18 claims jobs found in Detroit, MI

Departmental Summary: The Application Developer II will support ancillary lines of business Dental, Vision, EOB IT, CDH and Pharmacy, ensuring reliable execution of production processes and day-to-day operational stability. Responsibilities include monitoring and supporting batch and real-time workflows, triaging and resolving defects, and implementing enhancements to core business logic in alignment with evolving business needs and compliance   requirements . The role will participate in initiatives such as claims processing, membership reporting and reconciliation, and benefit updates, emphasizing accuracy, timeliness, data quality, and SLA adherence. This position will also contribute to strategic initiatives across Dental, Vision, and CDH products. As part of ongoing modernization, the analyst will help transition business functionality to distributed platforms and services (e.g., APIs, microservices, data pipelines), including analyzing existing logic and...

SUMMARY:     Workers Compensation Defense Attorney needed for in-house litigation position, working under the direction of the General Counsel.  This position will work defending litigated Workers’ Compensation claims before hearing locations, primarily in and surrounding Detroit, MI. This attorney will conduct research where necessary, examine records, conducts investigations, attends depositions, consult with witnesses, insured(s), legal assistants, and/or personnel.  Participate in negotiations on behalf of the Company including settlements.  In addition, this position will provide leadership and expertise on major company projects as necessary. Claims Focus:  This position will provide  state specific legal representation before courts, arbitration panels and/or administrative bodies.  Serve in an advisory capacity to company and employees.  Prepare legal pleadings, motions, memorandums, trial briefs, etc. Conduct research where necessary, examine records, attend...

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.  Job Description A day in the life of a Large Loss Field Property Adjuster, and what it takes to do the job! As a Large Loss Field Property Adjuster, you will be dedicated to providing exceptional service to our policyholders. Your primary responsibility will involve traveling to our customers' homes to conduct on-site inspections, investigate coverage, prepare estimates, and settle claims promptly and efficiently. Additionally, you will handle virtual claims countrywide, leveraging various platforms and software such as Xactimate and ClaimsX...

WHAT WE'RE LOOKING FOR Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a Business Development Manager in Michigan!  This individual will be responsible for business development efforts and brand strategy within a specified territory.  This involves evaluation of production patterns in new and renewal business to uncover opportunities for refinements to support profitable growth.  You will work collaboratively with other Business Development Managers, Underwriting management, and additional corporate resources to develop opportunities by industry, class code or segment, and to more effectively monitor/evaluate agency performance. You'll stay ahead of competitive intelligence and help prevent production barriers, as well as develop opportunities to improve ease of doing business with BHHC and provide input to improve overall customer experience.  Frequent travel within a specified territory required.   Must be legally authorized to...

Responsible for managing infrastructure that supports the Third-Party Administrators (TPA) product solution that allows BCBSM to bring competitive product offerings to market and support the product moving forward. Serve as a liaison between the group, operations, group account leaders and Information Technology to ensure roles, responsibilities, and performance expectations are clearly defined and followed by all for effective operations. Define and lead a process to support and manage FlexLink relationships that exist with TPAs as well as customer groups who support this solution. Work with operations to clarify roles, responsibilities and expectations; Support new programs, initiatives or regulations. Manage, create and enhance reporting for Flex Link related performance to ensure timely claim processing.  Partner with operations to establish an appropriate cadence and produce a performance tracking...

