Explore jobs
Find specific jobs
Explore careers
Explore professions
Best companies
Explore companies
Claims representative jobs in Wyoming, MI
- 24 jobsAll
Claims Representative
Claim Specialist
Claims Adjuster
Claims Analyst
Field Adjuster
Claims Technician
Adjuster
Property Adjuster
Claims Coordinator
Epic Resolute PB Claims Analyst
Deloitte
Claims representative job in Grand Rapids, MI
Are you an experienced, passionate pioneer in technology who wants to work in a collaborative environment? As an experienced Epic Resolute PB Claims Analyst you will have the ability to share new ideas and collaborate on projects as a consultant without the extensive demands of travel. If so, consider an opportunity with Deloitte under our Project Delivery Talent Model. Project Delivery Model (PDM) is a talent model that is tailored specifically for long-term, onsite client service delivery. Work you'll do/Responsibilities As a Project Delivery Senior Analyst (PDSA) at Deloitte, you will work within an engagement team and be responsible for supporting the overall project goals and objectives. In this role, you will interact with stakeholders and cross-functional teams. It is expected that you will be able to perform independent tasks as well as provide technical guidance to team members, as needed. * Work with the implementation team to plan and complete build, implement end-to-end Epic. * Work command center shifts to investigate during go-live, document, and resolve break-fix tickets. * Conduct and document root cause analysis and complete any assigned system maintenance. * Assist in low level design, operational discussions, build, test, and migrate Epic build, provide go-live support following migration of new build. * Communicate regularly with Engagement Managers (Directors), project team members, and representatives from various functional and / or technical teams, including escalating any matters that require additional attention and consideration from engagement management. The Team Join our AI & Engineering team in transforming technology platforms, driving innovation, and helping make a significant impact on our clients' success. You'll work alongside talented professionals reimagining and re-engineering operations and processes that are critical to businesses. Your contributions can help clients improve financial performance, accelerate new digital ventures, and fuel growth through innovation. AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements. Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector. Qualifications Required * Current Epic Certification in Epic Professional Billing * 3+ years' experience in Epic Professional Billing * Experience in Epic implementation or enhancement processes * Experience in application design, workflows, build, troubleshooting, testing, and support. * Bachelor's degree, preferably in Computer Science, Information Technology, Computer Engineering, or related IT discipline; or equivalent experience * Limited immigration sponsorship may be available. * Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve Preferred * Hospital or Clinic operations experience * Additional Epic Certifications * ITIL process knowledge * Analytical/ Decision Making Responsibilities * Analytical ability to manage multiple projects and prioritize tasks into manageable work products * Can operate independently or with minimum supervision * Excellent Written and Communication Skills * Ability to deliver technical demonstrations Additional Requirements Information for applicants with a need for accommodation: ************************************************************************************************************ Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. Check out recruiting tips from Deloitte recruiters. Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. Learn more about what working at Deloitte can mean for you. Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our clients' most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte's purpose is to make an impact that matters for our people, clients, and communities. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. Our purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. Learn more. Professional development From entry-level employees to senior leaders, we believe there's always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career. As used in this posting, "Deloitte" means Deloitte Consulting LLP, a subsidiary of Deloitte LLP. Please see ********************************* for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law. Requisition code: 316852 Job ID 316852$87k-110k yearly est. 10d agoAnalyst, Claims Research
Molina Healthcare Inc.
