18 apd claim representative ii jobs found

Description Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers an exciting opening for a Senior Workers Compensation Claims Specialist within the West Region!   The Senior Claims Specialist works within a Claims Team, using the latest technology to review, analyze and process claims that are routinely characterized as moderately complex to complex within assigned authority limits. This includes making decisions about liability/compensability, evaluating losses, negotiating settlements and managing an inventory of commercial property/casualty claims involving bodily injury or property loss. The Senior Claims Specialist may also assist the Claims Team Manager with assigning new claims to team members, providing technical direction, and monitoring caseloads.   Depending on your overall skills and experience, you may be considered as a Senior Claims...

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source Provide assessment, planning, implementation, and evaluation of...

Overview Position Summary: If you’re passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field adjusting position traveling to loss sites that have been damaged by fire, water, weather, or other unexpected events. You may also handle some claims via virtual technology and/or collaborate with vendors.  The Property Claims Field Adjuster ll will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and policyholders, and provide exceptional service to our customers.   Geo-Salary Information...

SUMMARY:     Claim Representative I:  This is the entry level professional claim handler.  Handles medical only and indemnity benefits.  Exercises some discretion in the determination of compensability of claims.  Considers many factors in the determination claim reserves.  Negotiates and settles claims within given authority.    Claim Representative II:  This is the intermediate level of the claim handler career path.  Handles moderate to difficult claims.  Exercises progressively more discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves.  Negotiates and settles claims within given authority.    Claim Representative III:  This is the advanced level of the claim handler career path.  Investigates claims and exercises significant discretion in the determination of compensability of claims.  May handle large, more complex customers requiring high touch, labor intensive claim service.  Considers many...

SUMMARY     This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large, more complex customers requiring high touch, labor intensive claim service. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Mentors lower-level claim handlers. Coordinates special projects and provides guidance to others. Candidate must have California experience.   ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following. Other duties may be assigned. Verifies workers’ compensation coverage of employers and injured employees.   Determines compensability under workers’ compensation by thorough investigation of the claim.   Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. Facilitates return to work for the injured employee....

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the worlds' largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of -a kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. THE OPPORTUNITY: The Account Manager II manages a book of insurance business, and provides professional, courteous service to clients, carrier representatives, underwriters, business partners, and HUB colleagues; manages complex risk and exposures and acts with a high degree of independent discretion, autonomy, and decision-making. The Account Manager II also supports Producers and other support...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the worlds' largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of -a kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. THE OPPORTUNITY: The Account Manager II manages a book of insurance business, and provides professional, courteous service to clients, carrier representatives, underwriters, business partners, and HUB colleagues; manages complex risk and exposures and acts with a high degree of independent discretion, autonomy, and decision-making. The Account Manager II also supports Producers and other support staff...

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source Provide assessment, planning, implementation, and evaluation of...

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source Provide assessment, planning, implementation, and evaluation of...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the worlds' largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of -a kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. THE OPPORTUNITY: The Account Manager II manages a book of insurance business, and provides professional, courteous service to clients, carrier representatives, underwriters, business partners, and HUB colleagues; manages complex risk and exposures and acts with a high degree of independent discretion, autonomy, and decision-making. The Account Manager II also supports Producers and other support...

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.   This is a remote position in CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and/or direct reporting manager   Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Utilize clinical and/or technical expertise to address the provision of medical care and identify inappropriate billing practices and errors, such as: duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time...

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source Provide assessment, planning, implementation, and evaluation of...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the worlds' largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of -a kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. THE OPPORTUNITY: The Account Manager II manages a book of insurance business, and provides professional, courteous service to clients, carrier representatives, underwriters, business partners, and HUB colleagues; manages complex risk and exposures and acts with a high degree of independent discretion, autonomy, and decision-making. The Account Manager II also supports Producers and other support...

The Utilization Review Case Manager gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay while supporting the goals of the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identifies the necessity of the review process and communicates issues of concern to the appropriate claims staff/customer Collects data and analyzes information to make decisions regarding certification or denial of treatment Documents all work in the appropriate manner Promotes utilization review services with stakeholders Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) Additional duties as assigned   KNOWLEDGE & SKILLS:  Must have thorough knowledge of both CPT and ICD...

The Utilization Review Case Manager gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay while supporting the goals of the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identifies the necessity of the review process and communicates issues of concern to the appropriate claims staff/customer Collects data and analyzes information to make decisions regarding certification or denial of treatment Documents all work in the appropriate manner Promotes utilization review services with stakeholders Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) Additional duties as assigned   KNOWLEDGE & SKILLS:  Must have thorough knowledge of both CPT and ICD...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the world's largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of-a-kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. THE OPPORTUNITY: The Employee Benefits Account Management team provides critical support to clients through day-to-day program oversight, client advocacy and systems management in order to effectively managing their health and welfare programs. The Account Manager II acts with a high degree of independent discretion, autonomy, and decision-making in managing a book of business. The Account Manager II...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the world's largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of-a-kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. WHY CHOOSE HUB? Throughout our network of more than 450 HUB offices in North America, we offer a competitive, exciting and friendly work environment that strategically positions our employees for longevity and success. At HUB, we believe in investing in the future of our employees, and provide continuous opportunities for growth and development .   Our entrepreneurial culture fosters an...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the world's largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of-a-kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. WHY CHOOSE HUB? Throughout our network of more than 450 HUB offices in North America, we offer a competitive, exciting and friendly work environment that strategically positions our employees for longevity and success. At HUB, we believe in investing in the future of our employees, and provide continuous opportunities for growth and development .   Our entrepreneurial culture fosters an...