68 customer care representative jobs found

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....

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: Remote  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 claim handling...

Responsible for the completion of assignments for the coordination of the Quality Management Program through problem identification, development and coordination of QM studies, investigation of quality-related member and practitioner inquiries, and plan compliance with state and federal regulations and accrediting bodies.  Measures and analyzes results of QI activities, recommends interventions, and conducts follow-up. Collaborates with Care Management, Customer Services, Provider Affairs, and other departments to provide rapid and thorough identification, investigation and resolution of member, practitioner, and provider quality related issues. Works with plan Medical Director on development and revision of Clinical Practice Guidelines.  Assists management with the revision of Quality Management policies. Develops, maintains, and enhances reporting methods to identify trends in physician and member behavior.  Completes applicable...

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....

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 Disability Representative Our teams thrive together! We collaborate in person and embrace a flexible hybrid work style. To join us, you’ll need to live near our dynamic Centers of Excellence📍 Southfield, MI. 3 00 Galleria Officentre Southfield MI 48034​. ✨ What we offer: A stable, consistent work environment —both in-office and virtual A comprehensive training program to help you support employees and customers from some of...

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....

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Claim Specialist - Michigan PIP – The Auto Club Group Reports to : Claim Manager as appropriate What you will do: The Auto Club Group is seeking prospective Claim Specialist who will work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims. 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. Ensure all possible policyholder benefits are identified. Create additional sub-claims if needed....

SUMMARY Medical Bill Review Specialist I Primarily responsible for analyzing bills for multi-state Workers Compensation medical claims to determine appropriateness of services billed. Responsible for analyzing simple billings by utilizing our Medical Bill Review (MBR) software to determine appropriateness of codes. Responsible for making bill review processing determinations according to rules, regulations, and/or third-party partners. Medical Bill Review Specialist II Primarily responsible for performing technical review of more complex medical bills, including modifiers, anesthesia, & psychiatric. Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software to determine appropriateness of codes and excessive charges. Also responsible for analyzing assigned medical bills to determine compliance with business rules, client specific requirements and multiple state rules, regulations and...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Claim Specialist – Michigan PIP – The Auto Club Group Reports to: Claim Manager as appropriate What you will do : The Auto Club Group is seeking prospective Claim Specialist who will work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims. 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. Ensure all possible policyholder benefits are identified. Create additional sub-claims if needed....

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Claim Specialist – Michigan PIP – The Auto Club Group Reports to: Claim Manager as appropriate What you will do : The Auto Club Group is seeking prospective Claim Specialist who will work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims. 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. Ensure all possible policyholder benefits are identified. Create additional sub-claims if needed....

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Intermediate Michigan PIP Claim Specialist – The Auto Club Group Reports to: Claim Manager as appropriate What you will do : The Auto Club Group is seeking prospective Claim Specialist who will work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims. 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. Ensure all possible policyholder benefits are identified. Create additional sub-claims...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Michigan Personal Injury Protection Claim Specialist – The Auto Club Group Reports to: Claim Manager as appropriate What you will do: The Auto Club Group is seeking prospective Claim Specialist who will work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims. 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. Ensure all possible policyholder benefits are identified. Create additional...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Claim Specialist – Michigan PIP – The Auto Club Group Reports to: Claim Manager as appropriate What you will do : The Auto Club Group is seeking prospective Claim Specialist who will work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims. 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. Ensure all possible policyholder benefits are identified. Create additional sub-claims if needed....

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Michigan Personal Injury Protection Claim Specialist – The Auto Club Group Reports to: Claim Manager as appropriate What you will do: The Auto Club Group is seeking prospective Claim Specialist who will work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims. 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. Ensure all possible policyholder benefits are identified. Create additional...

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 Care Team Representative Entry-level, Care Team Representative Our teams thrive together! We collaborate in person and embrace a flexible hybrid work style. To join us, you’ll need to live near one of our dynamic Centers of Excellence📍 Southfield, MI : 300 Galleria Officentre, Southfield MI 48034 ✨ What we offer: A stable, consistent work environment —both in-office and virtual A comprehensive training program to help you support employees and...

Would you like to take ownership in a dynamic, high-growth business that truly walks the talk? Oswald Companies seeks goal-driven professionals ready to take their career to the next level. JOB PURPOSE Responsible to generate sales opportunities with new clients in a defined market; coordinates personal sales efforts with department team members and other internal staff.  Also collaborates with the team to cross-sell products and services; develops and implements a personal sales plan with direct accountability for annual production goals. ESSENTIAL DUTIES AND RESPONSIBILITIES Establishes a sales development plan to originate business with new clients; builds and maintains a book of business and incrementally grows the book at plan each year.  Capitalizes on opportunities to cross-sell multiple lines of coverage to existing clients; collaborates with department peers and service staff managing the company's various practices to maximize the sale of services...

Job Type: Full time   Exempt/Non Exempt:   Hourly Job Description:   (Must reside within 50 miles from Dearborn, Michigan) Location Details: Dearborn, Michigan Position Schedule / Shift: Monday-Friday 8am-5:30pm ET Position Summary: The Auto Club Group is looking for a detail-oriented and analytical Michigan Medicare Compliance Claims Analyst to play a vital role in ensuring accurate, compliant, and cost-effective medical claims processing. In this dynamic position, you'll leverage web-based technology and specialized applications to review, analyze, document, and manage medical claims while helping deliver exceptional service to members, providers, and internal stakeholders. As a trusted subject matter expert, you'll investigate and evaluate medical billing charges, ensuring treatments and services aligning with claim-related injuries and Medicare compliance requirements. You'll analyze medical records, explanation of...