Claims representative job in Grand Rapids, MI
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific 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. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * 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. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.$21.2-46.4 hourly 12d agoAdjuster, Property Insurance Claims
Elevate Claims Solutions
Claims representative job in Grand Rapids, MI
Elevate Claims Solutions is founded on the belief that human experience and claim quality are the essence of profitable growth and retention for our adjuster partners, our clients, and ourselves. Are you ready, willing, and able to Elevate? Elevate Claims Solutions is seeking an Independent Adjuster in Western Michigan. How will we Elevate you? We want to know and understand your unique skillset and goals. We are committed to receiving your feedback on how we can best support your progression and advancement towards those goals. Expand your career opportunities in a role where you can see that you are making a difference in people's lives. Meaningful work in a culture of continuous improvement. A diverse market of carriers Clear communication of service and quality expectations; internal and external. Guidelines that provide upfront understanding of each carrier's requirements. Continuous feedback, including real -time Quality Assurance and formalized quarterly coaching sessions to identify areas of strength and opportunity. Training and development opportunities tailored to individual growth objectives. A tenured foundation of industry experts with a wide knowledge base for you to consult. How will you Elevate? Prioritize policyholders during their time loss through demonstrated empathy and understanding. Valuing our partnerships with our carrier clients; recognizing and maximizing the ways in which our Elevated Claims Handling can support them and their policyholders. Outstanding work ethic. This is not a 9 -5 position and you will be called upon to maintain a flexible schedule to help meet the needs of insureds and carriers. Clear, consistent, and timely communication. We, and our carriers, want and need strong lines of communication. You must be open to receiving and providing feedback. The ability to effectively and independently manage workload while exercising good judgement. Strong written and verbal communication skills. Strong technological skills with the ability to work within various claims management systems. Minimum of three years of residential and commercial property adjusting experience. Carrier experience is desired. Liability experience is a plus. Current, active Xactimate license and experience writing both residential and commercial damage estimates in Xactimate. Ability to pass a background screen. Current, active license where required. Equipment and ability to access roofs. If you are ready to Elevate claims with a firm that truly values and supports you, let us know - we may be a fit.$47k-58k yearly est. 60d+ agoField Claims Adjuster
EAC Claims Solutions
Claims representative job in Grand Rapids, MI
At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.$48k-58k yearly est. 60d+ agoIndependent Insurance Claims Adjuster in Grand Rapids, Michigan
Milehigh Adjusters Houston
Claims representative job in Grand Rapids, 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.$47k-58k yearly est. Auto-Apply 60d+ agoBodily Injury Claims Specialist
Auto-Owners Insurance Co
Claims representative 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. #LI-CH1 #LI-Hybrid$57k-76k yearly est. Auto-Apply 2d agoClaims Specialist
Loss Prevention Services, LLC
Claims representative job in Grandville, MI
The Claims Specialist is responsible for handling damage claims and property loss claims, to help resolve them efficiently and fairly. The successful Candidate needs to have automotive insurance claims experience. 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. 60d+ agoContents Adjuster
Sedgwick
Claims representative job in Grand Rapids, MI
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Contents Adjuster **PRIMARY PURPOSE** : To handle losses and claims for property and casualty insurers. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines insurance policies and other records to determine insurance coverage. + Interviews, telephones, and/or corresponds with claimant and witnesses regarding claim. + Consults police and hospital records and inspects property damage to determine extent of company's liability and varying methods of investigation according to type of insurance. + Estimates cost of repair, replacement, or compensation. + Prepares report of findings and negotiates settlement with claimant. + Recommends litigation by legal department when settlement cannot be negotiated. + Attends litigation hearings. + Revises case reserves in assigned claims files to cover probable costs. + Assists in preparing loss experience report to help determine profitability and calculates adequate future rates. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Obtain IIA-AIC designation within 12 to 18 months. Appropriate state adjuster license is required. **Experience** None. **Skills & Knowledge** + Strong oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Demonstrated commitment to timely reporting + Strong customer service skills + Strong interpersonal skills + Attention to detail and accuracy + Good time management and organizational skills + Ability to work independently or in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** : Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** : + Must be able to stand and/or walk for long periods of time. + Must be able to kneel, squat or bend. + Must be able to work outdoors in hot and/or cold weather conditions. + Have the ability to climb, crawl, stoop, kneel, reaching/working overhead + Be able to lift/carry up to 50 pounds + Be able to push/pull up to 100 pounds + Be able to drive up to 4 hours per day. + Must have continual use of manual dexterity. **Auditory/Visual** : Hearing, vision and talking As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($45,000 - $60,000 USD annually). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**$45k-60k yearly 37d agoOutside Property Adjuster - Grand Rapids, MI
Hanover Insurance Group, Inc.
