87 claim representative ii jobs found

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Remote Position Schedule / Shift: Monday-Friday 9am-6pm ET Position Summary: As an Auto Liability Michigan Claim Representative II , you will play a pivotal role in delivering exceptional claim outcomes while making a meaningful difference in customers' lives during challenging situations. In this dynamic and fast-paced role, you will investigate, evaluate, negotiate, and resolve automobile liability claims with confidence and expertise, ensuring compliance with Michigan insurance laws, company guidelines, and regulatory requirements. Leveraging strong analytical, problem-solving, and negotiation skills, you will assess liability, gather critical facts, and drive fair, timely claim resolutions. Key Responsibilities: Claim handling responsibilities will include the following: Reviewing assigned claims Contacting the insured and other...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Hybrid – Fremont, Michigan Position Schedule / Shift: Monday-Friday 8am-5pm ET Position Summary: As an Auto Liability Michigan Claim Representative II , you will play a pivotal role in delivering exceptional claim outcomes while making a meaningful difference in customers' lives during challenging situations. In this dynamic and fast-paced role, you will investigate, evaluate, negotiate, and resolve automobile liability claims with confidence and expertise, ensuring compliance with Michigan insurance laws, company guidelines, and regulatory requirements. Leveraging strong analytical, problem-solving, and negotiation skills, you will assess liability, gather critical facts, and drive fair, timely claim resolutions. Key Responsibilities: Claim handling responsibilities will include the following: Reviewing assigned claims Contacting...

SUMMARY This is the intermediate level of the claims handling career path responsible for managing a caseload of Michigan No-Fault Personal Injury Protection (PIP) claims of moderate to high complexity. The Claim Representative II investigates and administers both litigated and non-litigated PIP claims, exercising independent judgment in coverage analysis, compensability determinations, exposure evaluation, and claim resolution. The position requires thorough knowledge of Michigan No-Fault law, including order of priority investigations, coverage verification, injury causation analysis, and litigation management. The Claim Representative II collaborates regularly with insureds, claimants, healthcare providers, attorneys, and internal business partners to ensure timely, accurate, and compliant claim handling. This fully remote opportunity is available for candidates residing in Michigan.   RESPONSIBILITIES/TASKS:   Determines compensability under Michigan Assigned...

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 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.    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...

SUMMARY   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.    ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following. Other duties may be assigned. Verifies workers’ compensation coverage of employers and injured employees.  Determines compensability under workers’ compensation by thorough investigation of the claim.  Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. Facilitates return to work for the injured employee. 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 subrogation...

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 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.    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...

SUMMARY     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 in the determination claim reserves. Negotiates and settles claims within given authority. Mentors lower-level claim handlers. Coordinates special projects and provides guidance to others. Candidate must have California experience.   ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following. Other duties may be assigned. Verifies workers’ compensation coverage of employers and injured employees.   Determines compensability under workers’ compensation by thorough investigation of the claim.   Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. Facilitates return to work for the injured employee....

We are seeking a detail-oriented Inside Property Claims Representative II to investigate, evaluate, and settle property insurance claims through telephone and virtual methods. This position is responsible for independently handling complex claims, analyzing coverage, conducting thorough investigations, and delivering exceptional customer service while ensuring timely and accurate claim resolution. Key Responsibilities Investigate, evaluate, and settle assigned property insurance claims through telephone and virtual interactions. Independently manage large or complex claims with minimal supervision while maintaining accuracy, quality, and timeliness. Identify, secure, and analyze information related to property losses, verify policy coverage, establish appropriate reserves, and determine claim liability and settlement recommendations. Maintain complete and accurate claim files documenting loss details, communications, investigations, and settlement activity in...

At OneAmerica Financial, our purpose is to create more certainty for our customers that leads to better moments, every day. Our commitment is to advance stability and growth in every solution and relationship.  We deliver financial strength that builds for generations, and we are always aspiring, looking ahead, and collaborating to achieve more, together.  Come be a part of this journey with us as we champion lives! Job Summary LTD Claims Associates are responsible to contribute to the overall success of OneAmerica's objectives by providing timely and accurate support to our customers and the claims department. To obtain and analyze information in order to make claim decisions and payments on disability claims. To develop and apply appropriate claim and disability management techniques to ensure prompt and accurate payment and liability management of disability claims. To provide responsive customer service to claimants, policyholders, brokers, and internal departments....

At OneAmerica, we deliver on promises when customers need us most.  We believe the best way to serve our customers is to know that every individual, employee, family and business we work with has unique personal and financial goals.  We keep our promises, so we can help them achieve their goals and realize their definition of financial success. Job Summary The STD Claims Examiner is responsible for contributing to the overall success of OneAmerica objectives by providing timely and accurate support to our client companies and the Claims department. This individual will be responsible for managing appropriate adjudication of short-term disability claims in accordance with policy provisions. The STD Claims Examiner will initiate and facilitate case management as well as other ancillary services to assure optimum outcomes. We are currently seeking Level I & II Representative experience. KEY RESPONSIBILITIES: Promote a positive customer service image through prompt,...

