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senior liability claims adjuster complex

SageSure

<div>Overview:

If you're looking for the stability of a profitable, growing company with the entrepreneurial spirit of a startup, we're hiring. SageSure, a leader in catastrophe-exposed property insurance, is seeking a Senior Liability Claims Adjuster. A qualified candidate can comfortably and independently handle high severity and complex losses from start to finish. Losses usually involve litigation. You'll be able to effectively communicate and negotiate across multiple parties, including customers, claimants, attorneys and experts. This is a desk-based adjusting position. If you're interested in joining our growing Claims team, we'd love to hear from you.

What you'd be doing:
<ul>
<li>Investigate and document claims involving liability exposures and litigation proceedings,</li>
<li>Conduct detailed policy/coverage reviews, take recorded statements, assign inspections, actively manage reserves, prepare or review damages and injuries, hire coverage and defense council, and negotiate settlements on high severity or complex losses.</li>
<li>Communicate claim updates and decisions verbally and in writing</li>
<li>Handle claims in compliance with all applicable regulations and internal processes</li>
<li>Provide technical expertise and serve as an SME for Claims-related projects</li>
<li>Act as a resource for less experienced staff</li>
<li>Support catastrophe response as needed, to include potential overtime</li>
<li>Any other duties needed to help drive our purpose and fulfill our values</li>
</ul>
We're looking for someone who has:
<ul>
<li>7+ years of property and/or liability claims experience</li>
<li>3+ years of homeowners or commercial liability &amp; litigation claim handling experience</li>
<li>Excellent written and verbal communication skills</li>
<li>Strong organizational abilities</li>
<li>Empathetic interpersonal skills</li>
<li>Highly effective investigation skills</li>
<li>Complete understanding of Section II of a homeowner's policy</li>
<li>Adjuster licensed in home state or holds a non-resident license if license not required; meets requirements for licensing in additional states as needed</li>
</ul>
Highly preferred candidates also have:
<ul>
<li>10+ years of multi-line claim handling experience</li>
<li>5+ years of commercial &amp; personal lines liability experience</li>
<li>Professional designations
</li><li>Licensing in several of the states we do business</li>
</ul>
About the Claims team at SageSure:

On SageSure's Claims team, you'll be doing more than investigating and resolving losses. From the ground up, you'll be pioneering a best-in-class claims handling approach that leverages transformative technology to support our customers, agents and employees. As a part of this customer-focused, process-oriented team you will be the face of SageSure, helping our policyholders through some of their most trying times. Whether you hold a formal leadership role or are a key team player, you'll coach, mentor and engage with those around you in ways that bring out the best in people and effect change.
You can easily distill complex processes in ways those outside the industry can understand and know the importance of aligning communication tools to customer preferences. You thrive on setting and exceeding expectations, and know building relationships, not completing transactions, is the heart of the insurance business.
<div>
About SageSure: 
 
Named among the Best Places to Work in Insurance by Business Insurance for four years in a row (2020-2023), SageSure is one of the largest managing general underwriters (MGU) focused on catastrophe-exposed markets in the US. Since its founding in 2009, SageSure has experienced exceptional growth while generating underwriting profits for carrier partners through hurricanes, wildfires, and hail. Available in 16 states, SageSure offers more than 50 competitively priced home, flood, earthquake, and commercial products on behalf of its highly rated carrier partners. Today, SageSure manages more than $1.9 billion of inforce premium and helps protect 640,000 policyholders. 
 
SageSure has more than 1000 employees working remotely or in-office across nine offices: Cheshire, Connecticut; Chicago, Illinois; Cincinnati, Ohio; Houston, Texas; Jersey City, New Jersey; Mountain View, California; Marlton, New Jersey; Tallahassee, Florida; and Seattle, Washington. 
 
SageSure offers generous health benefits and perks, including tuition reimbursement, wellness allowance, paid volunteer time off, a matching 401K plan, and more. 
 
SageSure is a proud Equal Opportunity Employer committed to building a workforce that reflects the spectrum of perspectives, experiences, and abilities of the world we live in. We recognize that our differences make us strong, and we actively seek out diverse candidates through partnerships with organizations, institutions and communities that represent various backgrounds. We champion belonging and inclusion for all identities, including, but not limited to, race, ethnicity, religion, sexual orientation, age, veteran status, ability status, gender, and country of origin, striving to create a culture where all individuals feel valued, respected, and empowered to bring their authentic selves to work. 
 