Claims representative job in Grand Rapids, MI
Our Claims department is currently seeking an Outside Property Adjuster for the Michigan territory of Grand Rapids. This is a remote full-time/exempt role with field investigations. Outside property adjusters handle property claims requiring field investigations and/or inspections. They must establish rapport with our insureds and maintain relationships with our agents, underwriters, contractors, restoration vendors, and experts. They are expected to know their territory, including the geography; regulations and the law as pertains to property claims; state and local public safety and regulatory agencies and officials; the insurance and legal climate; and public adjusters. Outside property adjusters may use a company claims office location as their base of operations, or they may work out of their homes. IN THIS ROLE, YOU WILL: Handle personal property claims requiring outside field investigations and/or inspections May use a company claims office location as their base operations, or they may work out of their homes Handle business interruption (BI) features in conjunction with BI specialists Work within specific limits and authority on assignments of moderate technical complexity Possess functional knowledge and skills reflective of fully competent practitioner Identify possibly suspicious claims Investigate, analyze, evaluate and negotiate personal claims of minimal to moderate complexity May handle low complexity commercial claims May be responsible for all aspects of each claim, including informal hearings, arbitrations, and claims litigation and maintaining a high level of productivity, confidentiality and customer service Implement and coordinate the most effective management techniques to mitigate loss and expense payments Settlement and reserving authority levels are moderate Required to have and maintain sufficient home-based internet connection WHAT YOU NEED TO APPLY: 2+ years of experience adjusting claims Preferred experience with Xactimate estimating software Must have or secure and maintain appropriate states adjuster license(s) and continuing education credits Must have valid driver's license Dedicated to meeting the expectations and requirements of internal and external customers Makes decisions in an informed, confident and timely manner Maintains constructive working relationships despite differing perspectives Strong organizational and time management skills Ability to negotiate skillfully in difficult situations with both internal and external groups Demonstrates ability to win concessions without damaging relationships Demonstrates strong written and verbal communication skills Promotes and facilitates free and open communication Understanding of applicable statutes, regulations and case law Think critically and anticipate, recognize, identify and develop solutions to problems in a timely manner Easily adapt to new or different changing situations, requirements or priorities Cultivate an environment of teamwork and collaboration Operate with latitude for un-reviewed action or decision Computer experience (MS Office, excel, word, etc) Proficient using Claims systems (i.e. CSS, PMS, etc.) Ability to use a personal computer and other standard office equipment Ability to travel as necessary Ability to sit and/or stand for extended periods Ability to operate a motor vehicle 4-5 hours per day and to get in and out of the vehicle numerous times during the day Ability to load and unload equipment and supplies weighing up to 30 pounds from a motor vehicle as needed to perform field work Ability to bend, walk, and climb for several consecutive hours while inspecting damaged buildings, often with utilities turned off or inoperable Ability to use a ladder safely to get onto and off of roofs, and maintain balance while inspecting roofs Ability to perform field work in adverse weather This job posting provides cursory examples of some of the job duties associated with this position. The examples provided are not complete, and the position may entail other essential and job-related functions and responsibilities that employees will be required to perform.$56k-85k yearly est. 47d agoField Adjuster (Residential or Commercial) - Grand Rapids, MI
CCMS & Associates
Claims representative job in Grand Rapids, MI
Job Description CCMS & Associates is looking for a 1099 Field Adjuster in Michigan, specifically the Grand Rapids area. We are looking to add to our existing roster. The time is now to get on board with our team! We are seeking a residential or commercial field adjuster with at least 1 year of field experience. Requirements: Minimum 1 year first-party commercial and/or residential property adjusting experience Maintain own current estimating software - Xactimate preferred (Symbility experience a plus) Working computer - internet access and Microsoft Word required Must demonstrate strong time management and customer service skills Experience in preparing Statement of Loss, Proof of Loss, and denial letters Must have a valid drivers license Responsibilities: Complete residential and