49 claims customer service representative jobs found

SUMMARY:  Primarily responsible for the customer service process associated with workers compensation claims which includes servicing customers who contact us via the ACD phone line and supporting the claims management process for all claims teams across the Enterprise. Acts as a back up to the claims intake process. Acts as a backup to the Service Center Business Development and Provider Relations teams on the ACD phone line. This position has an end time of 6:00 pm.  PRIMARY RESPONSIBILITIES:  · Supports the customer service work and processes for the Enterprise claims teams as well as the Subrogation Teams. · Answers claim inquiries from policyholders, agents, injured workers, attorneys, pharmacies, medical providers for multiple jurisdictions for the Enterprise claims teams. Provides verification of claim status for multiple jurisdictions using multiple technology sources. · Performs all facets of IME’s, AME’s, DDE’s, QME’s and any other independent type evaluation...

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. Now offering a $2500 sign on bonus to qualified candidates! Key Responsibilities: Reviewing assigned claims...

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...

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 Disability Representative Sr. PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, thoroughly reviews contested claims,...

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown   is seeking   a   Commercial Lines Account Manager  to join our growing team in   Troy, MI !         The Account Manager works with the Producer and team to ensure overall client satisfaction and   appropriate level   of quality delivery for new and current clients.     How You Will Contribute:       Coordinates and markets new and renewal business opportunities with local,   regional   and national insurance carriers. In conjunction with   producer   prepares all submissions and works with producers in   determining   proper coverages, terms, conditions, and pricing.   Develops new and renewal proposals and presentations. Shares responsibility with   producer   for the quality and accuracy of the content.   Handles daily...

Customer Service Rep I Full-time Shift: 8:00 am to 5:30 pm (Shift bidding process based on seniority) Detroit, MI Assessment required-  Customer Service Rep   Analyzes, evaluates, resolves and primarily responds to low complexity level membership issues under various product lines. Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership.  Analyze and service various product lines in the area (i.e. Commercial, Medicare, Provider, etc.). Provide responses by telephone, email, chat, check-off letters, and/or automated letters. Follow department/corporate reporting requirements. Organize work to meet National/Corporate/Department Production and Quality Standards.  Reroute misdirected inquiries.  Primarily evaluates membership issues/inquiries and price/adjudicates low complexity claims/inquiries.  Interact with others inside and outside the organization to resolve the inquiry/claim...

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...

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job) The primary responsibility of this role is to create, maintain, and build a repository of provider panels adhering to state specific regulations. This position will submit panels to agents, insured’s, and internal customers. Daily contacts include internal staff at all levels, and external customers such as agents, insured and physician offices..   ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.   · Track production statistics. Develops and maintains, databases and filing systems used for storing panels and postings.   · Provide first line contact with physician offices to validate specialty, demographic information, and acceptance on injured workers at all participating locations. · Responds to inquiries from agents, insureds and brands, includes answering general questions, accommodating special request and sending completed panels · Create provider...

As a Claims Specialist, your primarily responsible for providing a high level of customer service to all customers and retailer partners by utilizing soft skill techniques. You will provide this service daily through receiving and transmitting phone calls from retailers and customers alike, responding to emails, creating claims, reviewing documentation, monitoring progress queues, and authorizing services to facilitate the repair of furniture.  Claims Specialists must be proficient users of computers, exhibit excellent verbal and written communication, have a friendly tone, be resilient to change, and adapt to new procedures, while demonstrating professionalism with every client. Your Impact: Provide daily inbound and outbound communication coverage (phone, email, etc.) Manage inbound customer/retailer inquiries and follow-up relating to entire claim processes (determine coverage, send inspection packets, authorize technicians, order parts, recommend exchanges,...

SUMMARY:     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. Trains and mentors other team members. Provides backup support to other...

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 a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to: Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss. Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage. Follow claims handling...

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...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Hybrid – Fremont, Michigan Position Schedule / Shift: Monday-Friday 8am-5pm ET Position Summary: As an Auto Liability Michigan Claim Representative II , you will play a pivotal role in delivering exceptional claim outcomes while making a meaningful difference in customers' lives during challenging situations. In this dynamic and fast-paced role, you will investigate, evaluate, negotiate, and resolve automobile liability claims with confidence and expertise, ensuring compliance with Michigan insurance laws, company guidelines, and regulatory requirements. Leveraging strong analytical, problem-solving, and negotiation skills, you will assess liability, gather critical facts, and drive fair, timely claim resolutions. Key Responsibilities: Claim handling responsibilities will include the following: Reviewing assigned claims Contacting...

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 Disability Representative Sr. Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence: Southfield, MI : 300 Galleria Officentre Southfield MI 48034 PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely...

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...

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....

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....

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...