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Claim Processor Jobs in Grand Rapids, MI

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  • Claims Analyst

    Netpolarity, Inc. (Saicon Consultants, Inc.

    Claim Processor Job 137 miles from Grand Rapids

    Job Title: Analyst (Claim) Client: DTE Energy-1896 Duration: 6 months Pay Rate: $28.00/hr. w2 Must Have: bachelor's degree Claims or complaint or damage Collection or billing. Advance Excel (pivot table or vlookups or H-look up) Nice to have: SAP is plus Job Description: Position will provide support for the Damage Claims and Damage Prevention organization within Gas Operations at DTE Energy. The position will support the damage prevention data analytics and billing processes. • Responsible for providing analytical, data requests, process and systems support for work unit. • Data entry, validation and analysis • Communication between internal and external groups • Development of materials for vendors and MPSC • Ability to work independently and identify appropriate course of action to analyze issues, recommend solutions and administer programs. • Performs analysis research, studies and prepares various report. Qualifications: • Bachelor Degree required • Experience resolving internal and external complaints • Advanced proficiency in Microsoft Excel and Word • Collection experience with internal and external vendors • SAP experience is preferred but not required
    $28 hourly 6d ago
  • Insurance Claims Representative

    JL Connects 4.4company rating

    Claim Processor Job 129 miles from Grand Rapids

    Title: Claims Support Representative - Independent Insurance Agency We are seeking a detail-oriented and customer-focused Claims Support Representative to join an independent insurance agency in Southfield. In this role, you will be responsible for assisting personal and commercial lines customers through the claims process, ensuring timely communication, and providing support from start to finish. Key Responsibilities: Provide exceptional customer service for daily claims-related phone calls Report claim details to carriers within one business day Track and monitor the progress of claims until resolution Act as a Customer Claim Advocate to ensure customer satisfaction Maintain up-to-date claim statuses in the Applied Epic (Agency Management System) Monitor daily claim activities and status updates Regularly check carriers' websites for claim status information Enter account activity into the claims system for processing Send claims documentation via fax, email, or mail to relevant parties Required Knowledge & Skills: Experience with Commercial and Personal Lines Insurance Property & Casualty License preferred but not required Familiarity with the Applied Epic or similar agency management systems Proficiency in Microsoft Word, Excel, and Outlook Ability to multitask and stay organized Strong sense of accountability and ownership Perks Comprehensive medical benefits covered 100% by the agency Competitive PTO package, 401K with matching, and flexible schedule hours Hybrid work environment that's 50% remote
    $42k-51k yearly est. 4d ago
  • Fabrication Processor

    Kuka 4.5company rating

    Claim Processor Job 137 miles from Grand Rapids

    The Processor job includes coordinating with the Purchasing team and getting work released to the KUKA Manufacturing Center floor. {KMC} ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Responsible for all packing slips for shipment of manufactured details from KMC facility. Review all internal departmental emails and request and prioritize with Purchasing, Project Teams, and Engineering Works closely with KMC floor personnel to determine steel requirements and order accordingly Coordinate and gather all information required to purchase required perishable materials for the KMC facility. Responsible for entering all outside services grinding, laser and burning, and steel cutting into Axapta or current ERP system Create all tagging in the KUKA Portal for shipping of material Works closely with shipping departments and Follow-Up teams in ensuring that all outstanding packing slips and material are closed in the KUKA Portal Adheres to the Quality System and participates in continuous improvement. Performs other departmental functions as required. Regular and predictable attendance is essential function of this job. QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE Associates degree from a two-year college or university or technical school; or one to five years related experience and/or training; or equivalent combination of education and experience. KUKA is an Equal Opportunity Employer committed to building an inclusive and diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other factor protected by applicable federal, state or local laws.
    $28k-34k yearly est. 13d ago
  • Claims Processor Analyst

    Cai 4.8company rating

    Claim Processor Job 59 miles from Grand Rapids

    **Job ID Number** R4679 **Employment Type** Full time **Worksite Flexibility** Remote As a Claims Processor Analyst, you will receive, investigate, and triage expedited appeal requests, ensuring timely processing of health insurance claims and appeals in compliance with regulatory standards, while performing claims research, authorization lookups, and maintaining case assignments. **Job Description** We are looking for a **Claims Processor Analyst** , you will receive, investigate, and triage expedited appeal requests, ensuring timely processing of health insurance claims and appeals in compliance with regulatory standards, while performing claims research, authorization lookups, and maintaining case assignments. This is a **full-time, remote, 6+ month contract position.** **_Due to the nature of this position, all candidates must be able to work direct for any employer without sponsorship._** **Schedule:** + Monday to Friday + 8-hour shift starting between 7am - 9am **What You'll Do** + Receive, investigate, and triage expedited appeal requests from members/member representatives enrolled in Senior Products + Timely assignment of cases to ensure member's appeal rights are processed in accordance with regulatory agencies' standards, including the Center for Medicare and Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA) + Claims research and processing, focusing on understanding why claims were denied + Processing appeals in the system + Authorization lookups + Processing health insurance claims **What You'll Need** Required: + At least 1 year of experience in health insurance claims and appeals is required + Outbound call experience is a plus (though not a major part of the job) + Customer service background and experience + High School Degree Desired: + A college degree and/or extensive experience would be considered + Medicaid experience is highly desired **Physical Demands:** + Ability to safely and successfully perform the essential job functions consistent with the ADA and other federal, state and local standards + Sedentary work that involves sitting or remaining stationary most of the time with occasional need to move around the office to attend meetings, etc. + Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard, and monitor \#LI-KM1 **Reasonable Accommodation Statement** If you require a reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employment selection process, please direct your inquiries to application.accommodations@cai.io or (888) 824 - 8111. **Equal Employment Opportunity Policy Statement** It is the policy of CAI not to discriminate against any employee or applicant due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran. It is also the policy of CAI to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Employees and applicants of CAI will not be subject to harassment due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran. Additionally, retaliation, including intimidation, threats, or coercion, because an employee or applicant has objected to discrimination, engaged or may engage in filing a complaint, assisted in a review, investigation, or hearing or have otherwise sought to obtain their legal rights under any Federal, State, or local EEO law is prohibited.
    $60k-85k yearly est. 5d ago
  • Claims Pmt & Compl Spec I - AR