Our nimble, highly responsive culture nurtures critical thinkers who run toward problems and engineer solutions. We relentlessly pursue better outcomes by investing in the technology, talent, and tools that position us to succeed in demanding markets. Come join our team! Visit sagesure.com/careers to find a position for you.</div></div>

Senior Liability Claims Adjuster, Complex

Midway Insurance Management International

Midway Insurance Management International, Inc. provides Claims Management and Adjusting Services.We understand the insurance industry operates in a world where only the fittest will survive. It follows that our success is inherently linked to the success of our insurance partners. We understand that it takes creativity, resourcefulness and honest hard work to become a successful adjusting company.We provide the solutions to the ever increasing demands of the insured, agents and brokers:<ul><li>Casualty</li><li>Transportation</li><li>Auto</li><li>Litigation Management</li><li>Program Management</li><li>Individual Claims Assignments</li><li>Consulting Services</li><li>Administration</li></ul>Liability Adjuster Position:Job Summary:The Liability Claims Adjuster will be responsible for investigating, evaluating, and resolving liability claims related to commercial trucking incidents. This role requires strong analytical and negotiation skills, along with a deep understanding of insurance policies, claims handling procedures, and regulatory compliance. The ideal candidate will have experience in handling complex claims, working with insured parties, claimants, attorneys, and other stakeholders to ensure fair and efficient settlements.Key Responsibilities:<ul><li>Investigate and analyze liability claims, including reviewing accident reports, witness statements, and other relevant documentation.</li><li>Determine coverage, assess damages, and evaluate liability exposure.</li><li>Communicate with insureds, claimants, attorneys, and other involved parties to gather information and negotiate settlements.</li><li>Collaborate with internal teams, including underwriting and risk management, to assess claim impact.</li><li>Manage claims from initial report through resolution, ensuring timely and accurate processing.</li><li>Maintain detailed and organized claim files in compliance with company policies and industry regulations.</li><li>Work with external experts, such as investigators and medical professionals, when needed.</li><li>Prepare detailed reports and recommendations for claims resolution.</li><li>Stay up to date with industry trends, legal developments, and regulatory changes affecting liability claims.</li></ul>Job Type: Full-timePay: $55,000.00 - $75,000.00 per yearBenefits:<ul><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: Hybrid remote in Atlanta, GA 30326

Liability Claims Adjuster

Reserv

<div>About Reserv
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike.
We have ambitious (but attainable!) goals and need people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can&rsquo;t wait to meet you. 
About the role<ul><li>
Come join an amazing and collaborative team! We are seeking a highly organized and customer-focused General Liability Adjuster with construction defect experience to join our team. The successful candidate will be responsible for speaking to customers on the phone, educating and helping the customer work through their claim to the best possible outcome. Your role will also be responsible for handling an inventory of claims, triaging critical claims, and delivering service to all constituents of the claim. 
 
The ideal candidate has a willingness to work through a design process that supports the quickest claim resolution with the best outcome. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements.</li></ul>
**While this position may not be open just yet, we are looking ahead. Submit your application to stay on our radar for future roles as we are growing quickly! 
 
