The Claims Associate provides quality assistance to adjusters at all phases of the claim lifecycle to drive the claim to timely conclusion. Supports the success of the organization through interactions with agencies, policyholders, and employees. Thi Claims, Adjuster, Associate, Insurance, Support
$49k-59k yearly est. 2d ago
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Claims Analyst
Cherokee Insurance Company
Claim specialist job in Sterling Heights, MI
Cherokee Insurance Company, a leading casualty insurance provider to the transportation industry is seeking an entry level liability adjuster for our Sterling Heights, MI office. Cherokee Insurance is rated ‘A' (Excellent) by A.M. Best Company. Now is your chance to join a team of trained professionals and enhance your skills.
We are seeking detail-oriented individuals with superior customer service and negotiation skills to investigate and process both first- and third-party claims. Liability Adjusters are trained on site and are not required to travel. Based at our Corporate Office, this is an exceptional chance for learning, exposure, and career advancement.
Job Responsibilities:
Gather accident information and assist the insured to begin the claim process
Take and organize detailed notes/information from all involved parties
Ensure that all claims information is accurately input to claims system
Prepare claim information
Meet deadlines while making priority adjustments as needed
Confidently and professionally work well with internal and external customers
Handle matters according to various state regulatory requirements and respond to issues in a timely, appropriate fashion
Stay abreast of and utilize claim handling best practices as directed by management and regulatory/professional organizations
Maintain file communications and associated details to ensure that a complete file is available to the company at all times
After appropriate training and foundational understanding (3 - 6 months), Liability Adjusters will be responsible for:
Determining responsibility, coverages and coverage limits
Consulting with all involved vendors and out of state contracted adjusters
Reviewing and approving price quotes
Settlement negotiation
The ideal candidate will possess the following:
Exceptional communication skills: listening, reading, writing, speaking
Solid organizational, multi-tasking and time-management skills
Strong analytical and problem-solving skills
Ability to work both independently and in a team-oriented environment
Intermediate knowledge of Microsoft Office Suite
Strong sense of urgency
Willingness to learn and desire for promotion/advancement
Bachelor's Degree in business, economics, finance or related field
Salary and Benefits:
Competitive Salary
Medical/dental benefits
401(k)
Paid vacation
Life Insurance
Collaborative environment
Opportunity for advancement
$44k-76k yearly est. 5d ago
Casualty Claim Specialist (Michigan PIP)
The Auto Club Group 4.2
Claim specialist job in Dearborn, MI
Casualty ClaimSpecialist (Michigan PIP) - The Auto Club GroupWhat you will do:The Auto Club Group is seeking prospective ClaimSpecialist who will work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.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.
Ensure all possible policyholder benefits are identified.
Create additional sub-claims if needed.
Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
Evaluate the financial value of the loss.
Approve payments for the appropriate parties accordingly.
Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.
Utilize strong negotiating skills.
ClaimSpecialists are assigned to the PIP unit and are responsible for Michigan PIP intermediate claims involving fractures, mild closed head injuries, surgical procedures, and claims involving attendant care. The role may require proficiency in dealing with the MCCA and attorney represented claims. May handle losses beyond those identified previously. Work with insureds, physicians' offices and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations With our powerful brand and the mentoring, we offer, you will find your position as aClaim Specialist can lead to a rewarding career at our growing organization.Work EnvironmentThis position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.How you will benefit:
A competitive annual salary between $65,700 to $75,000
ACG offers excellent and comprehensive benefits packages, including:
Medical, dental and vision benefits
401k Match
Paid parental leave and adoption assistance
Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
Paid volunteer day annually
Tuition assistance program, professional certification reimbursement program and other professional development opportunities
AAA Membership
Discounts, perks, rewards, and much more
We're looking for candidates who:Required Qualifications (these are the minimum requirements to qualify) Education:
Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience
In states where an Adjuster's license is required, the candidate must be eligible to acquire a State Adjuster's license within 90 days of hire and maintain as specified for appropriate states.
A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.