    Emergent 4.2company rating

    Claim Processor Job 59 miles from Grand Rapids

    Performs advanced technical duties which includes analyisis of wage data to calculate average weekly wage and compensation rates, determination of compensation owed for all benefit types and issuance of said compensation checks for all benefit types from proper reserve categories. Responsible for the determination of amounts owed to all parties for settlements and the issuance of said settlement checks from proper reserve categories. Filing required initial and subsequent jurisdictional filings via EDI, paper, and State Websites. Resolution of EDI FROI and SROI errrors. Issuance of miscellaneous payments, legal payments and manual payments, processing of refunds and transfers, posting manual payments. Contacts include agents, policyholders, claimants, attorneys, and other Claims staff. If requested, contacts employers to obtain missing wage information or to clarify information submitted. PRIMARY RESPONSIBILITIES: · Review payment requests to ensure compliance with the Workers Compensation regulations. · Analyze wage data and calculate average weekly wage and compensation rates. · Contacts policyholders for payment and/or wage data clarification and to obtain necessary information. · Verifies, calculates, and pays approved injured worker travel and miscellaneous expenses for all jurisdictions. · Determines compensation owed for all benefit payment types and issues benefit checks accordingly from proper reserve categories. · Determines compensation owed for compromise payments, dual wage earning, 70% appeal payments, supplemental benefits and issues benefit checks accordingly from proper reserve categories. · Determines amounts owed to all parties for settlements and issues settlement checks accordingly from proper reserve categories. · Reviews compensation orders to ensure compliace with the Workers Compensation Regulations. · Calculates coordination of benefits, (i.e. pensions, SSI, age reduction, unemployment and COLA). · Analyzes claim system data to determine the input needed into our EDI vendor system. · Files required initial and subsequent jurisdictional filings via EDI, paper, and State Websites. · Researches and resolves errors received from jurisdictional filings · Stops and voids payment checks as requested for all jurisdictions. · Validates, investigates and completes refund and transfer documents for all jurisdictions. · Analyzes, validates, approves and processes attorney, legal, IME, vocational rehabilitation, medical management and all other vendor invoices for all jurisdictions. · Issues penalty checks and files appropriate jurisdictional filings for penalties. · Prepares form letters and composes general correspondence. · Alerts Claim Handlers on reserve deficiencies. · Participates on projects as requested. · Keeps apprised of changing rules for data submission from regulatory agencies. · Posts internal claim costs where applicable. · Posts manual payments. Additional Responsibilities of Claims Payment and Compliance Specialist II: · Performs all duties of Claims Payment and Compliance Specialist I. In addition, is responsible for complex indemnity related work and processes. · Assists as a subject matter expert with the creation of training, procedural and workflow documentation. · Provides training and mentoring to Claims Payment and Compliance Specialist I. · Works with minimal supervision. This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS: EDUCATION REQUIRED: High School Diploma or G.E.D. Advanced training or college level coursework in business, accounting, or insurance. Combination of education and experience may be considered in lieu of additional training or coursework. Additional Education for Claims Payment and Compliance Specialist II: Minimum of Associates Degree in business or a related field. Additional training, work experience, or course work in workers compensation, insurance or accounting. A combination of education and experience may be considered in lieu of formal education. EXPERIENCE REQUIRED: Claims Payment and Compliance Specialist I: Two years experience in an insurance or finance organization performing similar duties or other equivalent relevant experience which provides the necessary skills, knowledge and abilities. Claims Payment and Compliance Specialist II: Three years experience in an insurance or finance organization with demonstrated technical knowledge in Workers' Compensation, or other equivalent relevant experience which provides the necessary skills, knowledge and abilities, including one year of experience as a Claims Payment and Compliance Specialist I. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Claims Payment and Compliance Specialist I: · Knowledge of computers. · Basic knowledge of spreadsheet software with data entry ability. · Basic knowledge of Word Processing software. · Excellent organizational skills and ability to prioritize work to meet established deadlines. · Math skills with the ability to use a ten-key calculator. · Demonstrated ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format. · Excellent verbal and written communication skills. · Demonstrated ability to manage work with minimal direction. · Demonstrated ability to be an independent thinker to solve issues. · Ability to enter alpha-numeric data accurately. · Ability to verify data for accuracy. · Basic knowledge of CPT, ICD9/ICD10 and drug codes. · Basic knowledge of the Workers Compensation Act for states handling. · Basic knowledge of Claims process. · Basic knowledge of medical terminology. · Basic knowledge of legal terminology. · Ability to use reference resources and apply information accordingly. Claims Payment and Compliance Specialist II: · Knowledge of computers. · Knowledge of spreadsheet software with data entry ability. · Basic knowledge of Word Processing software. · Excellent organizational skills and ability to prioritize work to meet established deadlines. · Math skills with the ability to use a ten-key calculator. · Demonstrated ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format. · Excellent verbal and written communication skills. · Demonstrated ability to manage work with minimal direction. · Demonstrated ability to be an independent thinker to solve issues. · Ability to enter alpha-numeric data accurately. · Ability to verify data for accuracy. · Demonstrated knowledge of the Workers Compensation Act for states handling. · Demonstrated knowledge of Claims process. · Demonstrated knowledge of medical terminology. · Demonstrated knowledge of legal terminology. · Demonstrated knowledge of CPT, ICD9/ICD10 and drug codes. · Ability to use reference resources and apply information accordingly. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED: · Additional training, work experience, or course work in workers compensation, insurance or accounting. · Insurance Institute of America Certification (IIA certification). · Workers' Compensation Experience - CPCS1 WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. REQUIRED TESTING: Claims Payment and Compliance Specialist I: Basic Windows, Basic Excel, Basic Word, Reading Comprehension, Alpha Numeric, 10-Key, Math, Proofreading. Claims Payment and Compliance Specialist II: Basic Windows, Intermediate Excel, Basic Word, Reading Comprehension, 10-Key, Math, Proofreading.
    $51k-68k yearly est. 7d ago
  • Claims Examiner II