Responsible to identify, prioritize and develop strategies to support Blue Cross Blue Shield of Michigan’s (BCBSM) competitive position, achieve positive business results, and improve the health and wellbeing of our members.  Responsible to make recommendations on consequential matters with long-term implications for the organization, including: setting enterprise aspirations and targets, developing enterprise-level strategies, assessing strategic investments and partnerships, and evaluating the enterprise’s overall portfolio of assets. Oversee or perform analyses including, but not limited to, financial modeling, claims analyses and complex statistical analyses.   Manage activities that are directly related to the corporate strategies, goals and objectives.     Utilize primary and secondary research to assist in identifying best practices and opportunities for the corporation.   Create executive level PowerPoint presentations and correspondence to...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   This is a hybrid position reporting to our Detroit office 2 days a week. Associate Attorney – AAA/The Auto Club Group Reports to: Supervising Practice Leader Under moderate supervision, handle litigation and cases of intermediate-level exposure and complexity in which the insured or the Company is a defendant.  Able to transition from courts of limited exposure to courts of unlimited exposure.  Develops and applies skills to control all aspects of litigation, including trial preparation, discovery, negotiation, presentation and appeals from District to Circuit Court.  Primary Duties and Responsibilities (details of the basic job functions): Reviews and analyzes files, insurance policies, all allegations and pertinent medical and technical...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Auto Field Appraiser- Detroit, MI PRIMARY PURPOSE : To handle field appraisal assignments for our corporate fleets and insurance clients with an emphasis on Auto's. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Set appointments same day, inspect within 24 hours and write estimate car side Depending on location - appraiser is expected to write 6 to 10 estimates per day Ensures proper vehicle tear down Determine repair time allotments and required labor operations...

About Integrated Specialty Coverages Integrated Specialty Coverages, LLC (ISC) is a growth stage technology and data-driven commercial MGA and insurance wholesaler leading innovation in the market.   Backed by one of the leading private equity firms, Onex Partners, and led by a forward-thinking management team, ISC is combining the worlds of insurance and technology to create an Insurtech powerhouse. As a leading online distributor of insurance products for a range of industries and “Main Street USA”, we are looking for the right people to help us in our mission of achieving exponential growth. We strive to be the number one place to go for brokers and agents to source insurance. To accomplish this, we’re building a digitally focused team that deeply understands the intersection between user experience, data, and AI/ML to optimize the way we engage with our customers and partners. Job Summary The Workers Comp Broker is responsible for supporting ISC’s newly...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   This is a hybrid position reporting to our Detroit office 2 days a week. Senior Trial Attorney – AAA/The Auto Club Group Reports to: Supervising Practice Leader Responsible for litigation of Circuit and Federal cases of unlimited exposure where there is a multiplicity of complicated legal and factual issues involving the more serious injuries, excess damages, and high exposure litigation of identified legal issues which the Company may pursue through the appeal process.  Primary Duties and Responsibilities: Case Management and Preparation: Analyzes, files, reviews all allegations, and renders legal opinions to Claims personnel regarding evaluation and disposition of injury cases. Prepares responses to civil complaints, files and...

Responsible to identify, prioritize and develop strategies to support Blue Cross Blue Shield of Michigan’s (BCBSM) competitive position, achieve positive business results, and improve the health and wellbeing of our members.  Responsible to make recommendations on consequential matters with long-term implications for the organization, including: setting enterprise aspirations and targets, developing enterprise-level strategies, assessing strategic investments and partnerships, and evaluating the enterprise’s overall portfolio of assets. Oversee or perform analyses including, but not limited to, financial modeling, claims analyses and complex statistical analyses.   Manage activities that are directly related to the corporate strategies, goals and objectives.     Utilize primary and secondary research to assist in identifying best practices and opportunities for the corporation.   Create executive level PowerPoint presentations and correspondence to...

Customer Service Rep I Full-time Shift: 8:00 am to 8:00 pm  (Shift bidding process based on seniority) Detroit, MI Assessment required -  Customer Service Rep   Blue Cross Blue Shield of Michigan is looking for outgoing, energetic, phone friendly individuals to work in a fast-pace call center environment. Our Customer Service Reps analyzes, evaluates, resolves and primarily responds to low complexity level membership issues under various product lines. Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership.  Analyze and service various product lines in the area (i.e., Facility, Professional). Provide responses by telephone, check-off letters, and/or automated letters. Follow department/corporate reporting requirements (i.e., PCRS, ICS, Special Surveys and Manual counts).  Organize work to meet National/Corporate/Department Production and Quality Standards.  Reroute misdirected...

Responsible for planning, coordinating, and supervising all administrative, operative and employee functions within assigned area(s) to ensure an efficient and cost effective area in accordance with departmental and corporate standards and objectives.   Supervise, coordinate, direct and monitor staff activities to ensure prompt, courteous and accurate response to customers; ensure an efficient and qualitative operation through effective planning, leading, controlling and organizing. Prioritize and assign work to employees and initiate corrective measures to resolve problems including scheduling or adjusting overtime requirements as necessary. Select, train, develop, appraise and counsel support staff personnel. Interface with diverse levels of internal and external personnel to develop and maintain effective rapport and to resolve issues and inquiries. Monitor and analyze proficiency and quality efforts subordinate personnel. Administer and adhere...