What you'll do<ul><li>
Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls, filing claims, and resolving customer requests</li><li>
Gather necessary information from customers to initiate the claim and explain policy, coverage, and appropriate course of action</li><li>
Manage an inventory of claims, analyze coverage and identify any potential coverage issues.</li><li>
Establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim</li><li>
Ability to handle all aspects of construction defect claims</li><li>
Ability to handle all aspects of general liability claims including but not limited to Slip and Falls, Habitational, Risk Transfer, Construction, and New York Labor Law</li><li>
Ensure compliance with specific state regulations, policy provisions, and standard operating procedures</li><li>
Communicate with involved parties and negotiate appropriate settlements with claimants, insureds, and attorneys within approved payment authority</li><li>
Provide input for continuous development of claims guidelines, best practices, and process improvements</li><li>
Oversee and direct outside investigative service providers, client counsel and investigative services to resolve the claim while closely with the client.</li><li>
Engage in learning opportunities to build knowledge of personal lines claims, court decisions impacting the claims function, current guidelines in claims function, and policy changes and modifications</li></ul> 
Who you are<ul><li>
Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org.</li><li>
Passionate adjuster who cares about the customer and their experience.</li><li>
Empathetic. You exercise empathy and patience towards everyone you interact with.</li><li>
Sense of urgency - at all times. That does not mean working at all hours.</li><li>
Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured&rsquo;s best interest.</li><li>
Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational.</li><li>
Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution.</li><li>
Anti-status quo. You don&rsquo;t just wish things were done differently, you action on it.</li><li>
Communicative. (we'd love to know what this means to you)</li><li>
And did we mention, you have a sense of humor. Claims are hard enough as it is.</li><li>
You are collaborative and a team player.</li></ul> 
Requirements<ul><li>
Bachelor's degree. JD, Professional insurance designations strongly preferred.</li><li>
Active adjuster license required: resident state license if available, otherwise a Designated Home State (DHS) license</li><li>
Minimum of 5 years of experience ideally with;</li><li><div><ul><li>
General Liability (Premise, Habitational, Auto, Garagekeepers, BOP&rsquo;s, Dwelling)</li><li>
Construction Liability is required.</li><li>
Employers Liability.</li><li>
Liquor Liability/Dram Shop.</li><li>
Complex claims involving litigation.</li><li>
Policy interpretation. Drafting Reservation of Rights letters, coverage declinations.</li><li>
Third-party bodily injury.</li><li>
Third-party litigated bodily injury/property damage.</li></ul></div></li><li>
Willing to obtain all licenses within 45 days, including completing state required testing</li><li>
Knowledge of state regulations, policy provisions, and standard operating procedures</li><li>
Ability to analyze and evaluate complex data and make sound decisions based on established guidelines, policies, and procedures</li><li>
Curious and motivated by problem solving and questioning the status quo</li><li>
Desire to engage in learning opportunities and continuous professional development</li><li>
Ability to collaborate with colleagues within and outside your department</li><li>
Willingness to travel for client and claims needs</li></ul> 
Benefits<ul><li>
Generous health-insurance package with nationwide coverage, vision, &amp; dental</li><li>
401(k) retirement plan with employer matching</li><li>
Competitive PTO policy &ndash; we want our employees fresh, healthy, happy, and energized!</li><li>
Generous family leave policy after 8 months of continuous work</li><li>
Work from anywhere to facilitate your work life balance</li><li>
Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder!</li></ul> 
Additionally, we will<ul><li>
Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role</li><li>
Work toward reducing and eliminating all the administrative work from an adjuster role</li><li>
Foster a culture of empathy, transparency, and empowerment in a remote-first environment</li></ul> 
At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!</div>

Pipeline General Liability Construction Defect

<div>About Reserv
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike.
We have ambitious (but attainable!) goals and need people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can&rsquo;t wait to meet you. 
About the role<ul><li>
As the Content Manager for Claims Technical Documentation, you will own two critical pillars of 
content at Reserv: technical claims documentation and customer communication management. 
You will build upon and maintain the comprehensive knowledge base that enables our claims 
teams to handle claims with precision, while simultaneously managing all communication 
templates within our claims management system to ensure every claimant interaction is clear, 
empathetic, and professional. 
 
On the technical documentation side, you will maintain our complete documentation library, and 
develop standard operating procedures, claims handling guidelines, and other materials that 
serve as the operational backbone for our growing claims organization. On the communication 
side, you will own our complete library of CMS templates. From initial acknowledgment letters to 
status updates, payment notifications, and closure communications, you will ensure consistency 
and quality across all claimant touchpoints. 
 