    AAA Life Insurance Company 4.5company rating

    Claim Processor Job 125 miles from Grand Rapids

    Bring your claims experience to the next level! AAA Life Insurance is hiring for a Claims Examiner II to join our growing claims team! This role analyzes, evaluates, and determines final decision for life, accidental injury & death, simple annuity and rider claims within scope of authority and experience level in accordance with established departmental and statutory guidelines. This position can be hybrid in our Livonia, MI office, our remote. Responsibilities Review and assess newly reported life, accidental injury & death, simple annuity claims. May also review and assess specified Rider Claims, including Disability Waiver of Premium and Accelerated Death Benefit claims. May handle claims occurring outside of the US. Analyzes requirements to determine accurate claim decision based upon specific contract for life, accidental injury & death, simple annuity and rider claims within prescribed limits and authority. Refers cases outside of prescribed limits and authority to Senior Claims Examiner or Claims Consultant. Calculates benefits, including statutory interest, for life, accidental injury & death, simple annuity and rider claims. Responds to customer inquiries regarding claim matters and written correspondence via telephone, written letter, and e-mail. May conduct interviews with claimants, beneficiaries, or next of kin on any type of claim to gather information to adjudicate claim. Acts as a mentor and provides secondary signature on claims referred to them by Claim Examiner I team members that are within scope of authority. Prepares beneficiary correspondence to communicate adverse decisions when appropriate consistent with department guidelines and statutory requirements. Read and interpret complex insurance policies/provisions as they relate to the claim presented. Reads and interprets Reinsurance Treaties related to claim processing. Refers files to reinsurance in accordance with treaty requirements. Qualifications Associate Degree, medical certification, or equivalent related work experience required. LOMA281 and LOMA2911) required within 12 months of starting position. ALHC Designation required within 24 months of starting position. Minimum 3 years' experience in Life/Health Insurance or Claims processing experience or related field required. Life insurance underwriting experience including knowledge and understanding of medical conditions, impairments and the financial and legal aspects of risk selection and other factors pertaining to acceptability and assessment of life insurance applications, preferred. Demonstrates strong knowledge and understanding of Life, Accident, Annuity, and Heath Products Completion of AAA Life Insurance Company Product training within 6 months of accepting position. Demonstrates knowledge of HIPAA, Privacy, ACLI Guidelines, Unfair Claims Settlement Act/Laws, Life Insurance and Medical Terminology. Proficient using internet based applications and Microsoft office products, specifically Word and Excel. Able to perform basic mathematical calculations to include addition, subtraction, multiplication, division, and percentage. Able to work hours as required by business needs (may include flex scheduling, irregular hours, weekends, and holidays). What We Offer: A collaborative, energetic work environment where you can put your passion for people to work Medical, Dental, Vision, Life and Disability coverage available day one Pension Plan Performance-based incentive plan 401k available with a Company match Holidays and Paid Time Off AAA Basic Membership
    $35k-56k yearly est. 14d ago
  • Claims Pmt & Compl Spec I - AR

    Blue Cross Blue Shield of Michigan Mutual Insurance Company 4.8company rating

    Claim Processor Job 59 miles from Grand Rapids

    Performs advanced technical duties which includes analyisis of wage data to calculate average weekly wage and compensation rates, determination of compensation owed for all benefit types and issuance of said compensation checks for all benefit types from proper reserve categories. Responsible for the determination of amounts owed to all parties for settlements and the issuance of said settlement checks from proper reserve categories. Filing required initial and subsequent jurisdictional filings via EDI, paper, and State Websites. Resolution of EDI FROI and SROI errrors. Issuance of miscellaneous payments, legal payments and manual payments, processing of refunds and transfers, posting manual payments. Contacts include agents, policyholders, claimants, attorneys, and other Claims staff. If requested, contacts employers to obtain missing wage information or to clarify information submitted. PRIMARY RESPONSIBILITIES: · Review payment requests to ensure compliance with the Workers Compensation regulations. · Analyze wage data and calculate average weekly wage and compensation rates. · Contacts policyholders for payment and/or wage data clarification and to obtain necessary information. · Verifies, calculates, and pays approved injured worker travel and miscellaneous expenses for all jurisdictions. · Determines compensation owed for all benefit payment types and issues benefit checks accordingly from proper reserve categories. · Determines compensation owed for compromise payments, dual wage earning, 70% appeal payments, supplemental benefits and issues benefit checks accordingly from proper reserve categories. · Determines amounts owed to all parties for settlements and issues settlement checks accordingly from proper reserve categories. · Reviews compensation orders to ensure compliace with the Workers Compensation Regulations. · Calculates coordination of benefits, (i.e. pensions, SSI, age reduction, unemployment and COLA). · Analyzes claim system data to determine the input needed into our EDI vendor system. · Files required initial and subsequent jurisdictional filings via EDI, paper, and State Websites. · Researches and resolves errors received from jurisdictional filings · Stops and voids payment checks as requested for all jurisdictions. · Validates, investigates and completes refund and transfer documents for all jurisdictions. · Analyzes, validates, approves and processes attorney, legal, IME, vocational rehabilitation, medical management and all other vendor invoices for all jurisdictions. · Issues penalty checks and files appropriate jurisdictional filings for penalties. · Prepares form letters and composes general correspondence. · Alerts Claim Handlers on reserve deficiencies. · Participates on projects as requested. · Keeps apprised of changing rules for data submission from regulatory agencies. · Posts internal claim costs where applicable. · Posts manual payments. Additional Responsibilities of Claims Payment and Compliance Specialist II: · Performs all duties of Claims Payment and Compliance Specialist I. In addition, is responsible for complex indemnity related work and processes. · Assists as a subject matter expert with the creation of training, procedural and workflow documentation. · Provides training and mentoring to Claims Payment and Compliance Specialist I. · Works with minimal supervision. This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS: EDUCATION REQUIRED: High School Diploma or G.E.D. Advanced training or college level coursework in business, accounting, or insurance. Combination of education and experience may be considered in lieu of additional training or coursework. Additional Education for Claims Payment and Compliance Specialist II: Minimum of Associates Degree in business or a related field. Additional training, work experience, or course work in workers compensation, insurance or accounting. A combination of education and experience may be considered in lieu of formal education. EXPERIENCE REQUIRED: Claims Payment and Compliance Specialist I: Two years experience in an insurance or finance organization performing similar duties or other equivalent relevant experience which provides the necessary skills, knowledge and abilities. Claims Payment and Compliance Specialist II: Three years experience in an insurance or finance organization with demonstrated technical knowledge in Workers' Compensation, or other equivalent relevant experience which provides the necessary skills, knowledge and abilities, including one year of experience as a Claims Payment and Compliance Specialist I. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Claims Payment and Compliance Specialist I: · Knowledge of computers. · Basic knowledge of spreadsheet software with data entry ability. · Basic knowledge of Word Processing software. · Excellent organizational skills and ability to prioritize work to meet established deadlines. · Math skills with the ability to use a ten-key calculator. · Demonstrated ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format. · Excellent verbal and written communication skills. · Demonstrated ability to manage work with minimal direction. · Demonstrated ability to be an independent thinker to solve issues. · Ability to enter alpha-numeric data accurately. · Ability to verify data for accuracy. · Basic knowledge of CPT, ICD9/ICD10 and drug codes. · Basic knowledge of the Workers Compensation Act for states handling. · Basic knowledge of Claims process. · Basic knowledge of medical terminology. · Basic knowledge of legal terminology. · Ability to use reference resources and apply information accordingly. Claims Payment and Compliance Specialist II: · Knowledge of computers. · Knowledge of spreadsheet software with data entry ability. · Basic knowledge of Word Processing software. · Excellent organizational skills and ability to prioritize work to meet established deadlines. · Math skills with the ability to use a ten-key calculator. · Demonstrated ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format. · Excellent verbal and written communication skills. · Demonstrated ability to manage work with minimal direction. · Demonstrated ability to be an independent thinker to solve issues. · Ability to enter alpha-numeric data accurately. · Ability to verify data for accuracy. · Demonstrated knowledge of the Workers Compensation Act for states handling. · Demonstrated knowledge of Claims process. · Demonstrated knowledge of medical terminology. · Demonstrated knowledge of legal terminology. · Demonstrated knowledge of CPT, ICD9/ICD10 and drug codes. · Ability to use reference resources and apply information accordingly. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED: · Additional training, work experience, or course work in workers compensation, insurance or accounting. · Insurance Institute of America Certification (IIA certification). · Workers' Compensation Experience - CPCS1 WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. REQUIRED TESTING: Claims Payment and Compliance Specialist I: Basic Windows, Basic Excel, Basic Word, Reading Comprehension, Alpha Numeric, 10-Key, Math, Proofreading. Claims Payment and Compliance Specialist II: Basic Windows, Intermediate Excel, Basic Word, Reading Comprehension, 10-Key, Math, Proofreading.
    $35k-48k yearly est. 7d ago
  • Claims Pmt & Compl Spec I - AR

