Investigates, evaluates, reserves and resolves Automobile, General Liability and Property claims for self insured and unbundled clients. Provides a superior level of customer service to internal and external business partners. Administers and resolves claims for TPA clients in a timely manner and in accordance with client, company and regulatory guidelines. Responsibiliti

Investigates, evaluates and resolves Commercial Automobile, and General Liability claims for self insured and unbundled clients. Provides a superior level of customer service to internal and external business partners. Administers and resolves claims in a timely manner and in accordance with client, company and regulatory guidelines. This position is typically assigned cl

The Claims Settlement Specialist supports claim settlement with providers through post payment negotiation. The Claims Settlement Specialist will be responsible for handling provider telephone calls regarding the payment amount paid to a provider by a payor based on Zelis data points. During this call, the Claims Settlement Specialist must understand (1) the procedures bi

Promptly investigate all assigned claims for coverage, liability, damages, subrogation and contribution Ensures timely disposition of all claims in accordance with regulatory and statutory requirements Within granted authority, establish appropriate loss and expense reserves with documented rationale Maintain and adjust reserves over the life of the claim to reflect chang

Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) Alerts Supervisor and Special Investigations Unit to potentially suspect claims Ensures timely denial or payment of benefits in accordance with jurisdi

Homeowner Claim Representative II Florida What you will do The Auto Club Group is seeking prospective Homeowner Claim Representative II who canwork under normal supervision with an intermediate level approval authority to handle moderately complex claims within Claim Handling Standards, resolve coverage questions, take statements and establish clear evaluation and resolut

The position is responsible for the investigation, evaluation, negotiation and settlement of personal and commercial claims of moderate complexity, including dispute resolution and/or recovery. This position requires successful completion of Citizens Fundamentals Claims School, which includes obtaining an overall passing score. ESSENTIAL FUNCTIONS THE FOLLOWING ARE THE US

The Risk Adjustment Coder is responsible for conducting Electronic Medical Record (EMR) chart audits for prospective Medicare Risk Adjustment (MRA) ICD 10 codes (International Classification of Diseases, version 10)/Hierarchical Condition Category (HCC) coding in advance of patient visits. This position will prepare coding review for the physician to utilize at the patien

Under the direction of the Branch Manager or Field Leader, the Mobile Examiner's primary responsibility is to provide coverage in the field ensuring that mobile exams are completed accurately and on time. Maintain a safe and professional environment for applicants, clients, and employees, perform with confidence all aspects of an insurance exam, including specimen collect