40 claim representative ii jobs found

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 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 factors...

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 factors...

SUMMARY:       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. Works remotely with occasional travel to on-site visits with insured municipalities.  Is a resident in the State of Michigan     RESPONSIBILITIES/TASKS: Verifies coverage of claimed property and casualty damage.   Determines liability for covered claims by thorough investigation of the claim and applicable exclusions.   Analyzes liability for claims pursuant to Michigan municipal liability statutes and caselaw. 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...

Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   Location Details: Remote - USA Position Schedule / Shift: Monday – Friday: 9:00 AM EST – 6:00 PM EST Position Summary: As a Desk Homeowners Claim Representative II , you'll be at the forefront of helping customers recover from property losses, providing support when they need it most. In this fast-paced and rewarding role, you'll manage claims from start to finish by investigating losses, reviewing coverage, evaluating damages, negotiating settlements, and collaborating with internal partners to ensure timely and fair outcomes. If you thrive in a role that combines critical thinking, customer advocacy, and decision-making authority, this is an opportunity to make a real difference every day. Preferred applicants should reside within a 50-mile radius of Tampa, Florida. Key Responsibilities: Review assigned claims. Contact the insured and other affected parties....

SUMMARY:     Claim Representative II:  This is the intermediate level of the claim handler career path. Handles moderate 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.  Must have CA/NV experience. RESPONSIBILITIES/TASKS: Claim Representative II: 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. Facilitate 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...

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 and 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.  South Carolina workers' compensation experience preferred.   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. Facilitate 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...

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     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. 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. Establishes timely...

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...

A Workers' Compensation Nurse Case Manager coordinates and manages the medical care of injured employees throughout the workers' compensation claim process. Responsibilities include evaluating medical needs, assessing treatment progress, identifying barriers to recovery, educating stakeholders, and ensuring care is delivered in accordance with workers' compensation regulations and best practices. The official NJM job title is Medical Management Coordinator II/Telephonic Nurse Case Manager. The position requires the nurse to work and communicate with other members of the Medical Management team in addition to the Workers' Compensation (WC) Claims team, WC Claims Supervisors, and other team members. Essential Duties and Responsibilities: Demonstrate knowledge, skills, and competency in the application of case management standards of practice. Develop and provide ongoing support of the rehabilitation plan through comprehensive assessment, planning, implementation, and...

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 Senior Workers Compensation Claims Specialist within the West Region!   The Senior Claims Specialist works 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. The Senior Claims Specialist 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 Senior Claims...

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...

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 ·...

SUMMARY: Level I is in a learning capacity and will progress to the senior level when the incumbent qualifies and is  able to provide coverage and assistance across all primary responsibilities and focus areas  independently. This job is primarily responsible for products and services underwritten by the Enterprise that require  manual processes due to the complex nature of the request or system limitations. Performs in-house  collection activity that ultimately determines financial resolution of delinquent funds owed to the  Enterprise. Services, bills and manages tasks related to “specialty” (i.e. Loss Sensitive, AccuPremium)  business underwritten by the Enterprise. Calculates commission owed to agencies on a monthly basis  and handles all servicing related to agency commissions. Contacts include: Enterprise employees,  agents and policyholders, external collection agencies, NCCI and legal representatives.  PRIMARY RESPONSIBILITIES:  • Maintains in-depth knowledge of policy...

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 (on average 3-4 days a week) via company vehicle (personal use, gas and maintenance included). Travel will encompass IL and surrounding states. Claims inspections will include onsite and virtual inspection.   Candidate Locations: Chicago, IL (preferred) Qualifications: ·         3-5 years of insurance field/property claims handling or adjusting experience ·         Solid experience...

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...

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....