    Emergent Holdings, Inc.

    Claim Processor Job 59 miles from Grand Rapids

    Performs advanced technical duties which includes analyisis of wage data to calculate average weekly wage and compensation rates, determination of compensation owed for all benefit types and issuance of said compensation checks for all benefit types from proper reserve categories. Responsible for the determination of amounts owed to all parties for settlements and the issuance of said settlement checks from proper reserve categories. Filing required initial and subsequent jurisdictional filings via EDI, paper, and State Websites. Resolution of EDI FROI and SROI errrors. Issuance of miscellaneous payments, legal payments and manual payments, processing of refunds and transfers, posting manual payments. Contacts include agents, policyholders, claimants, attorneys, and other Claims staff. If requested, contacts employers to obtain missing wage information or to clarify information submitted. PRIMARY RESPONSIBILITIES: * Review payment requests to ensure compliance with the Workers Compensation regulations. * Analyze wage data and calculate average weekly wage and compensation rates. * Contacts policyholders for payment and/or wage data clarification and to obtain necessary information. * Verifies, calculates, and pays approved injured worker travel and miscellaneous expenses for all jurisdictions. * Determines compensation owed for all benefit payment types and issues benefit checks accordingly from proper reserve categories. * Determines compensation owed for compromise payments, dual wage earning, 70% appeal payments, supplemental benefits and issues benefit checks accordingly from proper reserve categories. * Determines amounts owed to all parties for settlements and issues settlement checks accordingly from proper reserve categories. * Reviews compensation orders to ensure compliace with the Workers Compensation Regulations. * Calculates coordination of benefits, (i.e. pensions, SSI, age reduction, unemployment and COLA). * Analyzes claim system data to determine the input needed into our EDI vendor system. * Files required initial and subsequent jurisdictional filings via EDI, paper, and State Websites. * Researches and resolves errors received from jurisdictional filings * Stops and voids payment checks as requested for all jurisdictions. * Validates, investigates and completes refund and transfer documents for all jurisdictions. * Analyzes, validates, approves and processes attorney, legal, IME, vocational rehabilitation, medical management and all other vendor invoices for all jurisdictions. * Issues penalty checks and files appropriate jurisdictional filings for penalties. * Prepares form letters and composes general correspondence. * Alerts Claim Handlers on reserve deficiencies. * Participates on projects as requested. * Keeps apprised of changing rules for data submission from regulatory agencies. * Posts internal claim costs where applicable. * Posts manual payments. Additional Responsibilities of Claims Payment and Compliance Specialist II: * Performs all duties of Claims Payment and Compliance Specialist I. In addition, is responsible for complex indemnity related work and processes. * Assists as a subject matter expert with the creation of training, procedural and workflow documentation. * Provides training and mentoring to Claims Payment and Compliance Specialist I. * Works with minimal supervision. This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS: EDUCATION REQUIRED: High School Diploma or G.E.D. Advanced training or college level coursework in business, accounting, or insurance. Combination of education and experience may be considered in lieu of additional training or coursework. Additional Education for Claims Payment and Compliance Specialist II: Minimum of Associates Degree in business or a related field. Additional training, work experience, or course work in workers compensation, insurance or accounting. A combination of education and experience may be considered in lieu of formal education. EXPERIENCE REQUIRED: Claims Payment and Compliance Specialist I: Two years experience in an insurance or finance organization performing similar duties or other equivalent relevant experience which provides the necessary skills, knowledge and abilities. Claims Payment and Compliance Specialist II: Three years experience in an insurance or finance organization with demonstrated technical knowledge in Workers' Compensation, or other equivalent relevant experience which provides the necessary skills, knowledge and abilities, including one year of experience as a Claims Payment and Compliance Specialist I. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Claims Payment and Compliance Specialist I: * Knowledge of computers. * Basic knowledge of spreadsheet software with data entry ability. * Basic knowledge of Word Processing software. * Excellent organizational skills and ability to prioritize work to meet established deadlines. * Math skills with the ability to use a ten-key calculator. * Demonstrated ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format. * Excellent verbal and written communication skills. * Demonstrated ability to manage work with minimal direction. * Demonstrated ability to be an independent thinker to solve issues. * Ability to enter alpha-numeric data accurately. * Ability to verify data for accuracy. * Basic knowledge of CPT, ICD9/ICD10 and drug codes. * Basic knowledge of the Workers Compensation Act for states handling. * Basic knowledge of Claims process. * Basic knowledge of medical terminology. * Basic knowledge of legal terminology. * Ability to use reference resources and apply information accordingly. Claims Payment and Compliance Specialist II: * Knowledge of computers. * Knowledge of spreadsheet software with data entry ability. * Basic knowledge of Word Processing software. * Excellent organizational skills and ability to prioritize work to meet established deadlines. * Math skills with the ability to use a ten-key calculator. * Demonstrated ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format. * Excellent verbal and written communication skills. * Demonstrated ability to manage work with minimal direction. * Demonstrated ability to be an independent thinker to solve issues. * Ability to enter alpha-numeric data accurately. * Ability to verify data for accuracy. * Demonstrated knowledge of the Workers Compensation Act for states handling. * Demonstrated knowledge of Claims process. * Demonstrated knowledge of medical terminology. * Demonstrated knowledge of legal terminology. * Demonstrated knowledge of CPT, ICD9/ICD10 and drug codes. * Ability to use reference resources and apply information accordingly. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED: * Additional training, work experience, or course work in workers compensation, insurance or accounting. * Insurance Institute of America Certification (IIA certification). * Workers' Compensation Experience - CPCS1 WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. REQUIRED TESTING: Claims Payment and Compliance Specialist I: Basic Windows, Basic Excel, Basic Word, Reading Comprehension, Alpha Numeric, 10-Key, Math, Proofreading. Claims Payment and Compliance Specialist II: Basic Windows, Intermediate Excel, Basic Word, Reading Comprehension, 10-Key, Math, Proofreading.
    $27k-45k yearly est. 6d ago
  • Claims Processor, Brio Living Services

