86 claim representative ii jobs found

SUMMARY This is the intermediate level of the claims handling career path responsible for managing a caseload of Michigan No-Fault Personal Injury Protection (PIP) claims of moderate to high complexity. The Claim Representative II investigates and administers both litigated and non-litigated PIP claims, exercising independent judgment in coverage analysis, compensability determinations, exposure evaluation, and claim resolution. The position requires thorough knowledge of Michigan No-Fault law, including order of priority investigations, coverage verification, injury causation analysis, and litigation management. The Claim Representative II collaborates regularly with insureds, claimants, healthcare providers, attorneys, and internal business partners to ensure timely, accurate, and compliant claim handling.   RESPONSIBILITIES/TASKS:   Determines compensability under Michigan Assigned Claims Plan and the Michigan No Fault Act by a thorough investigation of the claim....

SUMMARY:       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. Works remotely with occasional travel to on-site visits with insured municipalities.  Is a resident in the State of Michigan     RESPONSIBILITIES/TASKS: Verifies coverage of claimed property and casualty damage.   Determines liability for covered claims by thorough investigation of the claim and applicable exclusions.   Analyzes liability for claims pursuant to Michigan municipal liability statutes and caselaw. Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. Documents specifics of claims with potential for...

SUMMARY:     Claim Representative II:  This is the intermediate level of the claim handler career path. Handles moderate 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.  RESPONSIBILITIES/TASKS: Claim Representative Ii: 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. Facilitate return to work for the injured employee. Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. Documents specifics of claims with potential for subrogation recovery,...

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 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.    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. Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. Documents specifics of claims with potential for subrogation...

SUMMARY:     Claim Representative I:  This is the entry level professional claim handler. 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 factors in the determination claim reserves....

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...

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....

Company Details     With over 35 years of proven expertise in the workers' compensation industry, Key Risk delivers innovative and responsive solutions that provide our clients the freedom to do what they do best. Offering guaranteed cost options to employers nationwide, Key Risk focuses on delivering products and services within specialized verticals to reduce workers' compensation exposures and deliver industry-leading results.   All products and services are distributed through appointed insurance agents and brokers. Key Risk is a member company of W. R. Berkley Corporation, whose insurance company subsidiaries are rated A+ (Superior), Financial Size Category XV by A.M. Best Company and A+ (Strong), by S&P.   For further information about Key Risk please visit  www.KeyRisk.com   Responsibilities The  Workers’ Compensation Claims Representative III is responsible for the analysis and management of complex...

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....

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 exciting openings for Workers Compensation Senior Claims Specialists within the Central Region!   As a Senior Claims Specialist, you will work 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. You may also assist the Claims Team Manager with assigning new claims to team members, providing technical direction, and monitoring caseloads.   Training is a critical component of your success, and that success starts with reliable attendance. Attendance...

At OneAmerica Financial, our purpose is to create more certainty for our customers that leads to better moments, every day. Our commitment is to advance stability and growth in every solution and relationship.  We deliver financial strength that builds for generations, and we are always aspiring, looking ahead, and collaborating to achieve more, together.  Come be a part of this journey with us as we champion lives! The Individual Life Claims Examiner is responsible for helping our customers maintain a sense of security by independently and effectively managing an assigned caseload of claims, in a fair and ethical manner and within all requirements and service standards. Job Summary Responsible for helping our customers maintain a sense of security by independently and effectively managing an assigned caseload of claims, in a fair and ethical manner and within all requirements and service standards. Individual Life Claims Associate is responsible for: Reviewing and...

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....

  The Casualty General Adjuster manages within company standards and best practices to investigate, evaluate, and handle to conclusion complex injury claims in litigation. Handle as required in specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel. This role is available for remote, hybrid, and onsite work arrangements. Candidates must have extensive experience handling large loss Transportation/Trucking liability claims . ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Successfully handles any complex coverage or liability claims investigation. Willingness to travel for Mediations, Trials and CAT Scene incidents Evaluates complex injury claims and determines the appropriate settlement value. Attends internal and external training programs to advance knowledge in the area of liability    claims. Works closely with the Claims Supervisor, Claims Manager, or Unit Vice...

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. This is a work-from-home position with day travel to policy locations (on average 3-4 days a week) via company vehicle (personal use, gas and maintenance included). Claims inspections will include onsite and virtual inspection. Candidate Locations: Dallas, TX (preferred) Qualifications: ·         3-5 years of insurance field/property claims handling or adjusting experience ·         Solid experience with Xactimate ·         Content Inventory, Pricing and...

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. This is a work-from-home position with day travel   to policy locations in Western PA   via company vehicle (personal use, gas and maintenance included). Claims inspections will include onsite and virtual inspection. Travel is estimated to be 50% for this role. Candidate Location: Pittsburgh, PA (preferred) Qualifications: ·         3-5 years of insurance field/property claims handling or adjusting experience ·         Solid experience with XactContents ·...

The Customer Service Representative is responsible for addressing client and/or provider inquiries via email, fax, telephonic, or written correspondence ensuring adherence to contractual and state guidelines as well as client instructions.  This role will primarily focus on supporting the area of liability claims but does not perform the functions of a Claims Adjuster. Success in this position requires strong attention to detail, sound judgment, the ability to prioritize competing demands, and a commitment to accuracy and timeliness. This role requires internet upload and download speeds of at least 80Mbps and candidate must reside in Phoenix, AZ area.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receive, review, and process liability claim submissions received through email, fax, telephone, and other designated intake channels Meet established daily productivity and email-processing goals while maintaining quality and accuracy standards Answer emails from...

The Commercial Claims department is seeking a Commercial Claims Specialist II . A Claims Specialist handles all lines of Commercial business including coverage issues and litigation exposures. The Commercial Claims Specialist II is a disciplined self-starter with outstanding communication & customer service skills. Has developed coverage skills, negotiation experience, and is a creative & analytic proactive problem solver. Also, can prioritize work assignments, is an independent worker but can work as a member of the team. Individuals should be decisive, "own" the decisions they make, and the work produced, responsible, dependable and developing presentation skills. Schedule: Monday-Friday, specific hours are subject to selected start times between 8:00am-9:00am pending supervisory approval. Essential Duties and Responsibilities: Essential functions of this job are listed below in order of priority. Reasonable accommodations may be made to enable individuals to...

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 Workers Compensation Claims Specialist within the West Region!   As a Workers Compensation Claims Specialist, you will work 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. You 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 Claims Specialist II,...