Role Description The Claims Supervisor supervises a team of P&L claims examiners, providing support and assistance to ensure proper claims handling and client satisfaction. - Assist directly with client questions, concerns and/or issues. - Handle personal claim file caseload as assigned. - Assist with balancing Examiner pending files. - Reviews Examiner technical work product and reserve adequacy. - Reviews accuracy of Examiner billable hours. - Works with Clients/Account Executives/Account Managers to schedule, prepare and conduct claim file reviews. - Attend JPA or other client meetings. - Responsible for ensuring claims are listed on agendas for JPA discussion. - Review Examiner write-ups for JPA meetings for technical correctness and readability. - Approve advance/special invoices. - Review monthly trust account invoicing. - Monitor trust account balances. - Review monthly loss runs. - Review incident reports. - Other duties as assigned. Qualifications - 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. - Minimum of five (5) years Property & Casualty liability claims experience required. - Minimum of two (2) years supervisory experience required. - Strong verbal and written communication skills. - Must be organized and detail oriented. Requirements - Bachelor's degree preferred. - 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. Benefits - Competitive compensation. - Comprehensive benefits programs designed to support your well-being. - Career development opportunities and ongoing learning. - A collaborative, people-first culture with accessible leadership. - The opportunity to do meaningful work with global reach and local impact.

Role Description The Audit Team Lead will be responsible for playing a leadership role in performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. This position will utilize information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations to document relevant findings. The Audit Team Lead will lead site visits and desk audits of provider claims, and medical and administrative records, to gather and analyze all necessary information to determine whether subjects adhered to state and federal compliance policies, reimbursement policies, and contract compliance. The Audit Team Lead will present and discuss audit findings with clients and input information into Optum audit workflow tools and the client’s case tracking system. Where applicable, the Audit Team Lead will support appeal and fraud investigation activities. Finally, the Audit Team Lead will supervise and support the work of other Auditors in all the responsibilities noted here. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm EST. It may be necessary, given the business need, to work occasional overtime. We offer 8 weeks of paid training. The hours during training will be 8:00 am to 5:00 pm EST, Monday - Friday. If you are located in Massachusetts, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: - Supervise and support the work of other Auditors as detailed below - Review medical and administrative records for audit/compliance review - Travel to provider sites up to 10% per month to collect records and engage with providers - Present and participate in discussions with clients regarding audit observations and findings - Collaborate with a team of 2-5 auditors to complete reviews - Enter audit findings data and notes in online/electronic platform using Excel-based templates - Attend and participate in dispute reviews and administrative hearings Qualifications - Active nurse licensure (RN or LPN) in MA - 1+ years of experience reviewing health care documentation in a clinical or administrative role - 1+ years of basic experience with Excel, including familiarity with basic formulas and data analysis - Ability to work full time (40 hours/week), Monday - Friday, with flexibility for occasional overtime or weekend needs - Located and able to travel up to 10% within the state of Massachusetts Preferred Qualifications - Clinical or administrative experience in long term care, for example, nursing facility care delivery/administration and/or community-based LTC service programs like Home Health - Experience in claim processing, healthcare provider information, and healthcare billing practices - Experience working in a remote/telecommute workspace - Working knowledge of medical terminology and claim coding - Familiarity with Medicaid program and/or billing requirements - Familiarity with CPT-4, HCPCs and ICD-10 code terminology Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) Salary Information The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. Company Description At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Role Description The Indemnity Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote position. - Receives claims, confirms policy coverage and acknowledgment of the claim - Determines validity and compensability of the claim - Establishes reserves and authorizes payments within reserving authority limits - Manages non-complex and non-problematic medical only claims and minor lost-time workers’ compensation claims under close supervision - Communicates claim status with the customer, claimant and client - Adheres to client and carrier guidelines and participates in claims review as needed - Assists other claims professionals with more complex or problematic claims as necessary - Additional duties as assigned Qualifications - Excellent written and verbal communication skills - Ability to learn rapidly to develop knowledge and understanding of claims practice - Ability to identify, analyze and solve problems - Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets - Strong interpersonal, time management and organizational skills - Ability to meet or exceed performance competencies - Ability to work both independently and within a team environment Requirements - Bachelor's degree or a combination of education and related experience - Minimum of 1 year of industry experience and claims management preferred - State Certification as an Experienced Examiner Benefits - A comprehensive benefits package is available for full-time regular employees and includes: - Medical (HDHP) w/Pharmacy - Dental - Vision - Long Term Disability - Health Savings Account - Flexible Spending Account Options - Life Insurance - Accident Insurance - Critical Illness Insurance - Pre-paid Legal Insurance - Parking and Transit FSA accounts - 401K - ROTH 401K - Paid time off Company Description CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make. The Senior Claims Adjuster will play a critical role in delivering quality claim file management and an industry-leading customer claims experience., This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers. How You’ll Do ItClaims Technical Management: - Independently handle all aspects of the workers’ compensation claims from set-up to closure. - Evaluate and handle high dollar, high exposure, complex claims. - Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change. - Mitigate the complex exposure while achieving the best outcome. - Determine timely and accurate compensability decisions within statutory requirements. - Set and adjust timely/accurate reserves within authority limits to ensure reserving activities are consistent with the case facts and company best practices. - Ability to present claims to senior management, internal and external stakeholders. - Timely administration of statutory medical and indemnity benefits throughout the life of the claim. - Comply with all applicable statutory guidelines, rules, and regulations. - Control legal activity with defense counsel through the litigation process while managing legal fees and costs. - Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement. Claims Customer Service: - Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations. - Assist as necessary in providing claim status to agents and insureds, coverage verification and loss run reports, etc. - Provide excellent customer service to internal and external customers and business partners. - Advocate to ensure that Pie has a leading claims customer experience. - Work to continuously improve our claims operations and look at opportunities and gaps in claim service, handling SOPs, protocols and processes. The Right Stuff - High School Diploma or equivalent is required. - Bachelor's Degree or equivalent experience with some college coursework is preferred. - Minimum of 5-years workers’ compensation claim adjusting experience is required (carrier background, preferred). - Claims experience handling California WC claims is required. - Ability to evaluate and identify high dollar, high exposure, complex claims. - Requires active licensing in applicable states Strong communication (written and verbal) skills, to deliver more complex information effectively. - Strong problem-solving skills to be able to manage complex tasks and work through to solutions with little guidance and direction. - Awareness of your own tasks and how it impacts the team and deliverables. - Experience using G-Suite Tools and collaboration tools like Slack is preferred. - Advanced knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements. - Advanced knowledge and experience in claim adjudication, medical, and litigation management. - Advanced ability to analyze and take necessary action in multiple focus areas based on several data points. - Ability to make claim decisions to mitigate exposure while achieving the best outcome. - Ability to use skills to overcome conflict and reach beneficial outcomes. - Ability to mentor junior adjusters. The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process. Base Compensation Range $95,000—$120,000 USD Compensation & Benefits - Competitive cash compensation - Comprehensive health plans - Generous PTO - Future focused 401k match - Generous parental and caregiver leave - Our core values are more than just a poster on the wall; they’re tangibly reflected in our work Making every part of working with us "Easy as Pie" - including our offer process. When we find someone we'd like as a Pie-oneer (a member of our team), we move quickly to put together a fair offer based on your skills, experience, location, and compensation expectations. Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members. Location Information Unless otherwise specified, this role is remote. Remote team members must live and work in the United States (territories excluded) and have access to reliable, high-speed internet. Additional InformationPie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic. Pie Insurance participates in the E-Verify program. Please click here, here and here for more information. Pie Insurance is committed to protecting your personal data. Please review our Privacy Policy. Safety First: Pie Insurance is committed to your security during the recruitment process. We will never ask you for credit card information or ask you to purchase any equipment during our interview or onboarding process. Pie Named to 2025 America's Best Startup Employers Pie Insurance 2025 State of Workplace Safety Report #LI-REMOTE #BI-REMOTE