8 customer service representative ii jobs found

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 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...

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:     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...

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)     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:  Primarily responsible for the following:  Authority to evaluate which submitted vendor physical and phone audits and decide which require further analysis; approval, completion and processing mail audits; processing adjustments, and reviewing phone and physical audits requiring further review in a multi-functional business unit.  Provides direct customer service via phone, fax, and e-mail to internal and external customers including, but not limited to; Business Development Consultants and Service Center representatives, Finance, and other Premium Audit staff, as well as agents, attorneys, NCCI / regulatory bureaus, and policyholders. PRIMARY RESPONSIBILITIES: •   Actively engages in the identification of solutions for multiple or cross-functional business areas.  Has an understanding of the direction of the overall industry and evaluates the related impact. •   Evaluate and decide in a timely manner which vendor audits submitted require further review and provide...

SUMMARY: Level I is in a learning capacity and will progress to the senior level when the incumbent qualifies and is  able to provide coverage and assistance across all primary responsibilities and focus areas  independently. This job is primarily responsible for products and services underwritten by the Enterprise that require  manual processes due to the complex nature of the request or system limitations. Performs in-house  collection activity that ultimately determines financial resolution of delinquent funds owed to the  Enterprise. Services, bills and manages tasks related to “specialty” (i.e. Loss Sensitive, AccuPremium)  business underwritten by the Enterprise. Calculates commission owed to agencies on a monthly basis  and handles all servicing related to agency commissions. Contacts include: Enterprise employees,  agents and policyholders, external collection agencies, NCCI and legal representatives.  PRIMARY RESPONSIBILITIES:  • Maintains in-depth knowledge of policy...