Working closely with Claims Operations, Compliance, Onboarding, and Customer Success 
teams you will be the bridge between technical complexity and clear communication. We're 
looking for someone with a deep understanding of claims who can dive deep into claim 
operations, interview subject matter experts about technical processes, and then craft both internal documentation and external communications that make complex information accessible 
and actionable.</li></ul>
What you'll do<ul><li>
Technical Documentation Development: Create and maintain comprehensive claims 
handling documentation including standard operating procedures, workflow 
documentation, desk-level procedures, and other reference materials that enable 
adjusters to handle claims consistently and accurately across multiple lines of business 
and claim types. 
<ul><li>CMS Communication Template Management: Own the complete lifecycle of</li></ul>
communication templates within our claims management system, including creating, 
testing, maintaining, and optimizing templates for letters, emails, SMS messages, and 
other claim party touchpoints to ensure consistency, clarity, and quality across all 
external communications. 
<ul><li>Cross-Functional Collaboration: Partner closely with Claim Operations, QA,</li></ul>
Compliance, Training, and Customer Success, and Claims leadership to gather 
requirements from subject matter experts, validate technical accuracy, and ensure 
documentation and templates support operational objectives, process changes, and 
system enhancements. 
<ul><li>Structured Communication: Partner closely with Claims Operations and Change</li></ul>
Management to ensure the organization is informed of updates to technical 
documentation and related communications. Ensure that all databases are easily 
searchable and referenced for relevant stakeholders. 
<ul><li>Continuous Improvement and Analytics: Leverage feedback from adjusters,</li></ul>
Customer Success, and QA to identify documentation gaps, improve template 
effectiveness, and proactively update materials to reflect process changes, best 
practices, and evolving business needs.</li></ul>
Qualifications<ul><li>
8+ years of claims handling or claims-related experience, preferably across multiple lines 
of business 
<ul><li>Demonstrated ability to create both technical documentation for internal teams and</li></ul>
customer-facing content, with strong attention to detail, accuracy, clarity, and user 
experience 
<ul><li>Strong project management skills with experience coordinating with multiple subject</li></ul>
matter experts, and delivering against competing priorities and deadlines 
<ul><li>Proficiency with documentation tools and content management systems (e.g., Notion,</li></ul>
Google Workspace, claims management systems) 
<ul><li>Excellent written and verbal communication skills with meticulous attention to detail,</li></ul>
technical accuracy, and the ability to adapt tone for different audiences 
<ul><li>Self-starter mentality with the ability to work independently, ask clarifying questions, and</li></ul>
navigate ambiguity in a fast-paced, evolving environment 
 
Preferred Qualifications 
<ul><li>Experience in claims leadership, training, quality assurance, or audit functions</li><li>Experience managing communication templates or customer-facing content at scale,</li></ul>
ideally within a CMS or similar platform 
<ul><li>Background in client services or account management within claims or insurance</li><li>Experience supporting client onboarding or implementation processes</li><li>Familiarity with claims systems, reporting tools, and documentation platforms</li></ul></li></ul> 
Benefits<ul><li>
Generous health-insurance package with nationwide coverage, vision, &amp; dental</li><li>
401(k) retirement plan with employer matching</li><li>
Competitive PTO policy &ndash; we want our employees fresh, healthy, happy, and energized!</li><li>
Generous family leave policy after 8 months of continuous work</li><li>
Work from anywhere to facilitate your work life balance</li><li>
Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder!</li></ul> 
Additionally, we will<ul><li>
Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role</li><li>
Work toward reducing and eliminating all the administrative work from an adjuster role</li><li>
Foster a culture of empathy, transparency, and empowerment in a remote-first environment</li></ul> 
At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!</div>

