44 apd claim representative ii 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:   How you will benefit: Will earn a competitive salary of $65,728.- $85,000 annually with annual bonus potential based on performance. Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include: 401k Match Medical Dental Vision PTO Paid Holidays Tuition Reimbursement  ***This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.***                                   Position Description ****This position is currently able to work remotely from a...

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:     How you will benefit: Will earn a competitive salary of $65,728.- $85,000 annually with annual bonus potential based on performance. Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include: 401k Match Medical Dental Vision PTO Paid Holidays Tuition Reimbursement  ***This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.***                                   Position Description ****This position is currently able to work remotely from a...

We're seeking a compassionate and skilled professional to support customers through the claims process with empathy and clarity. You'll investigate, evaluate, and resolve claims--ranging from minor incidents to more complex cases with bodily injury--while explaining and investigating coverage issues and next steps clearly. Through out this process, you will ensure timely decisions, authorize payments within policy limits, and document all claim activity. You may also encounter claims involving legal matters. If you're detail-oriented and driven to help others, this is your chance to make a real impact! This position will report to a Sentry Insurance office, or has the possibility to work remotely from home. What It Takes: As a Claims Representative II, you’ll ensure the delivery of quality claim service to our customers, and other parties to a claim, while protecting the assets of Sentry.  You’ll do this by: Claims being handled will fall under property damage, and...

Overview Position Summary: If you’re passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field adjusting position traveling to loss sites that have been damaged by fire, water, weather, or other unexpected events. You may also handle some claims via virtual technology and/or collaborate with vendors.  The Property Claims Field Adjuster ll will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and policyholders, and provide exceptional service to our customers.   Geo-Salary Information...

The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel.   ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides medical case management to individuals through coordination with the...

Overview The Client Experience Manager, reports to the Manager, Client Experience and is responsible for client support throughout the life of the policy.  The Client Experience Manager (CXM)’s goal is to support Sales, Underwriting and Claims to drive retention and growth by creating loyal and satisfied clients while improving loss cost and experience mods. The CXM will support our internal Sales, Underwriting and Claims teams by working along side them to address anything they need, or a client needs with a regional focus.  This model will allow one point of accountability to address any issues that arise over the life of a policy.   The CXM must maintain a solid understanding of AmTrust’s mission, vision, and values and uphold the standards of the AmTrust organization. Responsibilities Responsibilities:  The Client Experience Manager will be a proactive consultative resource for the client. They...

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:   Job Description     How you will benefit: Will earn a competitive salary of $57,699.20-$77,000.00 with annual bonus potential based on performance. Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include: 401k Match Medical Dental Vision PTO Paid Holidays Tuition Reimbursement  ***This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership....

  The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides medical case management to individuals...

The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides medical case management to individuals through...

We’re thrilled that you are interested in joining us here at the Amynta Group! We are seeking an experienced professional to support the Executive Managing Director in expanding Ambridge’s operations in the United States. This role involves leading marketing initiatives to strengthen the company’s local presence, assisting in the hiring and development of junior staff, and underwriting U.S.-based Representations & Warranties (R&W) insurance opportunities. The candidate will conduct detailed due diligence, negotiate and draft insurance policies with brokers, proposed insureds, and their advisors, and provide support to the claims team as needed. This position will also collaborate with Ambridge teams in Europe, Canada and other U.S. offices to support cross-border underwriting efforts. Underwriting Counsel – R&W •    Engage in marketing efforts to establish Ambridge’s local presence in Midwest  •    Review and underwrite US R&W opportunities  •    Review claims...

The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel.   ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides medical case management to individuals through coordination with the...