Experience:Three years of experience or equivalent training in the following:
Negotiation of claim settlements
Securing and evaluating evidence
Preparing manual and electronic estimates
Subrogation claims
Resolving coverage questions
Taking statements
Establishing clear evaluation and resolution plans for claims
Knowledge and Skills:Advance knowledge of:
Essential Insurance Act (Michigan)
Fair Trade Practices Act as it relates to claims
Subrogation procedures and processes
Intercompany arbitration
Handling simple litigation
Advance knowledge of:
Negligence Law
No-Fault Law
medical terminology and human anatomy
MCCA and attorney represented claims
Ability to:
Handle claims to the line Claim Handling Standards
Follow and apply ACG Claim policies, procedures and guidelines
Work within assigned ACG Claim systems including basic PC software
Perform basic claim file review and investigations
Demonstrate effective communication skills (verbal and written)
Demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns
Analyze and solve problems while demonstrating sound decision making skills
Prioritize claim related functions
Process time sensitive data and information from multiple sources
Manage time, organize and plan workload and responsibilities
Research, analyze, and interpret subrogation laws in various states
Preferred QualificationsEducation:
Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent
CPCU coursework or designation
#LI-LC1
Who We Are
Become a part of something bigger.
The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.
And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other.
We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.
To learn more about AAA The Auto Club Group visit ***********
Important Note:
ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.
The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.
The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
Regular and reliable attendance is essential for the function of this job.
AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.
$65.7k-75k yearly 2d ago
Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations
Stout 4.2
Claim specialist job in Royal Oak, MI
At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team.
About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include:
Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations.
Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies.
Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic.
Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning.
Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives.
Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support.
Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations.
Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery.
Continue developing technical, analytical, and consulting skills while building credibility with clients.
Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement.
Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team.
What You Bring
Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred.
Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles.
Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance.
Epic Resolute or other hospital billing system experience preferred; Epic certification a plus.
Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required.
Additional certifications such as CHC, CFE, or AHFI preferred.
Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization.
Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred.
Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act.
Willingness to travel up to 25%, based on client and project needs.
How You'll Thrive
Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions.
Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships.
Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time.
Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment.
Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility.
Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions.
Why Stout?
At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life.
We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.
We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals.
Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.
Learn more about our benefits and commitment to your success.
en/careers/benefits
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.
Stout is an Equal Employment Opportunity.
All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law.
Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.
$38k-46k yearly est. 3d ago
MACP Subrogation Claims Representative
Michigan Farm Bureau 4.1
Claim specialist job in Lansing, MI
OBJECTIVE
MACP Subrogation Claims Representative Objective
To maximize the recovery of Farm Bureau Insurance paid claims by handling Michigan Assigned Claims Plan (MACP) subrogation efforts for recovery cases, as well as provide technical support for the Assigned Claims Unit.
RESPONSIBILITIES
MACP Subrogation Claims Representative Responsibilities
Review and evaluate each subrogation file as directed to determine if all pertinent investigative information has been provided. Follow up with adjusters as necessary to obtain additional information.
Work with computer systems keying functions, including but not limited to, letter composition, log entry, time entry, diary entry, report of investigation composition, and draft production.
Handle subrogation claims on behalf of the Michigan Assigned Claims Plan. Confirm file closings and subrogation assignments.
Develop a working knowledge of the Michigan No-Fault Law and Statute of Limitations that apply and maintain timely payments.
QUALIFICATIONS
MACP Subrogation Claims Representative Qualifications
Required
· High school diploma or equivalent required.
· Minimum two years of experience in auto, property, or liability claims handling required.
Preferred
· Bachelor's degree or professional insurance designation preferred.
Note: Possible travel to court appearances.
Farm Bureau offers a full benefit package including medical, dental, vision, and 401K.
PM19
$49k-57k yearly est. Auto-Apply 35d ago
Lansing, Michigan Field Property Claim Specialist
Acg 4.2
Claim specialist job in Lansing, MI
Eligible candidates for this role should reside within a commutable distance of Lansing, Michigan.
Territory coverage includes Lansing, Jackson, Howell, and Flint Michigan areas.
Job Title- Field Property ClaimSpecialist
Reports to: Claim Manager as appropriate
What you will do:
Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.
Review assigned claims,
Contacting the insured and other affected parties, set expectations for the remainder of the claim process, and initiate documentation in the claim handling system.
Complete complex coverage analysis.
Ensure all possible policyholder benefits are identified.
Create additional sub-claims if needed.
Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
Evaluate the financial value of the loss.