Claims Technical Documentation & Content Manager

Safe-Guard Products International, LLC

Please do not respond to direct messages with your personal information. All job applications and your sensitive, personal information should only be submitted via our official job platform. External Job Title: Bi-lingual Customer Support Representative- Spanish or French Internal Job Title: Claims Support Specialist Location: US - SC - Greenville - Onsite FLSA: Non-exempt Shift Times: 11-8 Class Start Date: 9/8/2025 Job Overview: This position provides support to agents, clients, and customers by adjudicating claims, providing claims status, and resolving or escalating customer issues. Communicate effectively with all levels of the organizations. In executing the duties of the role, claims adjuster will ensure the proper documentation, adjudicate per the terms and conditions of the contract, utilizing available resources, and meet schedule expectations informing management of any changes. Job Responsibilities: Handling claims related calls per work schedule performing within defined metrics Order inspection when applicable Follow proper claims procedures as outlined in training and feedback provided by QA or Supervisor Master understanding of clients, agents, and contract terms and conditions Understand exceptions based upon dealership, agent, or client as noted in system Escalate issues to team lead, supervisor, or managers when unable to de-escalate Notify Supervisor when possible fraud is suspected Participate in all training as required to perform the duties of the role Keep record phone calls and transmit claim forms to Dealership or Repair Facility Drive the status of the claim within the Safe-Guard system Receive documentation and organize by claim number Order an appraisal when claim is over threshold amount or possible fraud Send letters to customers and copy dealership if necessary Send missing information letters to customers if documents are missing and copy Dealership if necessary Notate the system Adhere to Quality Assurance Guidelines Ensure premium is first received from Dealership before issuing checks The above statements are intended only to describe the general nature of the job and should not be construed as an all-inclusive list of position responsibilities. Job Requirements: High School Diploma or equivalent Minimum 1-2 years of experience in customer service, insurance claims, call/claims center environment. Proficient computer skills and the ability to troubleshoot and service policy issues Strong interpersonal, analytical and problem-solving skills Superior verbal/written skills and communications skills Ability to exercise sound judgment when interacting with customers and vendors Attention to detail and ability to handle complex situations Proficient in Windows and MS-Office Products (Outlook, Word, PowerPoint &amp; Excel) High attention to detail, good attendance, spelling, mathematical, grammar Ability to analyze complex-detailed reports Must be authorized to work in the U.S Must be able to successfully pass a background check Please note that Safe-Guard has a mandatory training and 90-day introductory period. During the first 90 days, it&rsquo;s important for new team members to adhere to their training and work schedules. The introductory/probationary period is key for training and learning, so being present and punctual is critical to success of the new hires. Candidates seeking this role must have the ability to arrive to work on time and be able to remain present during the full 90-day training and introductory period Job Preferences: Experience within Automotive Industry College degree 2+ years of experience in a high-volume Call Center 2+ years of experience in automotive insurance or warranty claims 1+ year of experience with in an automotive repair or tech role Bilingual or Trilingual with the ability to read, write and speak English and French and/or Spanish in a business setting #LI-Onsite Company Benefits: Medical, Dental, and Vision Insurance Flexible Spending Account Health Savings Account 401(k) Plan with Company Match Company-paid Short-Term and Long-Term Disability Company-paid Life Insurance Paid Holidays and Vacation Employee Referral Program Employee Assistance Program Wellness Programs Paid Community Service Opportunities Tuition Reimbursement Ongoing Training &amp; Personal Development And More! About Safe-Guard Products International Safe-Guard Products International is the leading provider of branded vehicle protection products in the finance and insurance space to the automotive, RV, marine and motorcycle/powersports industries. We are a proud partner to Original Equipment Manufacturers (OEMs), top retailers, and independent agents across the United States and Canada. In nearly thirty years, we have grown to power a client roster of over 50 leading protection brands and protect over 16 million consumers under Safe-Guard contracts. Our success is driven by over 700 employees, who serve over 12,000 dealers and support contract holders across the U.S. and Canada. Safe-Guard continues to experience dynamic growth and has earned a stellar reputation from our clients, dealers, and peers by providing: 1) the highest quality protection products in the industry, 2) a broad platform of branded product, technology, marketing, and training solutions, and 3) an unwavering commitment to uncomplicated care and customer service. Safe-Guard Products International is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to age, race, color, religion, creed, sex, sexual orientation, gender identity or expression, national origin, marital status, disability or protected veteran status, or any other status or characteristic protected by federal, state, or local law.

Bi-lingual Customer Support Representative- Spanish

Aspirion

<div>Description:

For over two decades, Aspirion has delivered market-leading revenue cycle services. We specialize in collecting challenging payments from third-party payers, focusing on complex denials, aged accounts receivables, motor vehicle accident, workers&rsquo; compensation, Veterans Affairs, and out-of-state Medicaid.
At the core of our success is our highly valued team of over 1,400 teammates as reflected in one of our core guiding principles, &ldquo;Our teammates are the foundation of our success.&rdquo; United by a shared commitment to client excellence, we focus on achieving outstanding outcomes for our clients, aiming to consistently provide the highest revenue yield in the shortest possible time.
We are committed to creating a results-oriented work environment that is both challenging and rewarding, fostering flexibility, and encouraging personal and professional growth. Joining Aspirion means becoming a part of an industry leading team, where you will have the opportunity to engage with innovative technology, collaborate with a diverse and talented team, and contribute to the success of our hospital and health system partners. Aspirion maintains a strong partnership with Linden Capital Partners, serving as our trusted private equity sponsor.
We are seeking an Appeals Specialist II to join our growing team. As an Appeals Specialist II, you will be exposed to the complex reimbursement methodology between hospitals and insurance companies. Appeals Specialists work closely with assigned project teams on the specialized retrospective recovery process. You will be exposed to the revenue cycle process and various provider clients and systems.
Key Responsibilities<ul><li>
Follow-up with insurance carriers on underpaid claims by phone; complete follow-up actions as advised</li><li>
Research claim variances in hospital patient accounting systems (EPIC, Meditech, Cerner, Athena)</li><li>
Draft appeals to insurance carriers on denied or underpaid claims</li><li>
Review claim detail including coding, billing and insurance information for discrepancies</li><li>
Run claims data through various pricing software</li></ul>
Requirements:
<ul><li>Strong healthcare industry knowledge</li><li>
Ability to troubleshoot and remedy claim submission errors</li><li>
Demonstrated attention to detail</li><li>
Excellent written and verbal communication skills</li><li>
Team-Oriented and Flexible</li><li>
Creative Problem-solving skills</li></ul>
Education and Experience<ul><li>
High School Diploma or GED required; bachelor's degree preferred</li><li>
Hospital billing experience required</li><li>
Previous work from home experience</li></ul>
Benefits
At Aspirion we invest in our employees by offering a full benefits package, including health, dental, vision and life insurance upon hire, matching 401k, competitive salaries, advancement opportunities, and incentive programs.
The US base pay range for this position starts at $19.00 hourly. Individual pay is determined by a number of factors including, but not limited to, job-related skills, experience, education, training, licensure or certifications obtained. Market, location and organizational factors are also considered. In addition to base salary, a competitive benefits package is offered.
AAP/EEO Statement
Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability, or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to.
Please note that this position is contingent upon the successful completion of a pre-employment drug screening and background check. These steps are part of our standard hiring process to ensure a safe and compliant workplace.</div>

Appeals Specialist - Hospital Billing, Underpayments

Stout

<div>
 
 At Stout, we&rsquo;re dedicated to exceeding expectations in all we do &ndash; we call it Relentless Excellence
 
 &reg;
 
 . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team.
 
 
 
 
 About Stout&rsquo;s Forensics And Compliance Group
 
 
 
 Stout&rsquo;s Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.
 
 
 What You&rsquo;ll Do
 
 
 As an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include:
 
 
 <ul>
 <li>
 Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations.
 </li>
 <li>
 Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies.
 </li>
 <li>
 Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic.
 </li>
 <li>
 Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning.
 </li>
 <li>
 Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives.
 </li>
 <li>
 Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post&ndash;go-live support.
 </li>
 <li>
 Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations.
 </li>
 <li>
 Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery.
 </li>
 <li>
 Continue developing technical, analytical, and consulting skills while building credibility with clients.
 </li>
 <li>
 Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement.
 </li>
 <li>
 Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout&rsquo;s Healthcare Consulting team.
 
 
 </li>
 </ul>
 What You Bring
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master&rsquo;s degree preferred.
 </li>
 <li>
 Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles.
 </li>
 <li>
 Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance.
 </li>
 <li>
 Epic Resolute or other hospital billing system experience preferred; Epic certification a plus.
 </li>
 <li>
 Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required.
 </li>
 <li>
 Additional certifications such as CHC, CFE, or AHFI preferred.
 </li>
 <li>
 Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization.
 </li>
 <li>
 Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred.
 </li>
 <li>
 Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act.
 </li>
 <li>
 Willingness to travel up to 25%, based on client and project needs.
 
 
 </li>
 </ul>
 How You&rsquo;ll Thrive
 
 
 <ul>
 <li>
 Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions.
 </li>
 <li>
 Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships.
 </li>
 <li>
 Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time.
 </li>
 <li>
 Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment.
 </li>
 <li>
 Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility.
 </li>
 <li>
 Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions.
 
 
 </li>
 </ul>
 
 Why Stout?
 
 
 
 At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life.
 
 
 We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.
 
 
 We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals.
 
 
 Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.
 
 
 Learn more about our benefits and commitment to your success.
 
 
 https://www.stout.com/en/careers/benefits
 
 
 
 The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.
 
 
 
 
 Stout is an Equal Employment Opportunity.
 
 
 All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law.
 
 
 
 Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
 
 
 A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - https://www.stout.com/en/careers/benefits.
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Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations

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