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 Homeowners Claim Rep II – Meemic What you will do: (Primary Duties & Responsibilities) The Auto Club Group is seeking prospective Homeowner Claim Representative II who can work under normal supervision with an intermediate-level approval authority to handle moderately complex claims within Claim Handling Standards in the field or inside units, resolve coverage questions, take statements, and establish clear evaluation and resolution plans for 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, and initiate documentation in the claim handling system. Complete coverage analysis including a review of policy...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the world's largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of-a-kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. WHY CHOOSE HUB? Throughout our network of more than 450 HUB offices in North America, we offer a competitive, exciting and friendly work environment that strategically positions our employees for longevity and success. At HUB, we believe in investing in the future of our employees, and provide continuous opportunities for growth and development .   Our entrepreneurial culture fosters an...

The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel. This position is onsite. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides medical case management to individuals through...

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc.  This is a remote role. Candidate must reside in CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and...

Overview Candidates can reside in Phoenix, AZ or Tuscon, AZ   Position Summary: If you’re passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field adjusting position traveling to loss sites that have been damaged by fire, water, weather, or other unexpected events. You may also handle some claims via virtual technology and/or collaborate with vendors.  The Property Claims Field Adjuster ll will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and policyholders, and provide exceptional service to our...

Job Summary The Account Manager II manages a book of insurance business, and provides professional, courteous service to clients, carrier representatives, underwriters, business partners, and HUB colleagues; manages complex risk and exposures and acts with a high degree of independent discretion, autonomy, and decision-making. The Account Manager II also supports Producers and other support staff in obtaining, maintaining, and expanding business.  Duties & Responsibilities Works closely with Producers and other HUB personnel on all aspects of client service, marketing, and renewal while adhering to HUB’s best practices and standard procedures.  Provides professional, courteous service to our clients, carrier representatives, underwriters, business partners, and HUB colleagues, resulting in a rate of account retention that meets or exceeds expectations.  Oversees (and performs when needed) the preparation and implementation of transactions, paperwork, and internal...

Reporting to the immediate designated PIP Supervisor, the PIP claims representative is responsible and accountable for conducting complete and thorough investigations on assigned claims and medically managing those claims through their life cycle. Schedule: Monday through Friday (8:45AM- 5PM) Hybrid: 3 days in office, 2 days remote once training is completed Essential Duties and Responsibilities: Review PIP coverages and/or identify coverage issues and investigate and analyze the loss event, the injury and other relevant information to make a determination as to coverage and course of action. Evaluate claims for fraud indicators and potential underwriting issues and process appropriate referrals. Conduct activities in compliance with state and company regulations and guidelines.  Render final coverage determination within regulatory guidelines: Maintain communication with involved parties during the course of the claim, via written and/or verbal...

CopperPoint has an exciting opportunity for a Premium Field Auditor II. The Premium Field Auditor II conducts medium to large complex physical and virtual Workers' Compensation and General Liability audits in several states. The auditor is responsible for working directly with the policyholders on original final audits as well as disputed final audits to ensure that information is in compliance with state agency regulatory rules and regulations.   Job Responsibilities: Independently conduct a final audit of the business operations of the policyholder through a review of all applicable records and interview with the owner, corporate officer, or authorized representative. Conduct a physical inspection of all operative hazards active for former policyholders. Meet monthly production targets Verify all Workers’ Compensation claims as valid and are classified correctly for unit statistical purposes. Analyze business operations to ensure compliance with all regulatory...

The Pharmacy Specialist will respond to departmental inquiries regarding pharmacy benefits for pharmacy lines of business. Work closely with pharmacies, claims adjusters, providers, claimants and other CorVel offices to quickly and professionally answer questions. The Pharmacy Solutions team hours are 8 a.m. to 11 p.m., Monday through Friday.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Answer pharmacy calls and e-mails in a prompt, friendly and professional manner. Assure escalated issues are referred to the management team.  Consult with claims adjusters regarding medications and pharmacy eligibility. Utilize proprietary programs to track inquiries and enter prescription information.  Participate in training of new representatives and personal, ongoing professional development, as required.  Work rejection report lines and additional duties as assigned by management. Displays familiarity with external pharmacy adjudication system and internal billing/claims...