Approve payments for the appropriate parties accordingly.
Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.
Utilize strong negotiating skills.
Employees will be assigned to the Michigan Homeowner claim unit and will handle claims generally valued between $10,000 and $75,000 and occasionally over $100,000 for field role. Investigate claims requiring coverage analysis. When handling claims in the field, must prepare damage estimates using Xactimate estimating software. Review estimates for accuracy. May monitor contractor repair status and updates.
Supervisory Responsibilities:
None
How you will benefit:
A competitive annual salary between $65,700 - $90,000
ACG offers excellent and comprehensive benefits packages, including:
Medical, dental and vision benefits
401k Match
Paid parental leave and adoption assistance
Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
Paid volunteer day annually
Tuition assistance program, professional certification reimbursement program and other professional development opportunities
AAA Membership
Discounts, perks, and rewards and much more
We're looking for candidates who:
Required Qualifications (these are the minimum requirements to qualify)
Education:
Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, associate in management or equivalent
CPCU coursework or designation
Xactware Training
Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience.
In states where an Adjuster's license is required, the candidate must be eligible to acquire a State Adjuster's license within 90 days of hire and maintain as specified for appropriate states.
Must have a valid State Driver's License
Ability to:
Lift up to 25 pounds
Climb ladders.
Walk on roofs.
Experience:
Three years of experience or equivalent training in the following:
Negotiation of claim settlements
Securing and evaluating evidence
Preparing manual and electronic estimates
Subrogation claims
Resolving coverage questions
Taking statements
Establishing clear evaluation and resolution plans for claims
Knowledge and Skills:
Advanced knowledge of:
Fair Trade Practices Act as it relates to claims
Subrogation procedures and processes
Intercompany arbitration
Handling simple litigation
Advanced knowledge of building construction and repair techniques
Ability to:
Handle claims to the line Claim Handling Standards
Follow and apply ACG Claim policies, procedures and guidelines
Work within assigned ACG Claim systems including basic PC software
Perform basic claim file review and investigations
Demonstrate effective communication skills (verbal and written)
Demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns
Analyze and solve problems while demonstrating sound decision-making skills
Prioritize claim related functions
Process time sensitive data and information from multiple sources
Manage time, organize and plan workload and responsibilities
Safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc.
Research analyze and interpret subrogation laws in various states
May travel outside of assigned territory which may involve overnight stay
Preferred Qualifications:Education:
Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent
CPCU coursework or designation
Xactware/Xactimate Training or equivalent
Work EnvironmentThis position is currently able to work remotely from a home office location for day-to-day operations, with traveling to field locations as necessary to complete job responsibilities, unless occasional team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.
Who We Are
Become a part of something bigger.
The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.
And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other.
We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.
To learn more about AAA The Auto Club Group visit ***********
Important Note:
ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.
The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.
The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
Regular and reliable attendance is essential for the function of this job.
AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.
$65.7k-90k yearly Auto-Apply 36d ago
Bodily Injury Claims Specialist
Auto-Owners Insurance Co 4.3
Claim specialist job in Lansing, 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.
#LI-DNI #IN-DNI
$58k-78k yearly est. Auto-Apply 60d+ ago
Automotive Claims Specialist
Loss Prevention Services, LLC 3.6
Claim specialist job in Grandville, MI
Job DescriptionSalary:
The ClaimsSpecialist is responsible for handling damage claims and property loss claims, to help resolve them efficiently and fairly. Successful Candidates MUST prior experience with automotive insurance claims or experience working with insurance in a body shop or similar vehicle repair facility to be considered for this position.
Job Type: Full Time On-Site or Hybrid at our office in Grandville, MI - This is not a fully remote position.
Duties and Responsibilities:
Investigating and analyzing details of damage claims and property loss claims to determine the level of liability.
Reviewing and evaluating damage claims and property loss claims for accuracy and completeness.
Interacting with service providers, clients, and claimants to gather more information about damage claims and property loss claims.
Documenting all claim related activities and maintaining claim files for review and auditing purposes.
Following all company policies and procedures and complying with all legal requirements
Maintaining a high level of customer service by answering questions and providing information to all parties involved in the claims process.
Requirements:
Experience in the Collateral Recovery industry required, preferably in a Claims related role.
Excellent written and verbal communications skills.
