123 claims processor jobs found

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 Contents Evaluator Associate PRIMARY PURPOSE : To evaluate content inventories and assist in the research of personal property claims. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Evaluates residential and commercial contents inventories on both a Replacement Cost and Actual Cash Value (ACV) basis. Finalizes inventory in preparation of reporting including: preparing enclosures, preparing letters, and making detailed notes for reporting purposes. Facilitates use of...

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,...

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,...

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,...

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we  CARE  through our values,  Sustainability  initiatives and  inclusive corporate culture .   Our Claims team is currently seeking an Adjuster PIP - Consultant Casualty Claims. This is a full-time, exempt role with a hybrid work schedule (two days in the office) in one of our Hanover offices: Howell, MI Southfield, MI Grand Rapids, MI   POSITION OVERVIEW: Michigan Assigned Claims Plan The Consultant Casualty Claims is responsible for managing a caseload of moderate complexity claims from start to finish.  This includes conducting thorough investigations, assessing liability, negotiating settlements within defined authority limits, and maintaining clear communication with claimants, third parties, and legal representatives. The role requires strong...

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we  CARE  through our values,  Sustainability  initiatives and  inclusive corporate culture .   Our Claims team is currently seeking an Adjuster PIP - Consultant Casualty Claims. This is a full-time, exempt role with a hybrid work schedule (two days in the office) in one of our Hanover offices: Howell, MI Southfield, MI Grand Rapids, MI   POSITION OVERVIEW: Michigan Assigned Claims Plan The Consultant Casualty Claims is responsible for managing a caseload of moderate complexity claims from start to finish.  This includes conducting thorough investigations, assessing liability, negotiating settlements within defined authority limits, and maintaining clear communication with claimants, third parties, and legal representatives. The role requires strong...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   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...

Job Type: Full time   Exempt/Non Exempt:   Hourly Job Description:   Location Details: Hybrid Position Schedule / Shift: Position is primarily remote and reports to an onsite office location approximately once every 4–6 weeks. Monday – Friday, 8am – 5pm Position Summary: Are you a detail-oriented Legal Assistant who enjoys solving problems, managing complex information, and supporting meaningful business outcomes? Join our team as a Legal Assistant, where you'll play a vital role in supporting attorneys, managing personal injury litigation matters, and serving as a trusted resource across the organization. This position offers the opportunity to work independently, collaborate with diverse stakeholders, and contribute to the successful resolution of legal and regulatory matters. Employ knowledge of company and legal procedures as well as principles of insurance, banking or corporate law.  Work independently while assisting attorneys in...

Job Type: Full time   Exempt/Non Exempt:   Hourly Job Description:   Location Details: Hybrid – Dearborn, Michigan Eligible candidates must reside within a fifty-mile radius of Dearborn, Michigan for consideration. Position Schedule / Shift: Monday – Friday: 8:00 AM EST – 5:00 PM EST 8:30 AM EST - 5:30 PM EST 9:00 AM EST - 6:00 PM EST The hours of operation for the Claims Service Center are Monday - Friday: 8:00 AM EST - 6:00 PM EST. A shift bid takes place annually based on performance to determine employee's allotted schedule. Position Summary: As a Michigan Claim Customer Service Representative , you will serve as the first point of contact for members reporting losses, guiding them through the claims process with professionalism, empathy, and efficiency. In this fast-paced call center environment, you will handle claim inquiries, initiate claim services, and resolve low-complexity, one-touch claims by interpreting coverage,...

SUMMARY: Primarily responsible for assisting Business Development Consultants (BDCs) in growing and maintaining a profitable book of business and assists agents with inquiries related to underwriting rules, procedures and regulations. Manages renewal book in accordance with the needs of the region they are aligned with. Mentors CSRs with complex agency/insured questions and policy information. Reviews policy structures to determine if changes need to be made to stay in compliance with bureau rules and regulations.  Provides customer service to agencies and policyholders related to complex underwriting inquiries, policy, and audit information. Contacts include state rating bureaus, Business Development Consultants, Business Development Directors, Service Center Managers, Underwriting Technical Advisor, Service Center staff, Finance Department, Claims Department, agents and policyholders.   ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned....

