7 medical case manager i jobs found

The Senior Indemnity Claims Specialist handles complex and high-profile Workers' Compensation claims following company standards. This role works closely with case managers and attorneys, manages subrogation, and negotiates settlements. The Senior Claims Specialist ensures the best possible outcome for the claim, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description The Bodily Injury Team Leader role will be managing a team of attorney-represented injury adjusters for our west coast claims team. Candidates must be able to work Pacific time zone hours. The Team Leader is responsible for providing our Agents exceptional claims and inquiry service through chat while managing and motivating ten to fifteen adjuster staff or vendors to achieve inspired levels of performance and expert execution of required claim processes. This individual supports the implementation of operational initiatives that enable the achievement of Claim, Discipline, Claims Service Area (CSA) and...

Job Responsibilities and Requirements Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy.  Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim. Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line. Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner. Conducts in-depth...

The Bilingual Customer Service Representative is responsible for addressing client and/or provider inquiries via email, fax, telephonic, or written correspondence ensuring adherence to contractual and state guidelines as well as client instructions.  This role requires internet upload and download speeds of at least 80Mbps.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Answer phone calls, return phone calls Answer emails from clients, providers and internal referring offices Review previous history of the provider in MedCheck, Scheck and SalesCloud Consult with Supervisor or other departments to clarify answers to inquiries Contact provider to discuss findings at the appropriate level Maintain reports and spreadsheets as needed Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of Workers Compensation fee schedules and regulations Effective verbal and written communication skills Good organizational skills and ability to...

Overview The Lead Claims Examiner is responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds, claimants and medical providers. Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization. Responsibilities Follows AmTrust policies and procedures in managing claims. Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers. Evaluates, establishes, maintains and adjusts reserves based on fact, company standard and experience. Skillfully negotiates claims, turning adverse perspectives into quick resolution. Gains trust of other parties to negotiations and demonstrates good sense of timing....

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description National General Insurance is currently hiring an experience Bodily Injury Telephone Adjuster. The ideal candidate will be based in one of the following Pacific time zone states: California, Nevada, Oregon, Arizona, and possess experience in handling homeowner, commercial, or auto liability claims. Candidates must be able to work 8am--5pm Pacific time zone hours. Litigation experience may be necessary for this role. The ideal candidate will possess strong analytical skills, excellent attention to detail, and the ability to effectively manage and negotiate claims. Responsible for investigating and...

CopperPoint has an exciting opportunity for a Sr. Associate Underwriter I. In this role, you will assist the Underwriter with the quoting, issuance, and ongoing maintenance of new and renewal business across Workers’ Compensation and Property & Casualty lines. You will own end-to-end process and workflow responsibility for assigned new and renewal accounts, including reviewing and requesting required underwriting information to support accurate policy quoting, issuance, and maintenance.   Job Responsibilities Prepare quotes based on set criteria/thresholds/revisions and instructions from Underwriting Assist in reviewing quotes in rating system pre underwriting to ensure quality control for new and renewal business. Solicit renewal information from broker/agency to include sending required pre-renewal notifications Quality assurance of below throughout the lifecycle of policy: Loss information in account summary. Underwriting platform/system...