Excellent listening, negotiation and problem-solving skills.
Attention to detail and high level of accuracy.
Must be proficient in Microsoft Office or Google Suite.
Benefits:
Medical, Dental and Vision Insurance
Paid Time Off
Paid Holidays
$51k-89k yearly est. 8d ago
Mortgage Claims Specialist
The Emac Group
Claim specialist job in Detroit, MI
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 ClaimsSpecialist 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 ClaimsSpecialist 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. 2d ago
Mortgage Claims Specialist
The EMAC Group
Claim specialist job in Detroit, MI
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 ClaimsSpecialist 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 ClaimsSpecialist 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. 60d+ ago
Pharmacy 340B Claims Specialist
Family Health Care 4.3
Claim specialist job in White Cloud, MI
Family Health Care is currently seeking applications for the position of Pharmacy 340B ClaimsSpecialist!
General Function: This position functions at the highest level (III) in the series of Pharmacy Technician roles within Family Health Care. The individual in this role is a “work-leader” serving as the expert on prescription claims reimbursement and performing self-auditing for the pharmacy department. This individual will ensure prescription claim integrity by having advanced knowledge of claim requirements for the various pharmacy benefit managers (PBM) and shall use that information to identify areas of improvement by performing targeted claim audits and will provide education to the pharmacy staff on billing requirements, when needed.
Responsibilities:
Acts as pharmacy claims auditor and will audit claims daily into order to track claims accuracy, trends, anomalies and other critical information to help BFHC ensuring appropriate reimbursement while mitigating organizational risk for claims remediations resulting from claim processing errors.
Acts as pharmacy 340B claims auditor and audits claims on a scheduled basis into order to track 340B claims accuracy, trends, anomalies, and other critical information to help BFHC maintain 340B claim integrity while ensuring adherence to 340B policies, procedures, rules and regulations.
Ensures timely and accurate billing/collections of all pharmacy charges and reimbursement activities through the use of reporting and reconciliation.
Ensures integrity if financial reports and provides necessary reports to the finance department upon request.
Assists the Chief Pharmacist and pharmacy staff in the research, development and implementation of new and existing pharmacy services.
Location(s): White Cloud, MI
Employment Type: Full Time
Exempt/Non-Exempt: Non-Exempt
Benefits: Competitive wage and excellent benefits package. FHC is an eligible organization for State and Federal Loan Repayment Programs.
Family Health Care is an Equal Opportunity Employer.
$52k-73k yearly est. 41d ago
Warranty Claims Specialist
Brightwing
Claim specialist job in Auburn Hills, MI
Job Title: Warranty ClaimsSpecialist
This role is responsible for reviewing and processing warranty claims, including conducting technical analyses to ensure compliance with established Warranty Policies and Procedures in effect at the time of repair. The position provides support to dealers, field staff, and corporate employees through phone and email to ensure claims are accurately submitted, reviewed, and paid in a timely manner.
Key Responsibilities:
Review and evaluate warranty claims for accuracy, compliance, and eligibility.
Provide guidance and support to dealers, field staff, and internal employees regarding claim submission and processing.
Clarify warranty coverage, policies, and procedures, including proper claim coding and documentation requirements.
Adjust and approve claims for payment and ensure all updates are properly recorded in the Warranty Audit Trail.
Maintain accurate data within the SAGA system to ensure smooth claim processing and reduce unnecessary rejections.
Review and resolve claims that fail SAGA system edits.
Track and analyze warranty trends to identify opportunities for improvement.
Train dealer staff, new corporate employees, and field employees on warranty procedures and claim adjusting processes.
Skills & Competencies:
Strong analytical and problem-solving skills
Excellent communication and customer service abilities
Attention to detail and accuracy
Ability to interpret warranty policies and technical documentation
Experience working with claims processing systems preferred
$40k-69k yearly est. 8d ago
Senior Claims Support Analyst
AAA Life Insurance Company 4.5
Claim specialist job in Livonia, MI
Why AAA Life
AAA Life is a respected and trusted American brand that has been focusing on Life Insurance and Annuity Products since 1969. At AAA Life we have over 1.8 million policies where we take pride in earning the trust of our policyholders who understand our promise to be there for them - and their families - when we're needed most. By joining the AAA Life team, you are joining a company that genuinely cares about helping each other, with a devotion to protect the lives of those around us. We embrace a diverse, equitable, inclusive culture where all associates can feel a sense of belonging and use their unique talents and perspective to influence, innovate, motivate, and thrive.