We are seeking a highly skilled and strategic Accounting Manager to lead complex accounting operations related to healthcare facility and provider contracts, with a focus on Non-Claim Benefit Expenses (NCBE), Medical Loss Ratio (MLR) impacts, self-funded group billings, and provider risk arrangements within our Controllership organization (Enterprise Accounting). This role requires a strong technical accounting foundation, deep understanding of GAAP and healthcare statutory principles, and proven leadership in managing teams and collaborating across departments and executive leadership. The ideal candidate will bring a blend of analytical rigor, operational excellence, and interpersonal effectiveness to drive governance, accuracy, and efficiency in high-risk accounting areas. Key Responsibilities Lead and oversee accounting for facility and provider contracts with unique risk and NCBE structures, ensuring compliance with GAAP and healthcare statutory requirements. Establish...

Position Title Branch Banking Client Consultant II   Location Detroit, MI 48201   Job Summary The Branch Banking Client Consultant II provides best in class experience by resolving concerns and providing various product details that focus on meeting the financial needs of our clients. Focuses on client management, client retention, and introductions to key bank partners (Mortgage, Business Banking) to ensure our clients have access to experts who can help them achieve their financial goals. This position will have greater lending and basic investment interactions and will participate in more complex banking conversations with clients.   Job Responsibilities: Sales Performance: Support team efforts to achieve growth targets in financial performance (outstanding deposits, outstanding loans, non-interest income) and primary client acquisition. Actively seek and deliver the right client introductions to the right team member(s) to achieve growth targets and execute...

The Director, Government Programs- Data & Engineering drives the execution of data use and adoption for Government Programs and CFO areas. This role promotes the use of AI, automation, and best-in-class technology across teams; will partner with business, technology, product, and operations leadership to lead the delivery of business imperatives. The Director will ensure access to accurate and high-quality data and provide support for reporting, analytics, and modeling across finance, controller, actuarial, UW, and Government Programs. The role leads the design of member level constructs across CFO, Commercial, MA, JVs. The Director also supports working with IT and ensuring migration of off legacy analytics systems (CADE/IDAP) as well as support for reporting and visualization creation working with business partners. Drive coordination with enterprise stakeholders (e.g., IT, ACoE) alongside the Actuarial, Finance, Underwriting, and Government Programs Planning...

The Director Government Programs- Planning & Consulting position is responsible for driving the execution of strategic analytic priorities for Government Programs and CFO areas through business planning, consultation, and delivery oversight of data, analytics, and modeling capabilities. This role promotes the use of AI, automation, and best-in-class technology across teams; drives organizational priorities and business outcomes as the consultative partner across analytics, operations, and modeling teams by managing and coordinating execution of insights, tools, and governance.  The Director leads, organizes and executes governance of Medicare Advantage analytics ecosystem working closely with MA segment leadership; establishes internal consultative intake and delivery of best-in-class data and advanced analytics / AI driven insights to support key segment initiatives and goals; partners with other government programs analytics functions and other key stakeholders...

Non-Exempt/Bargaining Unit Posting Local/Seniority Unit – 2500/4201 Date Posted Internal – 9/18/25, Deadline Date – 9/25/25 Department – 104700 Property Management Salary Grade – K Job Code - X285A Number of openings – 1  Shift – 7:00am-3:30pm M-F, please note shifts may change based on vacation relief. Site/Location: Detroit, MI Status – Regular Full Time       This position is responsible for the safe, reliable and efficient operation of all Detroit Service Center equipment and systems, as required to provide an optimum work environment for all facility personnel, data processing, and print center devices, critical to servicing BCBSM customers. Also, responsible for provision of emergency service response to all site emergencies, maintenance of all assigned spaces and equipment, and oversight of all contractor activity for protection of the BCBSM work environments for all buildings as assigned within region. Operate and maintain the Detroit Service Center...