commercial field property inspections utilizing Xactimate software Investigate claims by obtaining recorded statements from insureds, claimants, or witnesses and by interviewing fire, police, or other governmental officials as well as inspecting claimed damages Recommend claim reserves based on investigation, through well-supported reserve report Obtain and interpret official reports Review applicable coverage forms and endorsements, provide a thorough analysis of coverage and any coverage issues in a well-documented initial captioned report to the client Maintain acceptable product quality through compliance with established best practices Knowledge and Skills: In-depth knowledge of property and liability insurance coverage and industry standards Ability to prepare full-captioned reports by collecting and summarizing required information Strong verbal and written communications skills Prompt, reliable, and friendly Preferred but Not Required: College degree AIC, IICRC, HAAG or other professional designations All candidates must pass a full background check (void in states where prohibited) CCMS & Associates offers multi-line claim adjusting and third-party administration services dedicated to solving the challenges of the complex claim in the property and casualty insurance industry. We create programs that drive a successful claim life cycle while strategically managing all aspects of the complicated issues carriers and policyholders are facing. Servicing excess and surplus/domestic carriers in the United States. Powered by JazzHR DxwYpIKhtn$43k-57k yearly est. 29d agoClaims Coordinator (Property & Casualty)
Alera Group
Claims representative job in Grand Rapids, MI
Alera Group is looking for a Claims Coordinator (Property & Casualty). We are seeking highly motivated colleagues who bring experience and enthusiasm to our team - joining us may be the perfect fit for you! Alera Group was founded in 2017 and has grown to become the 14th largest broker of US business. We are passionate about our clients' success in the areas of Employee Benefits, Property and Casualty Insurance, Retirement Plan Services, and Wealth Services. With a network of offices nationwide, our commitment to collaboration allows us to offer national resources combined with local service. RESPONSIBILITIES * Manage and coordinate the claims process from initial incident notification through resolution, ensuring accurate documentation, timely communication, and compliance with carrier and regulatory requirements * Collaborate with clients, carriers, and internal teams to investigate, process, and resolve claims efficiently-providing expert guidance, identifying potential issues, and escalating complex cases when necessary * Deliver exceptional client service by offering proactive communication, technical expertise, and support throughout the claims process while contributing to a positive, team-oriented work environment QUALIFICATIONS * 1+ years of experience in a claims handling or insurance-related role within Property and Casualty * Possess or willing to obtain a Property & Casualty license * Ability to read, analyze, and interpret insurance coverages ADDITIONAL INFORMATION This job requires presence in the office on a hybrid schedule as agreed with the manager. Alera Group offers comprehensive benefits to our colleagues, including medical, dental, life and disability insurance, 401k, generous paid time off and much more. Salary range is $50K to 65K per year. We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status, or any other protected class. Alera Group is committed to protecting your privacy. Please review our Privacy Policy to understand what personal information we may collect and use as part of your application process. #LI-KL1 #LI-Hybrid Location Type Hybrid$50k-65k yearly 23d agoPharmacy 340B Claims Specialist
Family Health Care
Claims representative job in White Cloud, MI
Family Health Care is currently seeking applications for the position of Pharmacy 340B Claims Specialist! 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. 1d agoPharmacy Claims Technician
Kalamazoo Long Term Care Pharmacy
Claims representative job in Grand Rapids, MI
Job DescriptionSalary: $18-$22 Claims Technician -- Horizon LTC Pharmacy Full-Time | Grand Rapids, MI Are you someone who loves accuracy, enjoys solving billing puzzles, and wants to work where your attention to detail truly makes a difference? Horizon LTC Pharmacy is looking for afull-time Claims Technicianto join our growing long-term care pharmacy team. At Horizon LTC, we pride ourselves on supporting residents, facilities, and care teams with fast, reliable, and compassionate service. As part of our team, you'll be surrounded by a supportive network and a company committed to high-quality, patient-centered care. Our mission is simple: optimize the quality of life through personalized pharmacy solutions . And we live by our core values:be a team player, be professional, be positive, get better, and put the customer first. If those resonate with you, keep reading! What You'll Do You'll play a key role in keeping