The Senior Claims Support Analyst supports both the Claims and Treasury functions by ensuring the efficient flow of funds, accuracy of claims payments, and continuous improvement of claims financial processes. This role combines analytical and operational expertise to maintain regulatory compliance, improve claims payment accuracy, and optimize cash management procedures.
The analyst develops, monitors, and reports on key performance metrics, reconciles payment and claims data, supports quality reviews, and collaborates cross-functionally with Finance, Treasury, and Claims Leadership to streamline processes and improve financial integrity in claims operations.
Responsibilities
How You'll Work
Work Solution: Hybrid
Relocation Eligibility: Available
What You'll Do
Perform analytical reviews of claims payment and financial transactions to ensure accuracy, compliance, and adherence to internal controls and resolve related issues.
Compile and interpret data for claims-related financial and operational reports, including accuracy trends, payment reconciliation, and reserve management.
Maintain and analyze spreadsheets and databases used for claims funding, payment tracking, and financial reconciliations.
Partner with Treasury to forecast cash needs related to claims payouts and ensure adequate liquidity for daily claim obligations.
Develop and maintain process documentation and financial models to improve claims funding and payment accuracy.
Conduct quality audits for all claim types (Life, Annuity, A&H) to verify regulatory compliance and identify opportunities for improvement.
Support service recovery and resolution for escalated claim issues; provide data and analysis for Department of Insurance or external audit responses.
Collaborate with Finance to analyze trends, variances, and reconciliation discrepancies; recommend corrective actions.
Identify and implement process improvements to reduce manual handling, improve automation, and enhance data accuracy.
Prepare and present claims financial metrics and insights to management, highlighting process efficiencies and control improvements.
Serve as liaison for audit-related requests (internal, reinsurer, or regulatory) and provide supporting documentation.
Provide training, guidance, and feedback to claims staff on financial procedures and quality standards.
Ensure compliance with MAR, internal audit requirements, and fair claims practices regulations.
Qualifications
Qualifications
Bachelor's Degree in Business, Finance, Accounting, or related field (or equivalent work experience).
Minimum 5 years of experience in Claims Operations, Treasury Support, or related insurance field.
Strong understanding of claims processing systems, payment workflows, and audit requirements.
Preferred Qualifications
Proficiency in Microsoft Excel, Access, and financial modeling; familiarity with COGNOS or similar reporting tools preferred.
Demonstrated experience in data analysis, reconciliation, and process improvement.
Excellent communication and collaboration skills, with the ability to work effectively across departments.
Strong organizational and time-management skills with attention to detail.
Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
#LI-Hybrid
While performing the duties of this job, the employee is frequently required to stand, walk, sit, use hands to finger, handle, or feel, talk, hear and concentrate. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus.
This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodation will be made for otherwise qualified applicants as needed to enable them to fulfill these requirements.
We are committed to ensuring equal employment opportunities for all job applicants and employees. Employment decisions are based upon job-related reasons regardless of an applicant's race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, marital status, genetic information, protected veteran status, or any other status protected by law.
$86k-125k yearly est. Auto-Apply 45d ago
Claims Examiner
Harriscomputer
Claim specialist job in Michigan
Responsibilities & Duties:Claims Processing and Assessment:
Evaluate incoming claims to determine eligibility, coverage, and validity.
Conduct thorough investigations, including reviewing medical records and other relevant documentation.
Analyze policy provisions and contractual agreements to assess claim validity.
Utilize claims management systems to document findings and process claims efficiently.
Communication and Customer Service:
Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements.
Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process.
Address customer concerns and escalate complex issues to senior claims personnel or management as needed.
Compliance and Documentation:
Ensure compliance with company policies, procedures, and regulatory requirements.
Maintain accurate records and documentation related to claims activities.
Follow established guidelines for claims adjudication and payment authorization.
Quality Assurance and Improvement:
Identify opportunities for process improvement and efficiency within the claims department.
Participate in quality assurance initiatives to uphold service standards and improve claim handling practices.
