11 experienced claims service specialist jobs found in Lansing

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...

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job)   This is an entry-level position. This position leads to a Medical Only Claims Specialist I and is expected to last up to 12 months. Upon completion of the training plan the incumbent is expected to be proficient with the Medical Only Claims policies, processes, procedures, and terminology related to the job. In addition, the incumbent will be proficient in the job responsibilities and tasks of the Medical Only Claims Specialist I position description. The incumbent will be evaluated on their progress and successful completion of the training plan each quarter. Upon satisfactory completion, the incumbent will be eligible for the Medical Only Claims Specialist I position.  Medical Only Claims Associate will work with all members of the team and may receive direction, support, and instruction from the Manager or Medical Only Claims Specialists depending on the assignment....

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: Primarily responsible for assisting Large Account Underwriters and Business Development Consultants in growing and maintaining a profitable book of business and assisting agents with inquiries related to underwriting rules, procedures and regulations. Reviews policy structures to determine if changes need to be made to stay in compliance with bureau rules and regulations. Provides customer service to agencies and policyholders related to complex inquiries, policy and audit information. Contacts include state rating bureaus, Large Account Underwriters, Business Development Consultants, Business Development Directors, Service Center Managers, Underwriting Technical Advisor, Service Center staff, Finance Department, Claims Department, agents and policyholders. PRIMARY RESPONSIBILITIES: This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other...

SUMMARY:  Primarily responsible for supporting the document management including media by analyzing, processing, indexing, re-indexing and assigning a document type and/or sub-doc type to all documents received by all departments within the Enterprise. Documents are received via OnBase and/or paper, fax, media and email. The incumbent must distinguish what department a document belongs to, apply proper criteria to electronically route the document into an electronic database, and initiate workflow of these documents to appropriate core business units in an accurate and timely manner. Primary contacts include other departmental personnel, as well as external vendor contacts. This role is also responsible for processing of incoming documents for the Subrogation, Legal, Commercial Auto, Fronting Agreements, Assigned Risk, Regulatory, Investigations and Medicare/Medicaid teams. Subject matter expert for Document Specialists and Claims Document Analysts.   PRIMARY RESPONSIBILITIES:...

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...

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 Service Center teams Claims Support, Business Development, Billing Service Center.   Responsible for performing administrative and support tasks which may be highly confidential and sensitive in nature. PRIMARY RESPONSIBILITIES:  ·    Conducts and executes the production statistics and quality audits of completed work in comparison to established documented procedures to determine accuracy within the Service Center in a timely fashion while being in compliance with statutory regulations (30%). ·    Partner with management, union representatives, human resources, and team members to establish and maintain production and quality standards for Service Center teams (15%).  ·    Compile, create, prepare and review information, audits and reports for accuracy as requested or...

A career at Auto-Owners is challenging and rewarding.  Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Job Description We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, this specific role could have the flexibility to work from home up to 3 days per week. Auto-Owners Insurance, a top-rated insurance carrier, is seeking motivated nursing professional to join our team. The position requires the person to: Collaborate with claims associates to provide medical expertise in the investigation, evaluation, and appropriate resolution of injury claims including workers’ compensation, personal injury protection (no fault), and liability. Evaluate medical records for relatedness to the injury and appropriate utilization of medical treatment and services. Prepare and deliver trainings to claims staff via a variety of modalities...

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:   Eligible candidates for this role should reside within a commutable distance of Lansing, Michigan. Territory coverage includes Lansing, Jackson, Howell, and Flint Michigan areas. Job Title- Field Property Claim Specialist Reports to: Claim Manager as appropriate What you will do: Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.  Review assigned claims, Contacting the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.   Complete complex coverage analysis. Ensure all possible policyholder benefits are identified.  Create additional sub-claims if needed.  Complete an...

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:   After in office training is completed, this position will report to an office 1-2 times per month. 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.  To support those duties, we are applying a monthly cap on new case assignments. Primary Duties and Responsibilities (details of the basic job...

OBJECTIVE Complex Casualty Claims Specialist Objective To assure the consistent application of company procedures and practices in casualty claims handling and disposition of large complex casualty claims within the division. To ensure that claims are properly investigated, evaluated, and resolved within the company’s contractual and legal obligations. To provide appropriate and equitable resolution to claimants while protecting Farm Bureau insureds within the confines of the insurance policy and to aid in the retention and growth of business. RESPONSIBILITIES Complex Casualty Claims Specialist Responsibilities Investigate, control, and negotiate all casualty claims involving complex issues beyond the expertise of claim representative as such cases are discovered.   Understand and apply skills and awareness necessary to achieve effectual casualty claim settlements and remain current in the knowledge of the tools of...