24 technical claims specialist jobs found

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:   Sr. Claim Specialist (Michigan Assigned Claim Unit) – The Auto Club Group Candidates must reside within a 50-mile radius of Dearborn, Michigan, as this position requires occasional in-person court appearances. What you will do: The Auto Club Group is seeking prospective Senior Claim Specialist who can work under less supervision with a high-level of authority to handle highly complex technical issues and the most 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 coverage...

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:   Sr. Claim Specialist (Michigan Liability) – Fremont Reports to: Claim Manager as appropriate What you will do: The Auto Club Group is seeking prospective Senior Claim Specialist who can work under less supervision with a high-level of authority to handle highly complex technical issues and the most 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 coverage analysis on the most complex claims Ensure all possible policyholder benefits are identified. Create additional...

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...

OBJECTIVE Claims Operations Analyst Objective To serve as an expert for the Claims Division focused on claims systems, processes, file quality and training. To represent Claims on projects to ensure claim systems and processes meet business requirements. To develop, administer and perform examinations on auditable activities. To support all members of management in the effective discharge of their responsibilities by furnishing them with independent reports, analysis, appraisals, recommendations, and pertinent comments concerning the auditable activities reviewed. To monitor and report on vendor performance. To utilize analytics to measure, evaluate, and improve functions. To work with Claims division managers to develop best practices guidelines to drive quality and consistency. RESPONSIBILITIES Claims Operations Analyst Responsibilities Act as a resource for work relating to the implementation of any claims program or...

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:   Sr. Claim Specialist - Michigan PIP & Litigation – The Auto Club Group ****$5,000 Sign-On Bonus for qualified candidates. This Michigan-based position requires residency within the State of Michigan due to in-person court appearances. What you will do: The Auto Club Group is seeking prospective  Senior   Claim Specialist who can work under less supervision with a high-level of authority to handle highly complex technical issues and the most complex claims.  In this position, you will have the opportunity to: Review assigned claims, contact the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.   Complete coverage analysis on the most complex...

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...

SUMMARY:  Perform production and quality audits to ensure operations are effective, consistent and in compliance with business rules and processes.  Primary focus includes, but is not limited to, auditing the Service Center teams Claims Support, Business Development, Billing Service Center.   Responsible for performing administrative and support tasks which may be highly confidential and sensitive in nature. PRIMARY RESPONSIBILITIES:  ·    Conducts and executes the production statistics and quality audits of completed work in comparison to established documented procedures to determine accuracy within the Service Center in a timely fashion while being in compliance with statutory regulations (30%). ·    Partner with management, union representatives, human resources, and team members to establish and maintain production and quality standards for Service Center teams (15%).  ·    Compile, create, prepare and review information, audits and reports for accuracy as requested or...

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:   Eligible candidates must reside within the metro Detroit Michigan area for consideration and have a valid state driver's license. Preferred candidates should reside in Oakland, Macomb, or Wayne County. Metro Detroit Field Property Claim Specialist -AAA The Auto Club Group Reports to: Claim Manager as appropriate What you will do: Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.  Review assigned claims, Contacting the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.   Complete complex coverage analysis. Ensure all possible policyholder benefits are identified.  Create...

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:   Eligible candidates for this role must reside within a commutable distance of the Oakland County Detroit, Michigan area for consideration and have a valid state driver's license. Metro Detroit Field Property Claim Specialist -AAA The Auto Club Group Reports to: Claim Manager as appropriate What you will do: Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.  Review assigned claims, Contacting the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.   Complete complex coverage analysis. Ensure all possible policyholder benefits are identified.  Create additional sub-claims if...

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:   Eligible candidates for this role should reside within a commutable distance of Lansing, Michigan. Territory coverage includes Lansing, Jackson, Howell, and Flint Michigan areas. Job Title- Field Property Claim Specialist Reports to: Claim Manager as appropriate What you will do: Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.  Review assigned claims, Contacting the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.   Complete complex coverage analysis. Ensure all possible policyholder benefits are identified.  Create additional sub-claims if needed.  Complete an...

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:   This role reports to the Meemic Insurance sector of AAA Auto-Club Group. Eligible candidates must reside within the metro Detroit Michigan area for consideration and have a valid state driver's license. Metro Detroit Field Property Claim Specialist -AAA The Auto Club Group Reports to: Claim Manager as appropriate What you will do: Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.  Review assigned claims, Contacting the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.   Complete complex coverage analysis. Ensure all possible policyholder benefits are identified....

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:   This catastrophe field claims specialist will cover territories in Detroit Michigan, Chicago Illinois, or Minneapolis Minnesota. Eligible candidates must live within commutable areas of these locations for consideration. Catastrophe Field Claims Specialist - The AAA Auto-Club Group Reports to: Claim Manager as appropriate                                     What you will do: Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.  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....

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...