Collaborate with team members and management to implement best practices and enhance overall departmental performance.
Reporting and Analysis:
Generate reports and provide data analysis on claims trends, processing times, and outcomes.
Contribute to the development of management reports and presentations regarding claims operations.
$27k-45k yearly est. Auto-Apply 35d ago
Claims Examiner, Commercial Insurance
Arch Capital Group Ltd. 4.7
Claim specialist job in Garden City, MI
With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠.
Position Summary
Arch Insurance Group Inc., AIGI, has an opening with the Claims Division as a Claims Examiner, Casualty. In this role, the responsibilities include actively managing medium-high severity commercial liability claims in jurisdictions throughout the United States.
Responsibilities
* Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel, when necessary, as well as review coverage counsel's opinion letters and analysis
* Develop and implement strategy relative to coverage issues which correlate with the overall strategy of matters entrusted to the handler's care
* Develop and implement timely and accurate resolution strategies to ensure mitigation of indemnity and expense exposures
* Maintain contact with any/all associated claims carrier(s)' claims staff, business line leader, underwriter, defense counsel, program manager, and broker to communicate developments and outcomes as necessary
* Investigate claims and review the insureds' materials, pleadings, and other relevant documents
* Identify and review each jurisdiction's applicable statutes, rules, and case law
* Review litigation materials including depositions and expert's reports
* Analyze and direct risk transfer, additional insured issues, and contractual indemnity issues
* Retain counsel when necessary and direct counsel in accordance with resolution strategy
* Analyze coverage, liability and damages for purposes of assessing and recommending reserves
* Prepare and present written/oral reports to senior management setting forth all issues influencing evaluations and recommending reserves
* Travel to and from locations within the United States to attend mediations, trials, and other proceedings relevant to the resolution of the matter
* Negotiate resolution of claims
* Select and utilize structure brokers
* Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries from the insured, counsel, underwriters, brokers, and senior management regarding claims
Experience & Required Skills
* Exceptional communication (written and verbal), evaluating, influencing, negotiating, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines
* Strong time management and organizational skills
* Demonstrated ability to take part in active strategic discussions
* Demonstrated ability to work well independently and in a team environment
* Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint and Word
* Willing and able to travel 10%
* Hybrid schedule, 3 days a week in office
Education
* Bachelor's degree required.
* Minimum of 3 years of working experience with a primary and or excess carrier supporting commercial accounts for Casualty claims
* Proper & active adjuster licensing in all applicable states
#LI-SW1
#LI-HYBRID
For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible.
$95,000 - $150,000/year based on experience level
* Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future.
* Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits.
Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team.
$39k-52k yearly est. Auto-Apply 5d ago
Claims Processor
Saginaw County Community Mental Health Authority
Claim specialist job in Saginaw, MI
SCCMHA JOB VACANCY ANNOUNCEMENT
CLASSIFICATION: Claims Processor
PAY GRADE: $22.73 - $26.71 Hourly
Under the general supervision of the Chief of Network Business Operations, this position will have the primary responsibility of processing provider network and hospital claims for payment. This position requires claims coordination of benefits (COB) experience ensuring all third-party insurance carriers have been appropriately billed prior to Saginaw County Community Mental Health Authority (SCCMHA) claims payment. The tasks of this position have monthly claims batch payment deadlines, which are coordinated with the other staff within the accounting department. This position must maintain current knowledge of regulations pertaining to approved CPT/HCPCS and Revenue Codes, methods of billing, and procedures related to Medicaid/Medicare and various unique Commercial Insurance reimbursements rules. This position will be knowledgeable about and actively support culturally competent recovery based practices; person centered planning as a shared decision making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid consumer in the recovery process.
ESSENTIAL DUTIES AND RESPONSIBLITIES:
1. Coordinate and adjudicate paper and electronic claims submitted by the provider network and hospitals for payment in accordance with policies and procedures. Approve clean claims for payment. Assist as applicable with denied claims. Submit overrides for approval when appropriate.
2. Verify authorizations as they pertain to proper coding, dating, and fund source.
3. Review coordination of benefits documents prior to claims payment. Verify the Explanation of Benefits submitted by the Provider matches the Coordination of Benefits information on file for the consumer. Ensure reason codes are reasonable. Follow-up with provider as necessary to resolve discrepancies.
