35 claim operations analyst jobs found

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Remote Position Schedule / Shift: Monday-Friday 8am-5pm ET Position Summary: The Auto Club Group is seeking a highly skilled Claim Investigator who would be responsible for reviewing and investigating insurance claims to determine their validity, accuracy, and compliance with company policies and regulatory requirements. They gather and analyze evidence, interview claimants, witnesses, medical providers, and other involved parties, and examine documentation such as police reports, medical records, and property damage assessments. Their goal is to identify potential fraud, verify claim details, and support fair and timely claim resolutions. Key Responsibilities: Independently perform comprehensive assessment and investigation of personal lines property & casualty claims for the potential of claim fraud.  Maintain a thorough...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Remote Position Schedule / Shift: Monday-Friday 8am-5pm ET Position Summary: The Auto Club Group is seeking a highly skilled Large Loss Home Claim Investigator who would be responsible for investigating and managing complex, high-severity residential property insurance claims, typically involving significant financial exposure from events such as fires, severe weather, water damage, structural collapse, theft, or suspected fraud. The role combines field investigation, claim analysis, customer service, and collaboration with internal and external stakeholders to ensure accurate claim resolution and compliance with policy provisions. Key Responsibilities: Independently perform comprehensive assessment and investigation of personal lines property & casualty claims for the potential of claim fraud.  Maintain a thorough understanding of...

Departmental Summary: This position supports Medicare Part D pharmacy quality and medication adherence initiatives through data analysis, reporting, dashboard development, and operational support. Responsibilities include analyzing healthcare data, monitoring quality measures, providing actionable insights to business and clinical partners, and supporting initiatives that improve CMS Star Ratings. Required Skills and Qualifications: • Strong experience developing complex SQL queries and analyzing large healthcare datasets, including pharmacy claims, medical claims, membership, and provider data. • Proficiency in Python for healthcare analytics, reporting, process automation, and data quality validation. • Experience in writing and maintaining Spark SQL and Python code in Databricks to support process automation and data analytics • Familiarity with SAS programming for data manipulation, reporting, and analytics. • Strong Tableau experience in...

Responsible for leading the development and implementation of programs and strategies by identifying insights that enhance business decision making capability. This includes developing or changing workflows and implementing process improvements to enhance organizational products, programs and service to our customers. Identify and analyze operational data and develop insights in support of business objectives. Develop and improve work flows and business processes within defined areas to improve customer service, decrease operational costs and improve overall quality. Identify and/or analyze business problems and develop recommendations for solutions to problems. Lead the development and implementation of projects and/or teams in order to produce desired results. Document and communicate project concepts, milestones and results. Recommend and assist with implementing standard policies and procedures. Ensure that corporate compliance is communicated, implemented and...

Departmental Summary This role is responsible for duties within the Epic platform, including design, configuration, customization, testing, deployment, support, and optimization of assigned Epic application areas or modules. The position partners with clients, stakeholders, Epic representatives, analysts, and IT teams to translate operational workflow needs into Epic-based solutions that align with BCBSM business and project objectives. Departmental Requirements Candidates must have relevant experience in application analysis, application support, systems implementation, configuration, testing, or related IT/business systems work. Experience supporting healthcare payer operations, including clinical data, care management, utilization management, claims, or other health plan functions, is preferred. Prior Epic implementation experience is desirable. Epic certification is required; candidates without certification may be considered if they are willing to complete the...

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 to...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Job Description Location Details: Hybrid Position Schedule / Shift: Monday-Friday 8am-5pm ET  Position Summary:    As a Claim Specialist, you will evaluate coverage, assess claim exposures, and make informed decisions that drive fair and timely resolutions. Working closely with members, medical providers, attorneys, and internal partners under minimal supervision, you'll manage challenging and complex claim scenarios while ensuring compliance with applicable regulations and company standards. The ideal candidate will have experience interpreting and applying Michigan No-Fault reform regulations to support accurate claim handling and benefit determinations. This role is ideal for a detail-oriented professional who thrives on problem-solving, sound judgment, and delivering positive outcomes for members.  Key Responsibilities:   Review assigned claims and initiate...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Big Rapids/Mount Pleasant, Michigan Territory Position Schedule / Shift: Monday-Friday 8am-5pm ET Position Summary: A highly skilled Field Auto Appraiser responsible for inspecting, evaluating, and determining repair or total loss values for complex vehicle damage claims in the field. Operates with minimal supervision and is entrusted with a high degree of independent authority to resolve technically challenging and high-severity claims. Demonstrates advanced expertise in vehicle construction, damage analysis, repair methodologies, and estimating systems. Acts as a subject matter expert, making sound, timely decisions while ensuring accuracy, compliance, and cost efficiency. Effectively negotiates with repair facilities, customers, and vendors, and provides guidance on complex technical issues, policy interpretation, and claim...

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...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Hybrid Position Schedule / Shift: Monday-Friday 8:30am-5:30pm ET Position Summary: Join AAA – The Auto Club Group as a Michigan PIP Claim Specialist , where you'll play a critical role in helping members navigate some of life's most challenging events. In this highly autonomous position, you'll leverage your investigative expertise, analytical thinking, and negotiation skills to manage complex Michigan Personal Injury Protection (PIP) claims from inception through resolution. Key Responsibilities: In this position, you will have the opportunity to: Claim handling responsibilities will include the following: reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim process, and initiating documentation in the claim handling system. Complete complex coverage analysis....

