserves to claims; monitor reserve adequacy • Conduct detailed damage and bill reviews; control claim expenses • Communicate claims decisions clearly and professionally

Role Description This is a remote position based in California, and candidates must reside within the state. Keenan is a leading insurance brokerage and consulting firm serving hospitals, public agencies, and California school districts. Specializing in employee benefits, workers' compensation, loss control, financial services, and property & liability. Keenan is committed to delivering innovative solutions that protect and empower the communities we serve. We are seeking an experienced Claims Supervisor to provide leadership, technical oversight, and operational guidance within our Workers’ Compensation claims department. This role is responsible for ensuring claims are managed in accordance with company standards, regulatory requirements, and client expectations while fostering a culture of service excellence and continuous development. - Supervise and provide technical guidance to Claims Examiners, Senior Claims Examiners, Claims Assistants, and other designated staff. - Ensure claims are managed in accordance with Keenan's policies, procedures, and best practices. - Review and approve investigations, litigation referrals, settlements, reserve changes, delays, and denials within assigned authority levels. - Monitor complex claims, including cumulative trauma, subrogation, joint coverage, Serious & Willful, and Labor Code 132a matters. - Conduct quarterly file audits and maintain active oversight of high-value claims. - Partner with leadership to identify staffing needs and support employee development. - Deliver training and updates related to labor code changes, legislation, case law, and client procedures. - Participate in and lead client claim reviews while maintaining exceptional client service and satisfaction. - Manage special projects and support departmental initiatives as assigned. Qualifications - Required: High school diploma and 10 years related claim experience required. - Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements. - Knowledge of all team member related functions. - Preferred: Bachelor's degree preferred. Requirements - Requires exceptional analytical and problem solving skills. - Ensures flawless and consistent execution of client service instructions and performance guarantees. - Ability to actively review work of others via file reviews; identify coaching opportunities, act on needed coaching opportunities and position subordinates for successful development leading to advancement within the organization.

Role Description The 3rd Party Claims Specialist Team Lead is a subject matter expert (SME) on the company’s denial research methods, internal and external databases, reporting tools and policies and procedures. The Team Lead is a SME on all types of denials and functions performed by both the Claims Specialist I and Claims Specialist II and acts as a trainer and mentor to both. Shift: Multiple Shifts Available Remote position Responsibilities - Trains new employees and ensures all applicable training materials are provided and reviewed. - Provides support to staff and acts as a mentor/coach to promote a positive environment. - Provides feedback on all levels of staff to supervisor to be used in employees one on ones, check-ups and reviews. - Identifies staff performance issues and discusses with Supervisor. - Provides the necessary re-training or one on one support with staff to assist in meeting the performance expectations. - Assists management with fair distribution of work/site assignments, ensuring communication when workloads are off balance and making suggestions on how to reconcile. - Reviews variances and write-offs submitted by staff for accuracy of information and approval requirements before giving to Supervisor for approval. - Performs monthly quality assessments on staff to ensure accuracy. Reports any identified training needs to Supervisor and Manager for further review and follow-up action plan as needed. - Prepares and maintains reports and records for processing as well as runs and produces miscellaneous reports as assigned or necessary. - Identifies potential financial exposure and risk to the company with underperforming or non-compliant payers. - Stays up to date on third-party billing requirements. - Monitors and provides support to those assigned to work convert billing exception reports to ensure claims are billed to accurate financial plans timely. - Completes billing transactions for non-standard order entry situations as required. - Provides education to management and team members on payer specific claim processing rules, reimbursement, and other policy guidelines as gleaned by, and confirmed through working directly with payers. - Takes initiative to find opportunities and make suggestions for process improvement within the department. Qualifications - High School graduate, GED or equivalent experience. - Desired: Associates degree, 4 year college or technical degree. - 3+ years insurance billing experience. - Specialized understanding of billing requirements in one of the following areas: Medicare Part D, Medicaid, and Commercial billing. - Understanding of revenue cycle functions within pharmacy practice or equivalent setting. - Desired: Pharmacy Technician. Requirements - Strong analytical skills, excellent time management and attention to details. - Working knowledge in MS Office Products (Excel, Word) and basic computer knowledge. - Comfortable making phone calls and interacting with internal/external entities. - AS400, Frameworks or QS1, Computer Systems Experience. - Communication, problem solving, detail oriented and teamwork, customer service, and accuracy. - Strong organization skills, self-starter, and confidence. - Must be a positive mentor to all staff. - This position will require sitting, standing, and walking. It will also require frequent typing on a keyboard. Ability to push/pull 21-30 lbs, and carry up to 21-30 lbs. Benefits - Medical, Dental, Vision insurance. - Health Savings & Flexible Spending Accounts (up to $5,000 for childcare). - Tuition discounts & reimbursement. - 401(k). - Company Paid Time Off. - Shift Differential. - DailyPay. - Pet Insurance. - Employee wellness and discount programs.