4. Process Event Verification settlements following Network Service Auditing review.
5. Process retro payments when contracted rates are modified.
6. Verify all the backup for each provider check/EFT is an agreement prior to mailing the payment.
7. Research, compile and prepare claim(s) remittance reports and other statistical data. Reconcile provider explanation of benefits (EOB) back to the claims detail. Interpret provider contract rates and requirements as they pertain to claims payment and provider benefit packages.
8. Help to establish and implement ongoing improvements to procedures for claims processing.
9. Answer telephones/work with providers to obtain timely, accurate and complete claims data. Train providers or other staff when needed of proper SCCMHA claims processing requirements.
10. Enter daily CTN/CTS skill build SALs into Sentri based on daily attendance calendars submitted by the respective programs. Reconcile the SALs to the CTN/CTS attendance sheets.
11. Process consumer Ability to Pay (ATP) based upon CFIS documents. Enter consumer ATP's data into Sentri. Perform insurance verification as applicable.
12. Provide backup and other miscellaneous duties as assigned.
13. Adheres to the mission, vision, core values and operating principles of SCCMHA at all times.
INCIDENTAL DUTIES AND RESPONSIBILITES:
1. Communicates well with consumers, co-workers, and supervisors and meets deadlines and follows through with others as promised in order to provide additional information and/or to answer questions.
2. Demonstrates the ability to provide exceptional customer service to all consumers, staff, and providers of service.
3. Obtains necessary computer training in order to stay current with system changes as needed to complete all tasks related to this position. Works independently to stay informed of changes made within the assigned service area.
4. Attends meetings, in-service training, etc, as required for the finance department, the assigned service area or the Authority.
5. Reacts productively and responsively to change and handles other essential tasks as assigned.
6. Insures that the front desk is covered at all times in order to provide necessary customer service.
(The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all duties and responsibilities required of personnel so classified.)
REPORTING RELATIONSHIPS:
Reports to: Chief of Network Business Operations
Supervises: None
WORKING CONDITIONS/ENVIRONMENT:
Works in office environment with usual pressures of time constraints and stress of long periods of computer use. Performs daily data entry of confidential financial data for individuals suffering from mentally ill or developmentally disabled.
QUALIFICATIONS:
Education: Associate Degree with healthcare related courses required. Medical terminology and medical billing college level courses required.
Experience: Three (3) years of healthcare claims processing (including coordination of benefits) experience required.
Licenses and Certifications: Valid Michigan Driver's license with a good driving record.
Knowledge, Skills, and Abilities:
1. Professional knowledge of and ability to use computerized accounting software such as Great Plains.
2. Proficiency in Microsoft Office including Word, Excel, Access, and Outlook.
3. Comprehensive knowledge of the billing processing working with an Electronic Medical Records Healthcare System.
4. Knowledge of medical terminology and medical procedures associated with clinical billing codes.
5. Ability to communicate well with others and occasionally deal with irate individuals.
6. High degree of attention to detail.
7. Ability to diplomatically associate and relate to individuals of all social, economical, and cultural backgrounds.
8. Must be skilled in normal office procedures such as written and verbal correspondence and use of calculator and other office machines.
9. Maintaining a current knowledge of regulatory policies, procedures, and reporting will be required.
Physical/Mental Requirements:
1. Hearing acuity to converse in person and on telephone.
2. Visual Acuity to read and proofread documents and use CRT.
3. Ability to walk, stand or sit for extended periods of time.
4. Manual dexterity to write and to operate standard office equipment (PC, Keyboard, Copy Machine, Fax Machine, etc.)
5. Ability to lift and carry files and supplies at least 20 pounds.
6. Strong interpersonal skills to interact with leadership, employees, consumers and the general public.
7. Mental capacity to think independently, follow instruction and use judgment.
8. Analytical skills necessary to conduct research, analyze, and interpret complex data and identify and solve problems by proposing courses of action.
9. Ability to plan short and long range and to manage and schedule time.
10. Ability to handle stress in meeting deadlines and dealing with large numbers of employees and/or consumers.
(Listed qualifications are for guidance in filling this position. Any combination of education and experience that provides the necessary knowledge, skills, and abilities will be considered; however, mandatory licensing or certification requirements cannot be waived. Physical/mental requirements cannot be waived unless specifically indicated.)