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...

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. This is a work-from-home position with day travel   to policy locations in Western PA   via company vehicle (personal use, gas and maintenance included). Claims inspections will include onsite and virtual inspection. Travel is estimated to be 50% for this role. Candidate Location: Pittsburgh, PA (preferred) Qualifications: ·         3-5 years of insurance field/property claims handling or adjusting experience ·         Solid experience with XactContents ·...

Job Description: Pacific Life is seeking talented  Operations Quality Assurance Specialists  to join our Consumer Markets Division in Omaha, NE or Charlotte, NC. In this role, you will play a critical part in ensuring the accuracy, compliance, and quality of life insurance claims processing activities. You will conduct detailed transaction audits, identify trends and root causes, and provide actionable insights that improve operational performance, reduce risk, and strengthen service quality across the organization.  This is an excellent opportunity for individuals looking to grow their career in operations quality, risk, and process improvement within a leading financial services organization.  How You’ll Make an Impact:      Perform detailed quality audits of claims transactions across Pay QA, Set-Up QA, and Follow-Up QA, including claim payment accuracy, interest review and calculation, post-death interest, initial claim setup, documentation,...

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....

Description Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers exciting openings for Workers Compensation Senior Claims Specialists within the Central Region!   As a Senior Claims Specialist, you will work within a Claims Team, using the latest technology to review, analyze and process claims that are routinely characterized as moderately complex to complex within assigned authority limits. This includes making decisions about liability/compensability, evaluating losses, negotiating settlements and managing an inventory of commercial property/casualty claims involving bodily injury or property loss. You may also assist the Claims Team Manager with assigning new claims to team members, providing technical direction, and monitoring caseloads.   Training is a critical component of your success, and that success starts with reliable attendance. Attendance...

At OneAmerica Financial, our purpose is to create more certainty for our customers that leads to better moments, every day. Our commitment is to advance stability and growth in every solution and relationship.  We deliver financial strength that builds for generations, and we are always aspiring, looking ahead, and collaborating to achieve more, together.  Come be a part of this journey with us as we champion lives! The Individual Life Claims Examiner is responsible for helping our customers maintain a sense of security by independently and effectively managing an assigned caseload of claims, in a fair and ethical manner and within all requirements and service standards. Job Summary Responsible for helping our customers maintain a sense of security by independently and effectively managing an assigned caseload of claims, in a fair and ethical manner and within all requirements and service standards. Individual Life Claims Associate is responsible for: Reviewing and...

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....

  The Casualty General Adjuster manages within company standards and best practices to investigate, evaluate, and handle to conclusion complex injury claims in litigation. Handle as required in specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel. This role is available for remote, hybrid, and onsite work arrangements. Candidates must have extensive experience handling large loss Transportation/Trucking liability claims . ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Successfully handles any complex coverage or liability claims investigation. Willingness to travel for Mediations, Trials and CAT Scene incidents Evaluates complex injury claims and determines the appropriate settlement value. Attends internal and external training programs to advance knowledge in the area of liability    claims. Works closely with the Claims Supervisor, Claims Manager, or Unit Vice...

The Commercial Claims department is seeking a Commercial Claims Specialist II . A Claims Specialist handles all lines of Commercial business including coverage issues and litigation exposures. The Commercial Claims Specialist II is a disciplined self-starter with outstanding communication & customer service skills. Has developed coverage skills, negotiation experience, and is a creative & analytic proactive problem solver. Also, can prioritize work assignments, is an independent worker but can work as a member of the team. Individuals should be decisive, "own" the decisions they make, and the work produced, responsible, dependable and developing presentation skills. Schedule: Monday-Friday, specific hours are subject to selected start times between 8:00am-9:00am pending supervisory approval. Essential Duties and Responsibilities: Essential functions of this job are listed below in order of priority. Reasonable accommodations may be made to enable individuals to...

Description Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers an exciting opening for a Workers Compensation Claims Specialist within the West Region!   As a Workers Compensation Claims Specialist, you will work within a Claims Team, using the latest technology to review, analyze, and process claims that are routinely characterized as moderately complex to complex within assigned authority limits. This includes making decisions about liability/compensability, evaluating losses, negotiating settlements, and managing an inventory of commercial property/casualty claims involving bodily injury or property loss. You may also assist the Claims Team Manager with assigning new claims to team members, providing technical direction, and monitoring caseloads.   Depending on your overall skills and experience, you may be considered as a Claims Specialist II,...