our billing workflow running smoothly every single day. Your responsibilities will include: Processing and submitting daily prescription claims in real time Monitoring and clearing billing queues to maintain workflow Managing recurring billing cycles for long-term care and institutional patients Handling timely, accurate bulk claims tied to cycle fill schedules Creating, monitoring, and managing billing batches within our pharmacy systems Reviewing batch exceptions and resolving issues quickly Identifying rejected claims and navigating the prior authorization process Working with providers and payers to gather prior authorization documentation and reprocess claims Updating billing records when patients are admitted, discharged, or have insurance or level-of-care changes Prioritizing first-dose and urgent claims to support immediate patient needs Communicating and collaborating with our pharmacy team on time-sensitive billing issues Supporting the team with additional tasks as needed What You'll Bring We're looking for someone who can combine technical know-how with a strong sense of responsibility: High School Diploma or equivalent Michigan Pharmacy Technician License (required) 1-2 years of pharmacy billing or healthcare claims processing experience Experience with the pharmacy billing platforms like FrameworkLTC or QS/1 Solid understanding of Medicaid, Medicare Part D, and private insurance Strong problem-solving ability when it comes to claim rejections and PA issues Excellent attention to detail, communication, and time management A commitment to patient confidentiality Why You'll Love Working at Horizon LTC At Horizon LTC Pharmacy, you're not just joining a pharmacy--you're joining a team that cares deeply about the patients and facilities we serve. Your work directly ensures that residents receive the medications they need--on time, every time. And that means your role truly matters. If you want to put your billing skills to work in a mission-driven pharmacy setting, this could be the perfect opportunity. If you're ready to grow your career with a supportive long-term care pharmacy team, we'd love to meet with you!$18-22 hourly 10d agoWC Claims Specialist
Universal Forest Products, Inc.
Claims representative job in Grand Rapids, MI
The WC Claims Specialist is responsible for claims management and issues related to work comp. This position works under general supervision; exercises discretion and relies on experience and judgment to plan and accomplish goals; and requires a certain degree of creativity and autonomy to perform the job. Principal Duties and Responsibilities * Serves as primary contact for the field operations on WC related claim procedures and claims management issues * May serve as a back-up for FMLA, ADA, and disability related claim procedures and claims management issues * Assists with updating documentation and communication associated with related leaves of absences * Trains new plant HR/safety personnel, including acquisitions, on related leave of absence procedures * Produces quarterly trend reports and other related reports as requested * Assists with monitoring federal and state leave regulations and with working with vendors and plants to implement any necessary updates to existing procedures * Monitors claim activity to ensure timely and accurate delivery of benefits * Provides assistance to the field regarding medical management and return to work * Reviews claim data to ensure that claims are managed, paid, and resolved according to service criteria * Ensures that all claims are reviewed for appropriateness of acceptance or denial * Advises the field in identifying and maintaining quality medical providers * Assists in the identification of legal counsel with assistance from the claim managers/TPA * Assists in developing legal strategy for each litigated case * Advises the field in transitional and long-term return-to-work strategies * Ensures that the claim managers/TPA pay medical bills and other related invoices promptly * Provides guidance and related training to plant personnel with work comp responsibilities * Helps maintain documentation, legal evidence, and other related file administration * Maintains updated knowledge of state comp laws or other legal changes impacting areas of responsibility * Advises the field and claim managers/TPA in investigating aspects of serious or questionable claims * Acts as a liaison between injured worker and TPA/carrier * Prepares and participates in strategic claim resolution meetings * Assists with providing information to TPA/legal counsel in response to subpoena requests * May assist with training for other related areas of responsibility * May assist with policy updates for related areas of responsibility * May serve as backup for Substance Abuse policy administration * May serve as backup for other various safety related program administration * Performs other duties as required. Job Specifications Knowledge * Bachelor's degree or equivalent experience in a related field * Formal, working knowledge of claims management protocol and related employment law * Some knowledge and understanding of medical terminology Skills and abilities * Ability to solve problems and apply knowledge and education in complex situations * Ability to maintain and safeguard confidential information * Verbal and written skills with the ability to communicate at all levels within the organization * Interpersonal and problem-solving skills * Demonstrated ability to use computers and related business software and experience with advanced excel or other report writing programs * Ability to understand, analyze, and communicate financial information as a management tool * Ability to coordinate and prioritize case load * Ability to travel as required Conduct * Team player and goal oriented * Leads by example The Company is an Equal Opportunity Employer.$43k-49k yearly est. Auto-Apply 15d agoAnalyst, Claims Research
Molina Healthcare
Claims representative job in Grand Rapids, MI
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific 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. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - 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. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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 11d agoIndependent Insurance Claims Adjuster in Kalamazoo, Michigan
Milehigh Adjusters Houston
Claims representative job in Kalamazoo, 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.$47k-58k yearly est. Auto-Apply 60d+ agoField Claims Adjuster
EAC Claims Solutions
Claims representative job in Kalamazoo, MI
At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.$48k-58k yearly est. 60d+ agoBodily Injury Claims Specialist
Auto-Owners Insurance Co
Claims representative job in Muskegon, 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-CH1 #LI-Hybrid$57k-75k yearly est. Auto-Apply 2d agoField Adjuster (Residential or Commercial) - Grand Rapids, MI
CCMS & Associates
Claims representative job in Grand Rapids, MI
CCMS & Associates is looking for a 1099 Field Adjuster in Michigan, specifically the Grand Rapids area. We are looking to add to our existing roster. The time is now to get on board with our team! We are seeking a residential or commercial field adjuster with at least 1 year of field experience. Requirements: Minimum 1 year first-party commercial and/or residential property adjusting experience Maintain own current estimating software - Xactimate preferred (Symbility experience a plus) Working computer - internet access and Microsoft Word required Must demonstrate strong time management and customer service skills Experience in preparing Statement of Loss, Proof of Loss, and denial letters Must have a valid drivers license Responsibilities: Complete residential and commercial field property inspections utilizing Xactimate software Investigate claims by obtaining recorded statements from insureds, claimants, or witnesses and by interviewing fire, police, or other governmental officials as well as inspecting claimed damages Recommend claim reserves based on investigation, through well-supported reserve report Obtain and interpret official reports Review applicable coverage forms and endorsements, provide a thorough analysis of coverage and any coverage issues in a well-documented initial captioned report to the client Maintain acceptable product quality through compliance with established best practices Knowledge and Skills: In-depth knowledge of property and liability insurance coverage and industry standards Ability to prepare full-captioned reports by collecting and summarizing required information Strong verbal and written communications skills Prompt, reliable, and friendly Preferred but Not Required: College degree AIC, IICRC, HAAG or other professional designations All candidates must pass a full background check (void in states where prohibited) CCMS & Associates offers multi-line claim adjusting and third-party administration services dedicated to solving the challenges of the complex claim in the property and casualty insurance industry. We create programs that drive a successful claim life cycle while strategically managing all aspects of the complicated issues carriers and policyholders are facing. Servicing excess and surplus/domestic carriers in the United States.$43k-57k yearly est. Auto-Apply 60d+ agoPharmacy 340B Claims Specialist
Family Health Care
Claims representative job in White Cloud, MI
Family Health Care is currently seeking applications for the position of Pharmacy 340B Claims Specialist! 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. 3d ago
Learn more about claims representative jobs
How much does a claims representative earn in Wyoming, MI?
The average claims representative in Wyoming, MI earns between $35,000 and $70,000 annually. This compares to the national average claims representative range of $28,000 to $53,000.
Average claims representative salary in Wyoming, MI
$49,000
What are the biggest employers of Claims Representatives in Wyoming, MI?
The biggest employers of Claims Representatives in Wyoming, MI are:
Job type you want
Full Time
Part Time
Internship
Temporary