$22.7-26.7 hourly Auto-Apply 12d ago
Claims Representative
The Strickland Group 3.7
Claim specialist job in Detroit, MI
Join Our Dynamic Insurance Team - Unlock Your Potential!
Are you ready to take control of your future and build a career in one of the most stable and lucrative industries? We are seeking driven individuals to join our thriving insurance team, where you'll receive top-tier training, support, and unlimited income potential.
NOW HIRING:
✅ Licensed Life & Health Agents
✅ Unlicensed Individuals (We'll guide you through the licensing process!)
We're looking for our next leaders-those who want to build a career or an impactful part-time income stream.
Is This You?
✔ Willing to work hard and commit for long-term success?
✔ Ready to invest in yourself and your business?
✔ Self-motivated and disciplined, even when no one is watching?
✔ Coachable and eager to learn?
✔ Interested in a business that is both recession- and pandemic-proof?
If you answered YES to any of these, keep reading!
Why Choose Us?
💼 Work from anywhere - full-time or part-time, set your own schedule.
💰 Uncapped earning potential - Part-time: $40,000 - $60,000 /month | Full-time: $70,000 - $150,000+++/month.
📈 No cold calling - You'll only assist individuals who have already requested help.
❌ No sales quotas, no pressure, no pushy tactics.
🧑 🏫 World-class training & mentorship - Learn directly from top agents.
🎯 Daily pay from the insurance carriers you work with.
🎁 Bonuses & incentives - Earn commissions starting at 80% (most carriers) + salary
🏆 Ownership opportunities - Build your own agency (if desired).
🏥 Health insurance available for qualified agents.
🚀 This is your chance to take back control, build a rewarding career, and create real financial freedom.
👉 Apply today and start your journey in financial services!
(
Results may vary. Your success depends on effort, skill, and commitment to training and sales systems.
)
$41k-54k yearly est. Auto-Apply 60d+ ago
Bilingual Claims Examiner
Healthcare Support Staffing
Claim specialist job in Troy, MI
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. 2d ago
Claims Processor
EHIM 3.8
Claim specialist job in Southfield, MI
Receive, analyze and process assigned claims by product (medical, dental, vision, FSA or HRA) and group. Ensure accurate processing based on benefit plan design and/or regulations. Evaluate underpayments, resolve non-payments and rejected claims. Follow through until the
claim is completely resolved and check is issued.
Create appropriate Explanation of Benefits or letter to provider for each claim.
Identify and escalate claims for review or audit based on business rules.
Ensure required documentation or reporting is completed timely and accurately.
Answer incoming telephone calls related to claim processing, provider support and member benefit
coverage options.
Make outgoing calls to members and providers to obtain additional information as needed.
Retrieve and sort mail, fax and email to ensure timely and accurate handling and response.
Perform clerical functions including data entry, filing, and sorting, typing, organizing, and recording
information.
Train co-workers and new employees, as required.
Perform various related duties as assigned.
Position Requirements:
High school diploma or equivalent required, post high school education preferred.
Minimum two years of experience as a medical claims processor, medical biller or a similar service
position in the health care industry.
Must be flexible with scheduled work hours.
Must have strong customer service orientation and excellent communication skills, and the ability
to work effectively with clients, medical providers and plan members.
Proficient PC skills in Windows-based applications.
Ability to be flexible and quickly adapt to the changing needs in the department.
Must be highly organized with strong attention to detail.
Must be dependable and demonstrate responsible work patterns.
Must have a high level of professionalism and courtesy.
$28k-45k yearly est. 23d ago
Independent Insurance Claims Adjuster in Bay City, Michigan
Milehigh Adjusters Houston
Claim specialist job in Bay City, MI
IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement.
Why This Opportunity Matters:
With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand.
As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives.
This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation.
Join Our Team:
Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt?
If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster.
You're welcome to sign up on our jobs roster if you meet our guidelines.
How We Can Help You Succeed:
At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting.
Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges.
Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster.
Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals.
Seize the Opportunity Today!
Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews.
You can also find us on YouTube at: (*********************************************************
and Facebook at: (************************************************** for additional resources and updates.
APPLY HERE
#AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston
By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.