    Brio Living Services

    Claim Processor Job 116 miles from Grand Rapids

    Schedule: Full Time | 40 hours per week Work Type: with onsite requirements (training will be conducted onsite)
    $27k-45k yearly est. 6d ago
  • Claims Processor, Brio Living Services

    Porter Hills 4.3company rating

    Claim Processor Job 116 miles from Grand Rapids

    Schedule: Full Time | 40 hours per week with onsite requirements (training will be conducted onsite) The Claims Processor analyzes, supports, and executes functions within the claims adjudication process for PACE Shore-to-Shore (S2S), including LifeCircles PACE, Huron Valley PACE, and Thome PACE. What you'll do: Claims Adjudication Process * Verifying proper authorizations and documentation before processing claims, with necessary follow-up * Data entry for claims processing * Tracking claim status and communicating with vendors * Handling claims denials Claims Data Tracking and Reporting * Track and assist in reporting claims data for re-insurance and other key areas as assigned * Assist with monthly correspondence for True Out of Pocket (TOOP) cost tracking * Support monthly RAPs and EDS reporting, including resolving claim errors * Participate in monthly audits of RAPs return/output data Team Collaboration and Skill Development * Actively participate in team meetings and training opportunities to stay current and enhance professional skills Regulatory Compliance * Brio Living Services policies and safety guidelines * Federal, state, and local regulatory requirements This is a summary of the position, and it is not intended to be an exhaustive list of all duties. If selected for the position, you will receive a complete job description. What It Takes: * Associate Degree in Business, Accounting, Finance, or a related field, desired. * A combination of education and directly related experience may be considered. * Two years of previous financial experience. * Strong technology skills, including proficiency in computers, Microsoft Office (Word, Excel, Outlook), data entry, and system applications. Why Brio Living Services? * Make an impact on the lives of older adults. * Comprehensive benefits, including Medical, Vision, and Dental Insurance, Retirement Savings Plan, and Wellness Program with Reimbursement. * Generous paid time off, 6 Paid Holidays, and 2 Floating Holidays. * Growth opportunities, including an Educational Scholarship Program and Tuition Reimbursement. Accessibility Support Brio Living Services is committed to offering reasonable accommodation to job applicants with disabilities. If you need assistance or an accommodation, please contact us at *************************. Brio Living Services is an Equal Opportunity Employer We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, or genetics, in accordance with federal, state, and local laws. Req #: 9528
    $27k-42k yearly est. 20d ago
  • Bilingual Claims Examiner

    Healthcare Support Staffing

    Claim Processor Job 131 miles from Grand Rapids

    HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description: Are you an experienced Claims Representative looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Daily Responsibilities: • Resolves Provider Reconsideration Requests (PRR) from providers relating to claims payment and requests for claim adjustments • Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error • Identifies potential Provider problems through a proactive approach in which data is mined and trended to identify and prevent provider problem areas Qualifications Hours for this Position: • Mon-Fri 8am-4:30pm Advantages of this Opportunity: • Competitive salary, negotiable based on relevant experience • Acquire new skills and learn new knowledge • Fun and positive work environment Qualifications/ Requirements: • Must be bilingual in Spanish • Claims, Appeals, Denials experience for an insurance company or hospital or medical office or financial company • HS Diploma/GED Additional Information Interested in hearing more about this great opportunity? If you are interested in applying to this position, please click Apply Now and email your resume to Michael Grifon.
    $27k-45k yearly est. 6d ago
  • Claims Pmt & Compl Spec I - AR

