89 workers compensation jobs found

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in the Southeast Michigan/ Detroit Metro area. Work from home, and on the road. Monday – Friday, regular business hours.   As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides in-person and telephonic Medical Case Management to individuals, involving the patient, physician, other health care providers, the employer, and the referral source Utilizes their medical...

SUMMARY:  This is an entry level position that is part of a formal training program. This job is foundational and expected to be a starting point within a specific assigned risk discipline (policy management/audit, billing & collections or agency maintenance) and is expected to last up to one year.   Upon completion of the training program the trainee is expected to be familiar with the foundational department policies, processes, procedures, and terminology related to the jobs. In addition, the trainee will be proficient in the job responsibilities and tasks of the progressive positions within the career path. The trainee will be evaluated on their progress during the training period and on successful completion of the training plan. Upon satisfactory completion of training, the trainee will be eligible for a targeted position within the career path.   ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. In a Learning Capacity: Learn...

SUMMARY:   Primarily responsible for supporting the management of the all files by analyzing, indexing, e-indexing, and assigning a sub document type to all documents received by Departments within the Enterprise. Also responsible for identifying key information on documents and inputting information into the keywords of the document and in the appropriate data fields in the claim system.     PRIMARY RESPONSIBILITIES:  Analyzes incoming documents and assigns the appropriate document sub type to them Reviews each document and adds pertinent information to the document keywords and to appropriate data fields in the claim system Opens, sorts, prepares, bundles, scans, and validates/verifies physical and electronic mail for all departments daily. Determine appropriate criteria to accurately index an electronic image to initiate workflow to the proper department. Performs computer inquires through multiple systems for other departments and verifies member coverage....

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: (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....

SUMMARY:   Primarily responsible for supporting the management of the all files by analyzing, indexing, e-indexing, and assigning a sub document type to all documents received by Departments within the Enterprise. Also responsible for identifying key information on documents and inputting information into the keywords of the document and in the appropriate data fields in the claim system.     PRIMARY RESPONSIBILITIES:  Analyzes incoming documents and assigns the appropriate document sub type to them Reviews each document and adds pertinent information to the document keywords and to appropriate data fields in the claim system Opens, sorts, prepares, bundles, scans, and validates/verifies physical and electronic mail for all departments daily. Determine appropriate criteria to accurately index an electronic image to initiate workflow to the proper department. Performs computer inquires through multiple systems for other departments and verifies member coverage....

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 This role will focus primarily on underwriting and claims training. Candidates within a commutable distance to Lansing, MI will be considered Hybrid (1-3 days per week in office) Delivers and facilitates training to groups, managers, external customers and/or on-the-job (one-on-one) training. Topics primarily relate to operational training, processes, procedures and technologies.  Provides guidance and assists in the design and development of training programs and preparation of training materials. Conducts evaluations of training and provides follow-up training to trainees as needed. Recommends training tools and formats. Works with managers and employees to identify methods of improving employee performance. RESPONSIBILITIES Participates in the design and development of training plans/curriculum Project manages the implementation of training from end to end working with business SME and leaders; owning full implementation of training Assesses training...

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...

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 Sr Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence: Southfield, MI : 300 Galleria Officentre Southfield MI 48034 PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely...

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....

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in the West Michigan area. Work from home, and on the road. Monday – Friday, regular business hours.   As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides in-person and telephonic Medical Case Management to individuals, involving the patient, physician, other health care providers, the employer, and the referral source Utilizes their medical and nursing knowledge...

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....

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:   Delivers and facilitates training to groups, managers, external customers and/or on-the-job (one-on-one) training as well as collaborates with content team to design training material. This position is primarily responsible for the training needs of union represented jobs with a smaller amount of time spent on various non-union jobs as a secondary responsibility. Topics primarily relate to operational training, processes, procedures and technologies.  Provides guidance in the design and development of training programs and preparation of training materials. Evaluates training, develops recommendations, and project manages training solutions. Works with managers to identify methods of improving employee performance. PRIMARY RESPONSIBILITIES: Conducts training needs analysis, design, and development training.  Partners with leaders, Business Analysts, Subject-matter experts, content development and other trainers to implement training plans  Manages implementation...

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...

WHAT WE'RE LOOKING FOR Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a Business Development Manager in Michigan!  This individual will be responsible for business development efforts and brand strategy within a specified territory.  This involves evaluation of production patterns in new and renewal business to uncover opportunities for refinements to support profitable growth.  You will work collaboratively with other Business Development Managers, Underwriting management, and additional corporate resources to develop opportunities by industry, class code or segment, and to more effectively monitor/evaluate agency performance. You'll stay ahead of competitive intelligence and help prevent production barriers, as well as develop opportunities to improve ease of doing business with BHHC and provide input to improve overall customer experience.  Frequent travel within a specified territory required.   Must be legally authorized to...

WHAT WE'RE LOOKING FOR Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a Business Development Manager in Michigan!  This individual will be responsible for business development efforts and brand strategy within a specified territory.  This involves evaluation of production patterns in new and renewal business to uncover opportunities for refinements to support profitable growth.  You will work collaboratively with other Business Development Managers, Underwriting management, and additional corporate resources to develop opportunities by industry, class code or segment, and to more effectively monitor/evaluate agency performance. You'll stay ahead of competitive intelligence and help prevent production barriers, as well as develop opportunities to improve ease of doing business with BHHC and provide input to improve overall customer experience.  Frequent travel within a specified territory required.   Must be legally authorized to...

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 Sr Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:       Southfield, MI   : 300 Galleria   Officentre   Southfield MI 48034   PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining...