Medical Only Claims Spec I/II
1 week ago
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 Claim Handlers. PRIMARY RESPONSIBILITIES: * Investigates workers' compensation claims with a mandatory contact to the employer within the required time frame with additional contacts to the employee or provider, as necessary. * Documents claim file. * Verifies workers' compensation coverage (statutory and policy) of employers and injured employees. * Determines, documents, and manages the on-going medical treatment program including directing care, creating jurisdictional specific panels, and approving provider requests. * Remains abreast of new case law decisions affecting claim and medical management. * Monitors the work status of the injured workers. * Evaluates medical reports and correspondence for appropriate action/documentation * Supports the customer service work and processes for the multi-functional claims team; Communicates and collaborates with team members to ensure the appropriate and timely handling of claims in other states. * May be required to handle multiple jurisdictions based on team needs. * Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. Documents in the claim file the basis for reserve calculations. * Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. * Documents specifics of claims with potential for subrogation recovery * Assists Subro representative with investigation. * Engages ISU to obtain police reports. * Approves, edits, and denies payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury. * Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses. * Coordinates with outside vendors to ensure cost containment efforts. * Establishes and maintains effective working relationships with all internal and external customers. Assists with determining appropriate response to regulatory inquiries. * Coordinates all efforts with proprietary technology, including causation investigations, Care Analytics, and future models. * Determines appropriate response to regulatory inquiries and completes statutory filings, including EDI data completion * Composes correspondence and various reports in the administration of workers compensation claims; sets appropriate diaries. * Reads, routes and keys incoming mail, runs reports and answers/responds to incoming phone calls on both direct and ACD line, faxes, and emails. This may include completing work for peers during absences to provide uninterrupted service to customers. * Schedules independent medical evaluations provides synopsis and outlines all questions to IME physician. Upon receipt of results, communicates to all parties, facilitates future treatment, or may result in formal denials being filed * Assigns ISU to complete causation investigation * Stays abreast of changes in workers' compensation statutes, case law and
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Medical Only Claims Spec I/II
1 week ago
Lansing, United States Accident Fund Holdings, Inc. Full timeJob DescriptionSUMMARY: 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...
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Medical Only Claims Trainee
1 week ago
Lansing, United States AF Group Full timeSUMMARY: 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...
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Medical Only Claims Trainee
1 week ago
Lansing, United States Emergent Holdings Full timeJob DescriptionSUMMARY: 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...
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Claims Payment Specialist I/II
1 week ago
Lansing, United States AF Group Full timeSUMMARY: Claims Payment Specialist I Primarily responsible for all the following duties Enterprise wide; analysis and entry of detailed wage data into the claim system. May contact employers to obtain missing wage information or to clarify information submitted. Filing required, initial and subsequent jurisdictional filings via EDI, paper and State websites....
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Provider Relations Specialist I/II
2 months ago
Lansing, United States AF Group Full timeSUMMARY: 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...
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Medical Claims Specialist
6 days ago
Lansing, Michigan, United States Accident Fund Holdings, Inc. Full timeJob Summary:A Medical Claims Specialist with Accident Fund Holdings, Inc. is responsible for investigating and managing workers' compensation claims across multiple jurisdictions. This role involves conducting thorough investigations, determining compensability, and ensuring compliance with state laws and regulations.Responsibilities:Investigate workers'...
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Office Claims Adjuster
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Claims Representative
4 weeks ago
Lansing, United States TEKsystems Full timeJob DescriptionJob DescriptionJob Title: Claims RepresentativeJob DescriptionWe are seeking a skilled Claims Representative who is proficient with computers and has experience in claims processing and customer service. The role involves extensive data entry and system work, including indexing data within systems such as Guidewire, Onbase, and MedData. The...
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Claims Adjuster
4 weeks ago
Lansing, United States TEKsystems Full timeJob DescriptionJob DescriptionDescription:Knowledge, skills needed. The position will most likely be a lot of data entry and systems work, so would need someone who is adept at computers. Would definitely prefer someone who has worked in a claims capacity with customer service experience.!. They will be indexing data within their system (Guidewire, Onbase,...
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Claims Representative
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Claims Advocate Specialist
2 days ago
Lansing, Michigan, United States Michigan Farm Bureau Full timeAbout UsMichigan Farm Bureau is a leading provider of insurance and financial services in the region. Our team is dedicated to delivering exceptional customer experiences while upholding our commitment to excellence.Job SummaryWe are seeking an experienced Claims Advocate Specialist to join our team. As a key member of our claims department, you will play a...
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Claims Processing Associate
4 weeks ago
Lansing, United States Emergent Holdings Full timeJob DescriptionSUMMARY:This role will focus on maintenance of our incoming workload, issue resolution and first report of injury (FROI) issues. This position determines jurisdiction for entry of first notice of injury (FNOI) from multiple sources and distributes to the proper destination. Enters and supports priority and special requests, including...
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Claims Processing Specialist
7 days ago
Lansing, Michigan, United States Michigan Farm Bureau Full timeMichigan Farm Bureau seeks a skilled Claims Processing Specialist to join our team in Lansing, MI.About the Role:We are seeking an experienced Claims Processing Specialist to handle First Notice of Loss (FNOL) claims for our Michigan Farm Bureau customers. The successful candidate will have excellent customer service skills, strong typing skills, and the...
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Claims Mail Handling Specialist
20 hours ago
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Claims Specialist
2 days ago
Lansing, Michigan, United States Michigan Farm Bureau Full timeJob Summary:We are seeking an experienced Claims Specialist - Litigation Expert to join our team at Michigan Farm Bureau. As a key member of our litigation team, you will be responsible for investigating and managing first-party casualty claims in a fair and efficient manner.Key Responsibilities:Retain detailed knowledge of Michigan law, particularly the...
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Automotive Damage Claims Adjuster
4 days ago
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Supervisor, Commercial and Farm Property Claims
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Lansing, United States Michigan Farm Bureau Full timeOBJECTIVESupervisor, Commercial and Farm Property Claims Objective To assist the Director of Property & Casualty Claims and the Large Loss Property Claims Manager in managing all functions of a Property Claims Unit that are necessary to provide prompt and efficient handling, control, and disposition of claims in an assigned area. To establish and maintain...
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Lansing, Michigan, United States Michigan Farm Bureau Full timeMichigan Farm Bureau is seeking a skilled Insurance Claims Professional to join our team as a Commercial Property Claims Specialist. Based in Lansing, this role requires a strong background in multi-line or property claims, with a focus on complex commercial property losses.The ideal candidate will possess a Bachelor's degree in a relevant field, such as...
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Senior AMD Claims Representative
6 months ago
Lansing, United States Farm Bureau Insurance Full timeOBJECTIVE Senior AMD Claims Representative Objective To provide an efficient settlement of automobile physical damage losses while providing a WOW! customer experience. RESPONSIBILITIES Senior AMD Claims Representative Responsibilities Complete appraisals and evaluate damage on vehicles. Relate appraisals to appropriate repair costs...
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DuckCreek Developer
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Lansing, United States HTC Global Services Full timeHTC Global Services wants you. Come build new things with us and advance your career. At HTC Global you'll collaborate with experts. You'll join successful teams contributing to our clients' success. You'll work side by side with our clients and have long-term opportunities to advance your career with the latest emerging technologies. At HTC Global Services...