    AF Group 4.5company rating

    Claim Processor Job 59 miles from Grand Rapids

    Performs advanced technical duties which includes analyisis of wage data to calculate average weekly wage and compensation rates, determination of compensation owed for all benefit types and issuance of said compensation checks for all benefit types from proper reserve categories. Responsible for the determination of amounts owed to all parties for settlements and the issuance of said settlement checks from proper reserve categories. Filing required initial and subsequent jurisdictional filings via EDI, paper, and State Websites. Resolution of EDI FROI and SROI errrors. Issuance of miscellaneous payments, legal payments and manual payments, processing of refunds and transfers, posting manual payments. Contacts include agents, policyholders, claimants, attorneys, and other Claims staff. If requested, contacts employers to obtain missing wage information or to clarify information submitted. PRIMARY RESPONSIBILITIES: · Review payment requests to ensure compliance with the Workers Compensation regulations. · Analyze wage data and calculate average weekly wage and compensation rates. · Contacts policyholders for payment and/or wage data clarification and to obtain necessary information. · Verifies, calculates, and pays approved injured worker travel and miscellaneous expenses for all jurisdictions. · Determines compensation owed for all benefit payment types and issues benefit checks accordingly from proper reserve categories. · Determines compensation owed for compromise payments, dual wage earning, 70% appeal payments, supplemental benefits and issues benefit checks accordingly from proper reserve categories. · Determines amounts owed to all parties for settlements and issues settlement checks accordingly from proper reserve categories. · Reviews compensation orders to ensure compliace with the Workers Compensation Regulations. · Calculates coordination of benefits, (i.e. pensions, SSI, age reduction, unemployment and COLA). · Analyzes claim system data to determine the input needed into our EDI vendor system. · Files required initial and subsequent jurisdictional filings via EDI, paper, and State Websites. · Researches and resolves errors received from jurisdictional filings · Stops and voids payment checks as requested for all jurisdictions. · Validates, investigates and completes refund and transfer documents for all jurisdictions. · Analyzes, validates, approves and processes attorney, legal, IME, vocational rehabilitation, medical management and all other vendor invoices for all jurisdictions. · Issues penalty checks and files appropriate jurisdictional filings for penalties. · Prepares form letters and composes general correspondence. · Alerts Claim Handlers on reserve deficiencies. · Participates on projects as requested. · Keeps apprised of changing rules for data submission from regulatory agencies. · Posts internal claim costs where applicable. · Posts manual payments. Additional Responsibilities of Claims Payment and Compliance Specialist II: · Performs all duties of Claims Payment and Compliance Specialist I. In addition, is responsible for complex indemnity related work and processes. · Assists as a subject matter expert with the creation of training, procedural and workflow documentation. · Provides training and mentoring to Claims Payment and Compliance Specialist I. · Works with minimal supervision. This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS: EDUCATION REQUIRED: High School Diploma or G.E.D. Advanced training or college level coursework in business, accounting, or insurance. Combination of education and experience may be considered in lieu of additional training or coursework. Additional Education for Claims Payment and Compliance Specialist II: Minimum of Associates Degree in business or a related field. Additional training, work experience, or course work in workers compensation, insurance or accounting. A combination of education and experience may be considered in lieu of formal education. EXPERIENCE REQUIRED: Claims Payment and Compliance Specialist I: Two years experience in an insurance or finance organization performing similar duties or other equivalent relevant experience which provides the necessary skills, knowledge and abilities. Claims Payment and Compliance Specialist II: Three years experience in an insurance or finance organization with demonstrated technical knowledge in Workers' Compensation, or other equivalent relevant experience which provides the necessary skills, knowledge and abilities, including one year of experience as a Claims Payment and Compliance Specialist I. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Claims Payment and Compliance Specialist I: · Knowledge of computers. · Basic knowledge of spreadsheet software with data entry ability. · Basic knowledge of Word Processing software. · Excellent organizational skills and ability to prioritize work to meet established deadlines. · Math skills with the ability to use a ten-key calculator. · Demonstrated ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format. · Excellent verbal and written communication skills. · Demonstrated ability to manage work with minimal direction. · Demonstrated ability to be an independent thinker to solve issues. · Ability to enter alpha-numeric data accurately. · Ability to verify data for accuracy. · Basic knowledge of CPT, ICD9/ICD10 and drug codes. · Basic knowledge of the Workers Compensation Act for states handling. · Basic knowledge of Claims process. · Basic knowledge of medical terminology. · Basic knowledge of legal terminology. · Ability to use reference resources and apply information accordingly. Claims Payment and Compliance Specialist II: · Knowledge of computers. · Knowledge of spreadsheet software with data entry ability. · Basic knowledge of Word Processing software. · Excellent organizational skills and ability to prioritize work to meet established deadlines. · Math skills with the ability to use a ten-key calculator. · Demonstrated ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format. · Excellent verbal and written communication skills. · Demonstrated ability to manage work with minimal direction. · Demonstrated ability to be an independent thinker to solve issues. · Ability to enter alpha-numeric data accurately. · Ability to verify data for accuracy. · Demonstrated knowledge of the Workers Compensation Act for states handling. · Demonstrated knowledge of Claims process. · Demonstrated knowledge of medical terminology. · Demonstrated knowledge of legal terminology. · Demonstrated knowledge of CPT, ICD9/ICD10 and drug codes. · Ability to use reference resources and apply information accordingly. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED: · Additional training, work experience, or course work in workers compensation, insurance or accounting. · Insurance Institute of America Certification (IIA certification). · Workers' Compensation Experience - CPCS1 WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. REQUIRED TESTING: Claims Payment and Compliance Specialist I: Basic Windows, Basic Excel, Basic Word, Reading Comprehension, Alpha Numeric, 10-Key, Math, Proofreading. Claims Payment and Compliance Specialist II: Basic Windows, Intermediate Excel, Basic Word, Reading Comprehension, 10-Key, Math, Proofreading.
    $26k-41k yearly est. 7d ago
  • Claims Processor

    Teksystems 4.4company rating

    Claim Processor Job 131 miles from Grand Rapids

    Hours: 8am to 4:30pm during training, the first 3 to 4 weeks. Must not miss any time during this time. Schedule to stay the same after. Some flexibility within an hour each way. Fully on-site position for the first 3 to 6 months. After that they will be transitioned to a hybrid schedule ONLY IF they are meeting production, quality, and attendance metrics. Please do not promise this! It is an earned opportunity. For some it may be sooner then the 6 months and for others it may be longer.. it's all up to the employee Associates will assisting customers with claims on their homeowner's insurance. The specialist manages the loss claim from the point of reporting through completion of the repairs. Must have strong verbal and written communication skills to respond to questions and requests from clients, staff, borrowers, contractors, adjusters, and agents quickly and accurately. All activity pertaining to the claim must be documented and draws are issued for the repairs as needed. Processing must meet all compliance requirements. The specialist must demonstrate the ability to make decisions, problem analysis, and promptness to ensure the client's needs are met on a timely basis. . Claims can be very dramatic like a fire or a flood. The role will consist of assisting clients with releasing funds to be paid to restoration companies to perform repairs on their property. Most of the time there is more information or guidelines that need to be met before these funds can be released -Approx. minimum of 50 calls per day -Customers can be very angry and upset at times -Associates must be willing to listen and understand the customer's frustration -Must be able to stay calm under pressure -Should not cut off the customers -Be able to problem solve with the customer and make them feel at ease - (An example would be - a storm damaging someone's house - the homeowner want the house fixed as soon as possible, and doesn't have the funds available immediately to pay for the repairs - Proctor will identify how much they can endorse to the customer at a time - may have to send inspectors out before they send the full 100% of the check Will also be documenting all conversation and details into a multi-screen computer system Very fast paced - ability to multitask and not take things personal when talking with a frustrated customer Documenting into Excel Candidates will go through intense training of shadowing and a little class work initially to understand the industry and the Proctor process Skills customer, service, loss, draft, claim, homeowner, insurance, property, damage, storm Top Skills Details customer, service, loss, draft, claim, homeowner, insurance, property, damage, storm Additional Skills & Qualifications MUST HAVE: - office experience in a customer service, administrative, data entry or production role (1+ year) - ATTENDANCE: must be there every day! - tech savvy - able to use multiple monitors, multiple programs running at one time - at least 35 WPM - great verbal and written communication skills - analytical, ability to solve a problem (in this case the claim) - active internet connection at home, if they are to work a hybrid schedule in the future NICE TO HAVE: - basic to intermediate excel skills - insurance or mortgage experience - homeowner claims experience Experience Level Entry Level Pay and Benefits The pay range for this position is $16.00 - $16.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully onsite position in Troy,MI. Application Deadline This position is anticipated to close on Feb 14, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
    $16-16 hourly 2d ago
  • Analyst, Claims Research

