3 siu investigator jobs found in Lansing

SUMMARY Perform production and quality audits to ensure operations are effective, consistent and in compliance with business rules and processes.  Primary focus includes, but is not limited to auditing the Document Specialists, Claims Document Analysts, Senior Document Analysts, Mail Clerks, and Inserter Operators. Responsible for performing administrative and support tasks which may be highly confidential and sensitive in nature.   PRIMARY RESPONSIBILITIES    Completes production and quality audits, reviewing completed work in comparison to established documented procedures to determine accuracy while providing support to staff as an acting SME. Orients new employees to the departmental and unit procedures. Collaborate with management and stakeholders to ensure understanding, alignment, and consistency in workflow performance. Partner with training, management, and stakeholders to identify training needs based on quality assessment results Compiles, creates, prepares,...

SUMMARY:   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 one point contact on the managed claims, determines compensability of claims, manages the medical treatment program, and confirms the claimant’s disability will not exceed waiting period timelines.  This includes calling and discussing potential claim activity and work-related injuries with policyholders, and claimants, providers, attorneys, agents, and state agencies, when necessary.   ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Investigates workers’ compensation claims including a mandatory contact to the employer within the required time frame with additional contacts to the employee or provider, as necessary.   Inform medical providers of billing address and billing...

OBJECTIVE Litigation Representative Objective To provide efficient investigation, evaluation, supervision, and disposition of firstparty casualty claims in litigation. RESPONSIBILITIES Litigation Representative Responsibilities Retain detailed knowledge of the Michigan law, especially the No-Fault Automobile Act, MCL 500.3101, Negligence, Products and Insurance contract law, civil procedure, and Michigan Evidence law.   Review and advise of changes in statutory law, case law, and legal practice as it pertains to the handling of claims and management of litigation.   Participate in meetings, round-table discussions, and other collaborative efforts, providing others with constructive criticisms, encouragement, and advice in the handling of individual claims.   Encourage best practices in the handling of claims by providing an example to all by making timely and accurate notes of matters relevant to a given claim in a file,...