8 claims specialist ii jobs found

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...

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)     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 Doctors Company is seeking an experienced Claims Specialist for our Region II team. This is a remote or hybrid opportunity, depending on the final candidate’s location from the company's office, preferably in the states of Michigan, Indiana, or Illinois. The Claims Specialist independently and pro-actively manages the medical malpractice claims for assigned members. Monitors and reviews all new claims for designated members and establishes a plan of action to achieve a favorable claim resolution. Attends and facilitates member meetings and claim reviews. Reviews and recommends appropriate case reserves.  Negotiates settlements when appropriate and attends trial and provides insights and analysis.  Advocates, consults, and serves as a trusted resource and partner with physician members.   Responsibilities: Completes initial coverage analysis Develops a plan of action on assigned cases in conjunction with defense counsel and supervisor  Interview insureds within...

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...

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...

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....

Plans and delivers safety/risk management services to insured customers and internal associates. We are currently seeking a risk control professional that is technically proficient, self-motivated and results driven to fill an open position within our East Shared Services division. You must be able to conduct comprehensive safety and risk management assessments, provide our Underwriting teams with a strong analytical opinion of risk to support our goal of profitable growth within variety of middle to large premium market segment for Dealerships, Construction, Manufacturing, Wholesale Trade, Retail, Commercial Real Estate and Service industries.  In addition, the successful candidate will develop close relationships with our agents and policyholders, conducting selected safety seminars and training, to build the value-added service that Sentry is known for. The ideal candidate will be based in the suburbs west of Detroit (Wayne, Livonia, Farmington Hills, etc.) with good...