    Molina Healthcare 4.4company rating

    Claim Processor Job In Grand Rapids, MI

    Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints, legal requests, or identified internally by Molina. Identifies the root cause of processing errors through research and analysis, coordinates and engages with appropriate departments, develops and tracks remediation plans, and monitors claims reprocessing through resolution. Interprets and presents in-depth analysis of findings and results to leadership and respective operations teams. Responsible for ensuring the projects are completed accurately and timely. Job Duties · Uses analytical skills to conducts research and analysis for issues, requests, and inquiries of high priority claims projects · Assists with reducing re-work by identifying and remediating claims processing issues · Locate and interpret regulatory and contractual requirements · Tailors existing reports or available data to meet the needs of the claims project · Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing errors · Applies claims processing and technical knowledge to appropriately define a path for short/long term systematic or operational fixes · Helps to improve overall claims performance to ensure claims are processed accurately and timely · Identifies claims requiring reprocessing or re-adjudication in a timely manner to ensure compliance · Works closely with external departments to define claims requirements · Recommends updates to Claims SOP's and Job Aid's to increase the quality and efficiency of claims processing · Fields claims questions from Molina Operations teams · Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, overall progress, and status of impacted claims · Provides excellent customer services to our internal operations teams concerning claims projects · Appropriately convey information and tailor communication based on the targeted audience · Provides sufficient claims information to our internal operations teams that must communicate externally to provider or members · Able to work in a project team setting while also able to complete tasks individually within the provided timeline or as needed, accelerated timeline to minimize provider/member impacts and/or maintain compliance · Manages work assignments and prioritization appropriately · Other duties as assigned. Job Qualifications REQUIRED EDUCATION: Associate's degree or equivalent combination of education and experience REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: · 2-5 years of experience in medical claims processing, research, or a related field · Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas · Knowledge and experience using Excel PREFERRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience PREFERRED EXPERIENCE: · Project management · Expert in Excel and PowerPoint · Familiarity with Salesforce and iServe for managing claims inquiries and adjustment requests **PHYSICAL DEMANDS:** Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.2-46.4 hourly 19d ago
  • Bodily Injury Claims Specialist

    Auto-Owners Insurance Co 4.3company rating

    Claim Processor Job In Grand Rapids, MI

    We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to: * Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss. * Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage. * Follow claims handling procedures and participate in claim negotiations and settlements. * Deliver a high level of customer service to our agents, insureds, and others. * Devise alternative approaches to provide appropriate service, dependent upon the circumstances. * Meet with people involved with claims, sometimes outside of our office environment. * Handle investigations by telephone, email, mail, and on-site investigations. * Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute. * Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials. * Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule. * Assist in the evaluation and selection of outside counsel. * Maintain punctual attendance according to an assigned work schedule at a Company approved work location. Desired Skills & Experience * A minimum of three years of insurance claims related experience. * The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision. * The ability to effectively understand, interpret and communicate policy language. * The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues. Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. * Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.
    $57k-76k yearly est. 5d ago
  • Claims Processor, Brio Living Services

    United Methodist Retirement Communities 4.0company rating

    Claim Processor Job 116 miles from Grand Rapids

    Schedule: Full Time | 40 hours per week Work Type: with onsite requirements (training will be conducted onsite)
    $22k-27k yearly est. 14h ago
  • Mortgage Claims Default Specialist

    The Emac Group

    Claim Processor Job 131 miles from Grand Rapids

    The EMAC Group is a provider of mortgage recruiting services, we offer an extensive network of mortgage professionals and proven expertise developed over 20 years of experience identifying, attracting and recruiting mortgage talent for our clients. Job Description POSITION SUMMARY The Claims Specialist is responsible for processing required claims to Fannie Mae, Mortgage Insurance Companies, FHA, VA or other investors to recover advances incurred throughout the default process. The Claims Specialist will file required claims; meet investor time frames, and complete audits of claims processes for validation. Responsibilities as well will entail tracking of claim payments received for proper application, and filing of any required supplemental claims as necessary, and respond regarding any contested claim information as required. ESSENTIAL POSITION FUNCTIONS • Review, analyze, and ensure timely settlement of investor and mortgage insurance claims and manage aging claims to determine status and bring to closure and request extensions as needed. • Document and maintain all systems necessary for proper claim handling and follow-up. • Research issues and obtain proper supporting documentation in a timely manner as requested by investor or mortgage insurance company. • Manage application of all claim funds received and provide additional information as necessary in order to validate all available funds received prior to claim being closed. • Monitor claim process reports to ensure all required responses are timely filed. • Complete timely audits of all assigned claims to ensure all requirements have been met, and claim process can be validated. Qualifications EDUCATION / EXPERIENCE REQUIREMENTS • Graduation from a 4-year college or university with major course work in a discipline related to the requirements of the position is preferred. Will consider the equivalent combination of job experience & education that demonstrates the ability to perform the essential functions of this job. • Knowledge of Microsoft Office a must; knowledge of YARDI, LoanSphere, VALERI, USDA LINC and Workout Prospector a plus. • Previous work with mortgage claim filing is a requirement. Additional Information Please contact Tabitha Wolf at: ************
    $41k-69k yearly est. 6d ago
  • Mortgage Claims Default Specialist

