4 claim representative ii jobs found in Lansing

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job)     The Medical Only Claims Specialist I is an entry level claims role. The incumbent is expected to be proficient with the Claims unit, policies, processes, procedures, and terminology.      The Medical Only Claims Specialist II is an experienced level claims role. The incumbent is expected to perform at a high level with minimum supervision.     Primarily responsible for the investigation and management of workers’ compensation claims. Conducts a 1 to 3-point contact on the managed claims, which is dependent on either the facts of the case or the claim type; determines compensability of claims, manages the medical treatment program, and assists in the return-to-work process. This includes calling and discussing potential claim activity and work-related injuries with policyholders, claimants, providers, attorneys, agents, and state agencies....

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job)     The Medical Only Claims Specialist I is an entry level claims role. The incumbent is expected to be proficient with the Claims unit, policies, processes, procedures, and terminology.      The Medical Only Claims Specialist II is an experienced level claims role. The incumbent is expected to perform at a high level with minimum supervision.     Primarily responsible for the investigation and management of workers’ compensation claims. Conducts a 1 to 3-point contact on the managed claims, which is dependent on either the facts of the case or the claim type; determines compensability of claims, manages the medical treatment program, and assists in the return-to-work process. This includes calling and discussing potential claim activity and work-related injuries with policyholders, claimants, providers, attorneys, agents, and state agencies....

SUMMARY: Primarily responsible for providing customer service and underwriting technical support to agencies and policyholders related to underwriting rules, procedures and regulations, policy, and audit information. Reviews & approves/declines endorsement requests and responds to bureau criticisms to maintain policies and stay in compliance with Accident Fund’s and bureau rules and regulations. Verifies coverage for current policy and/or additional named insureds/DBA’s/locations. Completion of experience rating promulgations or Loss Pricing & Projection Model. Mentors PPRs & CBR’s with basic questions and policy information. Contacts include state rating bureaus, Service Center staff, Business Development Consultants, Business Development Managers, Corporate Underwriting, Finance Department, Claims Department, agents, and policyholders. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. • Respond to basic policy inquiries and...

SUMMARY Medical Bill Review Specialist I Primarily responsible for analyzing bills for multi-state Workers Compensation medical claims to determine appropriateness of services billed. Responsible for analyzing simple billings by utilizing our Medical Bill Review (MBR) software to determine appropriateness of codes. Responsible for making bill review processing determinations according to rules, regulations, and/or third-party partners. Medical Bill Review Specialist II Primarily responsible for performing technical review of more complex medical bills, including modifiers, anesthesia, & psychiatric. Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software to determine appropriateness of codes and excessive charges. Also responsible for analyzing assigned medical bills to determine compliance with business rules, client specific requirements and multiple state rules, regulations and...