Healthcare Claims Quality Analyst Integra PartnersHealthcare Claims Quality AnalystTroy, MIRemoteThe Claims Quality Assurance Analyst is responsible for monitoring and documenting production quality in support of departmental goals and initiatives, with a primary focus on claims auditing and claims-related interactions within the Revenue Cycle Management (RCM) function. Working knowledge of Revenue Cycle Management (RCM) workflows and downstream impacts (e.g., clean claim submission, edits, denials, appeals, payment posting/reconciliation) across commercial, Medicaid, and Medicare.
Medicare Advantage (MA) Claims Analyst Iconma LLCMedicare Advantage (MA) Claims AnalystDetroit, MIThe ideal candidate will monitor regulatory and policy changes, analyze claims data to identify trends and root causes, develop solutions that improve payment accuracy and operational efficiency, and deliver meaningful reports and dashboards that provide stakeholders with insights into claim performance, defect resolution, and process improvement opportunities. This role is responsible for configuring MA benefit parameters in the claims platform to ensure compliance with CMS requirements, conducting detailed claim reviews to validate reimbursement accuracy, and identifying and resolving system defects in partnership with IT, NASCO, and vendor teams.
Claims Examiner - Bodily Injury Sedgwick Claims Management Services, Inc.Claims Examiner - Bodily InjuryMI$80,000–$85,000 / yearTo analyze complex auto bodily injury claims on behalf of our valued clients by evaluating coverage, investigating liability, and managing damages, while ensuring timely resolution within service expectations, industry best practices, and specific client requirements. Education & Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.
NewClaims Representative, Auto | Property Damage Sedgwick Claims Management Services, Inc.Claims Representative, Auto | Property DamageMI$50,000–$55,000 / yearProcesses auto and general liability property damage claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.
Unemployment Claims Specialist HR-1Unemployment Claims SpecialistWarren, MichiganAs the Unemployment Claims Coordinator you'll help manage day-to-day activities related to unemployment claims, including: Communicate with HR-1 customers to collect information related to employee separations. Oversee unemployment insurance function on behalf of HR-1 customers to control unemployment insurance costs.
Claims Advocate HylantClaims AdvocateAnn Arbor, MichiganProactively manage the claims process for assigned clients/claims liaising with clients, adjusters, carriers, and other external parties as well as Hylant client executives and client services team members to advocate and facilitate claim resolution. The Claims Advocate is a client facing role providing interpretation of policy language, coverage analysis, advocacy, coverage and dispute resolution, specifically working with Clients in the Small Business and Personal Lines space.
Remote Claims Support Specialist Latitude Subrogation ServicesRemote Claims Support SpecialistBloomfield Hills, MichiganRemoteLSS has provided solutions for insurers, self-insured entities, third party administrators and specialty risk companies as a subrogation vendor and purchaser of subrogation assets. Come join our people first culture and enjoy excellent employee benefits such as comprehensive health, dental, vision, short and long term disability insurance, life insurance, and paid time off, (PTO).
Claims Attorney (Municipal Entities) HCC Life Insurance CompanyClaims Attorney (Municipal Entities)Troy, MIRemoteThe Company will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e))(the "VCCLEA"), which restricts financial institutions and insurers such as TMHCC from employing individuals with certain types of criminal convictions. The Tokio Marine HCC - Public Risk Group is seeking a self-motivated Claims Attorney to join our growing Claims Department and handle litigated and non-litigated claims primarily arising under Auto and General Liability, as well as potentially some Law Enforcement, Public Officials, and Employment Practices liability policies in various jurisdictions.
Claims Representative Internship - Summer 2027 Auto-Owners Insurance GroupClaims Representative Internship - Summer 2027Troy, MIThe position requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability and pay or deny losses. Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs.
Manager, Chief Claims Examiner AAA Life Insurance CompanyManager, Chief Claims ExaminerLivonia, MILead claims transformation and modernization efforts, including workflow redesign, automation, AI-assisted capabilities, digital tools, and adoption of new ways of working. Serve as the senior claims subject-matter expert, providing guidance on policy interpretation, investigations, beneficiary issues, underwriting and medical evidence, fraud indicators, and regulatory requirements.