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Detroit, Michigan Chicago, Illinois Position Schedule / Shift: Hybrid– Field schedule Monday – Friday: 8:30 AM EST – 5:30 PM EST. Some weekend hours may be required based on work assignments. Position Summary: Make a meaningful impact when people need it most. As a Catastrophe Field Claims Specialist, you'll be on the front lines helping customers recover after catastrophic events by conducting on-site inspections, evaluating damage, and guiding them through the claims process. This dynamic role combines problem-solving, relationship-building, and travel, offering the opportunity to deliver exceptional service while helping communities rebuild and move forward. Key Responsibilities: Reviewing assigned claims Contacting the insured and other affected parties Setting expectations for the remainder of the claim process, and initiating...

Description     At Liberty Mutual, we’re committed to delivering exceptional legal services to our customers around the world, working to uphold and protect our policyholders’ rights and positively impacting our business. As an Attorney at Liberty Mutual, you’ll join a diverse team that values a healthy work/life balance and enjoy benefits that include eligible performance bonuses, 20 days of flexible time off each year, personal holidays, and a 401(k) plan with matching contributions. If you’re looking for a place to build a long-term career while making a positive difference, consider joining our legal team where you’ll represent Liberty Mutual and our policyholders in moderately complex civil litigation matters involving claims for monetary damages or compensation for personal injuries or property damage of moderate value.   Liberty Mutual is seeking a skilled and proactive Attorney to independently manage moderately complex civil litigation matters....

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 Leave of Absence Coordinator Leave of Absence Coordinator Our teams thrive together! We collaborate in person and embrace a flexible hybrid work style. To join us, you’ll need to live near our dynamic Center of Excellence📍 Southfield, MI. 3 00 Galleria Officentre Southfield MI 48034​. ✨ What we offer: A stable, consistent work environment —both in-office and virtua $19.31 per hour A comprehensive training program to help you...

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....

This role will focus primarily on technical training (Example: billing & policy operations, Claims and Underwriting) and soft skills training (sales & customer experience).   SUMMARY Delivers and facilitates training to groups, managers, external customers and/or on-the-job (one-on-one) training. Topics primarily relate to operational training, processes, procedures and technologies.  Provides guidance and assists in the design and development of training programs and preparation of training materials. Conducts evaluations of training and provides follow-up training to trainees as needed. Recommends training tools and formats. Works with managers and employees to identify methods of improving employee performance. Participates in the design and development of training plans/curriculum Project manages the implementation of training from end to end working with business SME and leaders; owning full implementation of training Assesses training needs using surveys,...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Detroit, Michigan – Wayne, Oakland, and Macomb County Position Schedule / Shift: Hybrid – Field schedule Monday – Friday: 8:30 AM EST – 5:30 PM EST. Position Summary: Join our team as a Field Property Claim Specialist serving the Metro Detroit area, where you’ll be the face of our claims experience and make a meaningful difference for customers during challenging times. In this role, you’ll inspect property damage, investigate claims, and work directly with homeowners to provide exceptional service and fair claim resolutions. If you enjoy working independently, building relationships, and combining problem-solving skills with field-based work, this is an opportunity to grow your career while helping customers recover and move forward. Key Responsibilities: Reviewing assigned claims Contacting the insured and other affected parties Setting...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Remote  Position Schedule / Shift: Monday-Friday 8am-5pm ET  Position Summary:    As a Claim Specialist, you will evaluate coverage, assess claim exposures, and make informed decisions that drive fair and timely resolutions. Working closely with members, medical providers, attorneys, and internal partners under minimal supervision, you'll manage challenging and complex claim scenarios while ensuring compliance with applicable regulations and company standards. The ideal candidate will have experience interpreting and applying Michigan No-Fault reform regulations to support accurate claim handling and benefit determinations. This role is ideal for a detail-oriented professional who thrives on problem-solving, sound judgment, and delivering positive outcomes for members.  Key Responsibilities:   Review assigned claims and initiate claim handling...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Hybrid Position Schedule / Shift: Monday-Friday 8am-5:30pm ET Position Summary: Join AAA – The Auto Club Group as a Senior Michigan PIP Claim Specialist , where you'll play a critical role in helping members navigate some of life's most challenging events. In this highly autonomous position, you'll leverage your investigative expertise, analytical thinking, and negotiation skills to manage complex Michigan Personal Injury Protection (PIP) claims from inception through resolution. Key Responsibilities: In this position, you will have the opportunity to: Claim handling responsibilities will include the following: reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim process, and initiating documentation in the claim handling system. Complete complex coverage...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Detroit, Michigan Chicago, Illinois Minneapolis, Minnesota Position Schedule / Shift: Hybrid– Field schedule Monday – Friday: 8:30 AM EST – 5:30 PM EST. Some weekend hours may be required based on work assignments. Position Summary: Make a meaningful impact when people need it most. As a Catastrophe Field Claims Specialist, you'll be on the front lines helping customers recover after catastrophic events by conducting on-site inspections, evaluating damage, and guiding them through the claims process. This dynamic role combines problem-solving, relationship-building, and travel, offering the opportunity to deliver exceptional service while helping communities rebuild and move forward. Key Responsibilities: Reviewing assigned claims Contacting the insured and other affected parties Setting expectations for the remainder of the claim process,...

The Marketing Manager, Vendor Relations owns the company’s promotional products, corporate gifting, and branded apparel function. This role is responsible for strategy and execution within this domain, including vendor management, sourcing, program development, and system optimization. Acting as a key partner to marketing and business stakeholders, this individual drives cost-effective, scalable solutions while ensuring high-quality brand representation and a seamless internal customer experience. Responsibilities Own the end-to-end promotional products and corporate gifting function, including vendor strategy, product selection, and program development Develop and evolve sourcing strategies to support marketing programs, events, and employee engagement initiatives Identify opportunities to improve efficiency, reduce costs, and enhance program effectiveness Build, manage, and grow a network of vendors for...