    The EMAC Group

    Claim Processor Job 137 miles from Grand Rapids

    The EMAC Group is a provider of mortgage recruiting services, we offer an extensive network of mortgage professionals and proven expertise developed over 20 years of experience identifying, attracting and recruiting mortgage talent for our clients. Job Description POSITION SUMMARY The Claims Specialist is responsible for processing required claims to Fannie Mae, Mortgage Insurance Companies, FHA, VA or other investors to recover advances incurred throughout the default process. The Claims Specialist will file required claims; meet investor time frames, and complete audits of claims processes for validation. Responsibilities as well will entail tracking of claim payments received for proper application, and filing of any required supplemental claims as necessary, and respond regarding any contested claim information as required. ESSENTIAL POSITION FUNCTIONS • Review, analyze, and ensure timely settlement of investor and mortgage insurance claims and manage aging claims to determine status and bring to closure and request extensions as needed. • Document and maintain all systems necessary for proper claim handling and follow-up. • Research issues and obtain proper supporting documentation in a timely manner as requested by investor or mortgage insurance company. • Manage application of all claim funds received and provide additional information as necessary in order to validate all available funds received prior to claim being closed. • Monitor claim process reports to ensure all required responses are timely filed. • Complete timely audits of all assigned claims to ensure all requirements have been met, and claim process can be validated. EDUCATION / EXPERIENCE REQUIREMENTS • Graduation from a 4-year college or university with major course work in a discipline related to the requirements of the position is preferred. Will consider the equivalent combination of job experience & education that demonstrates the ability to perform the essential functions of this job. • Knowledge of Microsoft Office a must; knowledge of YARDI, LoanSphere, VALERI, USDA LINC and Workout Prospector a plus. • Previous work with mortgage claim filing is a requirement. Additional Information Please contact Tabitha Wolf at: ************
    $41k-69k yearly est. 60d+ ago
  • Insurance Claims Liaison Specialist

    First National Bank of America 4.0company rating

    Claim Processor Job 59 miles from Grand Rapids

    First National Bank of America is looking for a professional and customer-service oriented Insurance Claims Liaison Specialist to join the Servicing Operations team. A successful candidate in this role will be able to grasp policies and regulations swiftly and explain them in a way that's easy to understand, regardless of the audience's expertise. The ideal Insurance Claims Liaison Specialist will have strong follow-up skills, an eye for detail, problem-solving abilities, a capability to work and prioritize in a fast-paced environment, and strong verbal communication skills. Responsibilities: Demonstrates the ability to communicate firm decisions clearly and empathetically, ensuring compliance with company policies and regulatory standards Clear, concise and timely communication and follow up with borrowers, fellow employees, and insurance providers to answer insurance and escrow related questions Exhibit strong listening skills with every situation, maintaining composure and professionalism Maintain accurate records of customer interactions and transactions Enter insurance policies into the database Place force-placed insurance as required Prepare, understand and explain escrow analyses to borrowers Qualifications: Strong phone skills are essential, as you will spend at least 50% of your time on the phone Interpersonal skills, handling calls under pressure while exhibiting empathy and firmness Proven ability to assess daily goals and continually prioritize work Proficient navigation of Microsoft Word, Excel, and Outlook Insurance/Industry claims experience beneficial, but not required Bilingual (Spanish/English) is preferred but not required Employee benefits Medical - Multiple plans to choose from including HSA and traditional. Premiums as low as $0.00 Dental - Premiums as low as $0.00 Vision - Low premium Plan Discounted childcare Pet Insurance Paid Time Off (PTO) 401k with employer match At First National Bank of America , we are looking for exceptional individuals with a "servant's heart" or a natural humility that recognizes the importance of prioritizing others' needs. We celebrate and acknowledge efforts that exceed expectations, whether it's delivering added value to customers or supporting colleagues. Just as interest compounds over time, the little things we do can make a substantial difference. First National Bank of America recognizes that the quality of our people is the foundation for our success. Attracting exceptional individuals who value a challenging work environment that rewards the contributions of its people is the cornerstone of our hiring philosophy. Note: These statements are intended to describe the general nature and level of work involved for this job. It is not an exhaustive list of all responsibilities, duties, and skills required for this job. First National Bank of America is an Equal Opportunity Employer. #LI-Onsite
    $38k-46k yearly est. 8d ago
  • Provider Reimbursements Representative - Veterans Evaluation Services

    Maximus 4.3company rating

    Claim Processor Job In Grand Rapids, MI

    Description & Requirements Maximus is currently hiring for a Provider Reimbursements Representative to join our Veterans Evaluation Services (VES) team. This is a remote opportunity. The Provider Reimbursements Representative is responsible for working closely with providers to establish good rapport and to answer their inquiries regarding DBQs, travel pay, contractual agreements, and pay rates. They will issue bonus requests, rate increases, and other fees as required as well as follow up on reports that are pending signature. - Due to contract requirements, only a US Citizen or a Green Card holder can be considered for this opportunity. Essential Duties and Responsibilities: - Provider Reimbursements must be well versed in VES contracts and able to explain and negotiate contracts with our providers. - Negotiates rates with our provider network; Reimbursements should be able to assess a number of factors when considering rates, including provider timeliness, report quality, history with the company, and any outlying circumstances. - Negotiates provider bonuses as applicable and issues bonus requests; when considering bonuses, Reimbursements team should be able to assess a variety of factors, including the size and approximate difficulty of a given case, any differences in regional pricing which may factor in, and any prior payment agreements which we may have with the provider. - Reimburses travel expenses for VES related work and conveys VES policies re: travel to providers; Provider Reimbursements should communicate with Regional Operations Managers and scheduling leadership to assess VES' needs which necessitated travel and to discuss any other challenges related to provider travel. - Assists Billing team with provider inquiries into past payments. - Assists Accounting by answering provider questions on 1099s and tax issues, and with dispersal of 1099s as needed. - Assist providers with any and all questions related to payment. - Reliably route providers to the proper department or person when assisting with non- payment related issues. - Ability to work a training schedule of 8am-4:30pm CT Monday - Friday required Please note: With this position you have the option to have Maximus provide you with equipment to use, or you may use your own equipment. Home Office Requirements Using Your Own Equipment: - Internet speed of 20mbps or higher required (you can test this by going to ****************** - Preferred Windows or Mac (no Chromebooks) - OS for Windows - Windows 10 or newer - OS for Mac - Big Sur (11.0.1+); Catalina (10.15); MacOS (up to 12.5) or newer - Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router - USB plug and play wired headset with a microphone and noise suppression - Private work area and adequate power source - A second monitor is highly recommended for most positions - Must currently and permanently reside in the Continental US Home Office Requirements Using Maximus-Provided Equipment: - Internet speed of 20mbps or higher required (you can test this by going to ****************** - Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router - Private work area and adequate power source - Must currently and permanently reside in the Continental US Minimum Requirements - Bachelor's degree or equivalent experience required. - Billing or finance experience highly preferred - Intermediate knowledge of Excel and Outlook preferred - QA experience preferred EEO Statement Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances. Minimum Salary $ 21.64 Maximum Salary $ 36.69
    $27k-32k yearly est. 8d ago

Learn More About Claim Processor Jobs

How much does a Claim Processor earn in Grand Rapids, MI?

The average claim processor in Grand Rapids, MI earns between $21,000 and $56,000 annually. This compares to the national average claim processor range of $26,000 to $62,000.

Average Claim Processor Salary In Grand Rapids, MI

$35,000
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