Department Summary The department serves as Commercial Markets’ dedicated labor relations function, building and maintaining trusted relationships with labor organizations across Michigan while providing specialized support to UAW Union Benefit Representatives. The Sr. Auto Account Representative plays an important role in retaining key labor-based business relationships, strengthening stakeholder trust, improving member support experiences, resolving issues proactively, and aligning labor organizations, employers, and Blue Cross. Responsibilities include relationship management and stakeholder engagement. Supports communication, issue resolution, renewals, and information coordination. Provides field servicing and advisory support for UAW Benefit Representatives and labor organizations. Participates in and supports labor-sponsored education, training, and conference activities.   Responsible for providing Best in Class services for the Auto/UAW Retiree Medical...

SUMMARY: This job is primarily responsible for payment application related to accounts receivable. This position requires working in several billing, receivable and ancillary systems that require manual intervention due to complexity of systems and products underwritten by the Enterprise. Responsible for providing accurate and timely payment application and balancing, along with other ad hoc requests. Contacts include various employees of the Enterprise, agents, policyholders, medical facilities, other insurance companies, NCCI and legal representatives. PRIMARY RESPONSIBILITIES: · Balances, validates, and posts incoming cash receipts and other receivable-based transactions to various billing and ancillary systems for the Enterprise. · Independently troubleshoots and researches issues related to cash receipts and accounts receivable; reaches out to other departments regarding issues as needed. · Initiates premium write-off requests for the Enterprise as applicable after...

SUMMARY:  Provider Relations Specialist I Responsible for servicing internal and external customers who contact AF Group via the ACD phone line. Responsible for providing quality, consistent and accurate medical payment information to internal and external customers.  Provider Relations Specialist II Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software and reference library to determine appropriateness of codes and excessive charges. Responsible for making coding determinations according to state rules and regulations.  PRIMARY RESPONSIBILITIES:  PRIMARY RESPONSIBILITIES: Provider Relations Specialist I •    Utilizes ACD phone lines to manage incoming calls and inquiries. •    Provides high level of customer service for all internal or external customers thru telephonic, email and fax. •    Demonstrates dependable work ethic. •    Manages confidential client information with discretion and good...

Customer Service Rep I Full-time Department Hours of Operations: 8:00 am to 5:00 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., Facility, Professional). Provide responses by telephone, check-off letters, and/or automated letters. Follow department/corporate reporting requirements (i.e., PCRS, ICS, Special Surveys and Manual counts).  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...

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 motivated nursing professional to join our team. The position requires the person to: ·        Collaborate with claims associates to provide medical expertise in the investigation, evaluation, and appropriate resolution of injury claims including workers’ compensation, personal injury protection (no fault), and liability. ·        Evaluate medical records for relatedness to the injury and appropriate utilization of medical treatment and services. ·        Prepare and deliver trainings to claims...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details : Hybrid. The EADS must reside within Southeastern Michigan/Metro Detroit area.   Position Schedule: Monday through Friday, 8:30 a.m. to 5:00 p.m.   Position Summary: The Entrepreneurial Agent Development Specialist (EADS) serves as a business consultant and partner by providing tactical and strategic support to Entrepreneurial Agents (EA) in the assigned geography.  This position requires regular travel to agents’ office locations within assigned Metro Detroit geography.       Key Responsibilities:   Operate as a subject matter expert by becoming well versed on all components of the Connected Member Vision and product/sales knowledge.  Assist assigned EAs in the development and implementation of agency business goals.  Own and be accountable for agency success/retention and agent productivity and growth goals.  Support the acquisition of profitable new...

Description Join us as a Field Property Claims Adjuster where you’ll be responsible for helping our customers navigate the claims process and get back on their feet following damage to the homeowner’s property.  This is a role where people who love every day to be new, different and exciting, can thrive – you’ll be traveling on the road to meet customers in person, providing hands-on assessment of damage and empathetic support .   The Field Property Claims Adjuster will be traveling locally to insured homes within Sterling Heights, MI (48310) and surrounding areas. To be successful within the role, candidates should live within or near this area.   Sign-On Bonus Available!  We’re offering a sign-on bonus for experienced and actively licensed new hires.   What you’ll do Investigate and evaluate onsite to resolve complex coverage and damage issues to include preparing complete estimates of repair for the covered damages. This may...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Livonia through Ann Arbor 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 resolution strategies. Key...

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 analysis....

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 analysis....