Claims Representative Internship - Summer 2027 Auto-Owners Insurance CoClaims Representative Internship - Summer 2027Troy, MIThe position requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability and pay or deny losses. Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs.
Field Claims Representative - Oakland, Macomb, Wayne County Auto-Owners Insurance CompanyField Claims Representative - Oakland, Macomb, Wayne CountyTroy, MichiganAbility to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents). This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability.
Complex Claims Consultant - Private & NFP D&O CNA Financial CorpComplex Claims Consultant - Private & NFP D&OSouthfield, MI$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex Financial Lines claims, with large exposures that require a high degree of specialized technical expertise and coordination, by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Resolves claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that includes management of timely and adequate reserves, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
Complex Claims Consultant - Epl, Private & NFP D&O CNA Financial Corp.Complex Claims Consultant - Epl, Private & NFP D&OSouthfield, MI$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex Financial Lines claims, with large exposures that require a high degree of specialized technical expertise and coordination, by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Resolves claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that includes management of timely and adequate reserves, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
Specialty Operations Claims (Property& Casualty Reinsurance) Senior Consultant II Allstate Insurance CompanySpecialty Operations Claims (Property& Casualty Reinsurance) Senior Consultant IIMI$80,000–$125,000 / yearKey Responsibilities: Independently manage a portfolio of complex reinsurance claims involving asbestos, environmental, and other latent injury exposures-analyzing liability, damages, and contractual obligations to drive informed and strategic claim outcomes. Establish accurate case reserves, leveraging cedent reporting, internal assessment, and designated authority levels; seek management approval for exposures exceeding authority.
Seeking General Liability Claims Adjusters! Morgan & Morgan, P.A.Seeking General Liability Claims Adjusters!Detroit, MichiganThis employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. From attorneys in all 50 states, to client support staff, creative marketing to operations teams, every member of our firm has a key role to play in the winning fight for consumer rights.
Claims Director - Professional Liability CRC Insurance Services, LLCClaims Director - Professional LiabilityMI$140,000–$200,000 / yearPlease review the following job description: The position is responsible for maintaining active oversight of open claims and/or incident reports, driving regular communication with carrier claims departments and adjusters, and ensuring significant claim developments are promptly communicated to Negley management and underwriting personnel. The position is expected to dig into open files, challenge claim handling when appropriate, identify issues requiring escalation, and maintain continuous visibility into claim status, litigation strategy, reserves, settlement activity, coverage concerns, and emerging loss trends.
Supervisor, Claims Provider Network Operations (Pno) Amerihealth Caritas Health PlanSupervisor, Claims Provider Network Operations (Pno)Southfield, MIRemoteRole Overview: The Provider Network Operations Supervisor supports the daily operations of the Provider Network Operations team by overseeing staff performance, ensuring operational efficiency, and maintaining compliance with internal policies and contractual requirements. Work Arrangement: Remote - This position is fully remote; the candidate must be located in Michigan (MI) and attend monthly meeting as needed in Southfield, MI.
Medicare Advantage (MA) Claims Analyst ICONMA, LLCMedicare Advantage (MA) Claims AnalystDetroit, MI$33.83–$36.98 / hourThe ideal candidate will monitor regulatory and policy changes, analyze claims data to identify trends and root causes, develop solutions that improve payment accuracy and operational efficiency, and deliver meaningful reports and dashboards that provide stakeholders with insights into claim performance, defect resolution, and process improvement opportunities. This role is responsible for configuring MA benefit parameters in the claims platform to ensure compliance with CMS requirements, conducting detailed claim reviews to validate reimbursement accuracy, and identifying and resolving system defects in partnership with IT, NASCO, and vendor teams.
Claims Examiner - Workers Compensation Epitec IncClaims Examiner - Workers CompensationDetroit, MIThe Claims Examiner will work closely with claimants, clients, legal teams, and vendors to drive timely resolution and maintain high-quality claim file documentation. This position is ideal for a claims professional with strong experience in workers' compensation, claim investigation, and settlement negotiation who can manage claims independently while maintaining compliance and cost effectiveness.