17 claims operations technician jobs found

We’re thrilled that you are interested in joining us here at the Amynta Group! Provides exceptional customer service to internal and/or external customers, including field technicians and business partners. Responsibilities include but are not limited to: providing standard information, completing forms, determining status of claims and cases based on plan guidelines and meeting or exceeding department metrics for productivity and quality. ESSENTIAL JOB FUNCTIONS: Assists consumers by providing highest level of customer service; remains professional and polite at all times. Provides primary dispatching and administrative duties related to scheduling requests for service to technicians. Creates, dispatches and processes work orders to field personnel while ensuring all appropriate documentation and data entry is completed in a timely manner; interprets and follows-up on technician reports. Develops strong relationships with technicians and business partners....

We’re thrilled that you are interested in joining us here at the Amynta Group! Provides exceptional customer service to internal and/or external customers, including retailers and business partners. Responsibilities include but are not limited to: providing standard information, completing forms, determining status of claims based on plan guidelines and meeting or exceeding department metrics for call handling, productivity and quality. ESSENTIAL JOB FUNCTIONS: Assists consumers by providing highest level of customer service; remains professional and polite at all times. Responds to standard questions and concerns in a timely manner from consumers requesting status updates; completes follow-up requests to ensure customer satisfaction; communicates in a clear and educated manner. Reviews protection plans, service requests and technician reports to confirm accurate plan coverage; determines appropriate next steps for claim resolution. Contacts retailers,...

This role is responsible for designing, optimizing, and governing the conversational content and prompt architecture that powers AI-enabled member self-service. The role translates complex healthcare, insurance, benefits, and operational terminology into clear member language and influences model behavior through grounded prompt design, conversational examples, testing, feedback, monitoring, and continuous refinement. This role will also partner with Product Management, Product Owners, design, engineering, data and AI teams, member experience, operations, legal, compliance, privacy, clinical, and business subject-matter experts to ensure conversations are understandable, accurate, trusted, accessible, and aligned to product outcomes and organizational standards. Lead conversational content and prompt strategy for AI-enabled member self-service. Define member-friendly wording, conversational tone, response length, response structure, progressive disclosure, follow-up patterns,...

Provides technical, data and analytical support to customer departments such as  Quality, Value Partnerships, Hospital Contracting, Care Management, Risk Adjustment and HCV.   ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following. Other duties may be assigned.  Leads or participates, with some direction, in projects where data solutions are necessary. Provides programming and data expertise for simple and moderately complex projects and ad-hoc requests.   Presents data and solutions to internal and/or external customers in a logical way. Provides data support and analysis for programs supporting over 4 million BCBSM beneficiaries using administrative claims and supplemental data. .   Provides analysis and data support for various corporate departments including Quality, Risk Adjustment, Value Partnership, Care Management, and Hospital Contracting, in support of major corporate initiatives such as EMR Connectivity, PGIP,  Risk Adjustment,...

SUMMARY:  Primarily responsible for performing incident management on Enterprise IT equipment, which includes installation, maintenance, troubleshooting, and repair of hardware and software. Assists and consults with vendors, consultants, subject matter experts, management, and the customer on the evaluation, analysis and troubleshooting of systems. Provides support documentation, workarounds and solutions to customer and peers through training and communication. Maintains a high level of customer service through relationship management and actionable follow through. Expounds upon the skills and responsibilities of the Systems Support Technician position. 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 relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS: A. EDUCATION REQUIRED:   Associate degree in computer science field...

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...

                                                                   Moderate travel, including nationwide travel, is required (up to 50%) Department Summary Serve as a subject matter expert for UAW Trust benefits, claims, and member advocacy. Possess NASCO claims processing knowledge and experience. Demonstrate strong understanding of MAPPO, Medicare Advantage, Commercial, HMO, and PPO benefit structures and claim processing differences. Investigate and resolve complex claims issues, benefit processing concerns, and member escalations. Support member meetings and travel team activities, including direct member interactions and issue resolution. Attend and actively participate in internal and external workgroup meetings representing the Trust account. Coordinate, submit, and oversee benefit implementation requests and ensure implementations are accurately configured and tested. Partner with operational, benefit, provider, and claims teams to identify and...

Join the Health Care Value Strategic Informatics and Program Performance team where you will be responsible for leveraging advanced analytics, predictive modeling, and data visualization to generate actionable insights that improve healthcare outcomes, optimize program performance, and support strategic decision-making. This role partners with business leaders, clinical teams, pharmacy services, and operational stakeholders to analyze healthcare data, identify trends, evaluate program effectiveness, and provide data-driven recommendations related to cost, quality, utilization, and member outcomes. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Analyze large volume of health care claims data using advanced statistics/machine learning methods to understand existing and predict future health care trends and anomalies. Proactively discovers potential areas for medical cost improvement and management/healthcare initiative strategies....

Position Summary Responsible for planning, organizing, directing, and executing complex analytical initiatives that support Health Care Value programs and performance management activities. This position operates with a high degree of independence and is responsible for researching, analyzing, and interpreting healthcare data to identify trends, evaluate program performance, quantify savings, and provide actionable business recommendations. The Senior Healthcare Analyst partners with internal stakeholders, vendors, providers, and leadership teams to develop analytical solutions, monitor contractual performance, and deliver strategic insights that improve healthcare affordability, quality, and operational effectiveness. Key Responsibilities Healthcare Analytics & Performance Measurement Lead the research, analysis, and evaluation of healthcare claims, authorization, utilization, provider, and membership data to identify trends, risks, and opportunities....

SUMMARY The Senior Commercial Insurance Field Underwriting Specialist (internal title: Senior Business Development Specialist) drives profitable growth, retention, and agency engagement for Accident Fund Commercial Markets Small Business across Western to Mid-Michigan. This field-based role develops and manages independent agency relationships, evaluates and underwrites complex commercial insurance risks within assigned authority, and identifies new business opportunities. Working closely with internal partners, the specialist delivers responsive solutions, supports territory strategy, and serves as a key market representative through regular agency visits and business development activities. ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following. Other duties may be assigned. Evaluates prospective and existing accounts for eligibility, insurability, exposure, and pricing; prepares quotations and accepts or declines business within assigned underwriting...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   This is primarily a remote position reporting to an office roughly once every 6 weeks, in addition to any required in-person court appearances.    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 functions): Reviews and analyzes files, insurance policies, all allegations and pertinent...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: After in office training is completed, this position may be required to report to an office 1-2 times per month. Position Schedule Monday- Friday 9am-5pm Position Summary: Uses advanced specialized knowledge to handle complex to highly complex litigation of cases of unlimited exposure in which the insured or the Company is a defendant. Controls all aspects of litigation, including trial preparation, discovery, negotiation, presentation and appeals from District to Circuit Court.  Exercises discretion and judgment in performing all functions with minimal supervision. To support those duties, we are applying a monthly cap on new case assignments. Key Responsibilities: Case Analysis and Preparation Analyzes, files, reviews all allegations, and renders legal opinions to Claims personnel regarding evaluation and disposition of injury cases....

Job Title: Financial Analyst - FP&A - Enterprise Reporting Department: Finance Location: Grand Rapids, MI About Acrisure    A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the solutions to grow boldly forward. Bringing cutting-edge technology and top-tier human support together, it connects clients with personalized solutions across a range of insurance, reinsurance, payroll, benefits, cybersecurity, real estate services – and beyond. Since 2013, Acrisure has grown in revenue from $38 million to ~$5 billion and employs ~20,000 colleagues in 19 countries. And this is just the beginning. To learn more, visit Acrisure.com. Scope and Responsibilities: Monitor, review, and report on trends and patterns of revenue, expenses and other financial and operational KPI’s with Acrisure’s Partners.  This FP&A position will collaborate with FP&A leadership, operational leaders and budget owners. Effectively...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: This is primarily a remote position reporting to an office roughly once every 6 weeks, in addition to any required in-person court appearances. Position Schedule Monday- Friday 9am-5pm Position Summary: Uses advanced specialized knowledge to handle complex to highly complex litigation of cases of unlimited exposure in which the insured or the Company is a defendant. Controls all aspects of litigation, including trial preparation, discovery, negotiation, presentation and appeals from District to Circuit Court.  Exercises discretion and judgment in performing all functions with minimal supervision. To support those duties, we are applying a monthly cap on new case assignments. Key Responsibilities: Case Analysis and Preparation Analyzes, files, reviews all allegations, and renders legal opinions to Claims personnel regarding evaluation...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: This is primarily a remote position reporting to an office roughly once every 6 weeks, in addition to any required in-person court appearances. Position Schedule Monday- Friday 9am-5pm Position Summary: 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.  Key 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 answers any appropriate motions when questions of law or liability are in dispute....

Help us insure it Tokio Marine HCC - Public Risk Group,  a member of the Tokio Marine group of companies, is a market leader in providing specialized insurance products for municipal entities. We cover counties, cities, townships, villages, police departments, prisons, fire departments and more. We serve the growing insurance and risk management needs of medium and large governmental entities and provide property and casualty insurance coverages in multiple states. Role Overview Systems Analyst – Data (Insurance Claims) ***The ideal candidate is legally authorized to work in the United States and resides within a reasonable commuting distance of Troy, Michigan, to support a hybrid schedule. *** As a Systems Analyst for Public Risk Group, you will help design, build, and maintain the data solutions that power our underwriting, operations, reporting, and analytics platforms. Working alongside experienced engineers, you will develop data pipelines, integrate...

Job Title: Vice President, Actuarial and Business Operations Location: Troy, Michigan – Hybrid; 3 days in-office and 2 days work-from-home Employment Type: Full-Time Requisition Begin Date: 09/08/2026 Requisition End Date: 11/08/2026 Posting may close earlier if filled or business needs change. Help us insure it Tokio Marine HCC – Public Risk Group, a member of the Tokio Marine Group of companies, is a market leader in providing specialized insurance products for municipal entities. We serve counties, cities, townships, villages, police departments, prisons, fire departments, and other governmental entities. Our business supports the insurance and risk management needs of medium and large public entities by providing property and casualty insurance coverages in multiple states. Role Overview Tokio Marine HCC Public Risk Group is seeking an accomplished Vice President, Actuarial and Business Operations to serve as a key member of the leadership team. Reporting...