Claim Specialist

• Review assigned claims and contact insureds and other affected parties
• Set expectations for the remainder of the claim process and initiate documentation in the claim handling system
• Complete complex coverage analyses and identify all possible policyholder benefits
• Create additional sub-claims when needed
• Investigate claim facts to determine payment eligibility, applicable limits or exclusions, and recovery potential
• Review damages and determine applicability of state law and other claim-related factors
• Evaluate the financial value of losses
• Approve payments for appropriate parties
• Refer claims to Underwriting, Recovery Units, or the Claims Special Investigation Unit when necessary
• Document and code claim files and complete claim closure activities in the claims management system
• Negotiate claim settlements
• Handle Michigan PIP claims involving MCCA, quadriplegic injuries, traumatic brain injuries, amputations, and other catastrophic injuries
• Work with insureds, guardians, conservators, attorneys, treatment teams, and case managers to obtain information and complete claim reviews
• Make appropriate claim determinations

Senior Claim Specialist

• Evaluate coverage, assess claim exposures, and make informed decisions for fair and timely resolutions
• Manage challenging and complex claims involving members, medical providers, attorneys, and internal partners
• Review assigned claims and initiate claim-handling activities
• Contact insureds and affected parties to gather information and set expectations
• Document claim activity and maintain accurate records in the claims management system
• Perform complex coverage analysis and identify applicable policyholder benefits
• Establish and manage sub-claims
• Investigate coverage applicability, claim validity, policy limits, exclusions, and recovery opportunities
• Analyze claim facts, damages, state laws, and other factors affecting claim decisions
• Evaluate loss values and authorize appropriate claim payments
• Negotiate settlements and claim resolutions
• Refer claims to Underwriting, Recovery Units, and the Claims Special Investigation Unit when necessary
• Complete claim documentation, coding, closure activities, and compliance processes
• Handle intermediate to complex Michigan Personal Injury Protection claims, including fractures, mild closed head injuries, surgical procedures, and attendant care claims
• Manage claims involving the Michigan Catastrophic Claims Association
• Handle attorney-represented claims and legal involvement throughout the claim process
• Investigate and manage losses extending beyond standard PIP scenarios
• Collaborate with insureds, physician offices, medical providers, and insurance carriers to obtain documentation and information
• Review medical and claim-related information to determine coverage and payments
• Maintain compliance with state regulations, company policies, and claim-handling standards

• Review assigned claims and contact insureds 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 and identify all possible policyholder benefits
• Create additional sub-claims when needed
• Investigate claim facts to determine payment, applicable limits or exclusions, and recovery potential
• Review damages and determine applicability of state law and other claim factors
• Evaluate the financial value of losses
• Approve payments for appropriate parties
• Refer claims to Underwriting, Recovery Units, Claims Special Investigation Unit, or other company units when necessary
• Thoroughly document and code claim files and complete claim closure activities in the claims management system
• Negotiate claim settlements
• Handle Michigan PIP claims involving MCCA, quadriplegic injuries, traumatic brain injuries, amputations, and other catastrophic injuries
• Work with insureds, guardians, conservators, attorneys, treatment teams, and case managers to obtain necessary information and complete claim reviews
• Make appropriate claim determinations

• Review assigned Michigan Personal Injury Protection (PIP) claims
• Contact insureds and other affected parties and set expectations for the claim process
• Initiate and maintain documentation in the claim handling system
• Complete complex coverage analysis and identify all applicable policyholder benefits
• Create additional sub-claims when needed
• Investigate claim facts to determine payment, applicable limits or exclusions, and recovery potential
• Review damages and determine applicability of state law and other claim-related factors
• Evaluate the financial value of losses
• Approve payments for appropriate parties
• Refer claims to Underwriting, Recovery Units, Claims Special Investigation Unit, or other company units when necessary
• Document and code claim files and complete closure and related activities in the claims management system
• Negotiate claim settlements
• Handle claims involving MCCA, quadriplegic injuries, traumatic brain injuries, amputations, and other catastrophic injuries
• Work with insureds, guardians, conservators, attorneys, treatment teams, and case managers to obtain information and complete claim reviews
• Make appropriate claim determinations
• Occasionally travel for meetings, collaborative activities, or team-building activities as specified by leadership

Senior Claim Specialist, Medical Management Unit

• Review assigned claims
• Contact insureds and other affected parties
• Set expectations for the claim process and initiate documentation in the claim handling system
• Complete complex coverage analysis and identify all applicable policyholder benefits
• Create additional sub-claims when needed
• Investigate claim facts to determine payment limits, exclusions and recovery potential
• Review damages and determine applicability of state law and other claim factors
• Evaluate the financial value of losses
• Approve payments for appropriate parties
• Refer claims to Underwriting, Recovery Units or Claims Special Investigation Unit when necessary
• Document and code claim files and complete claim closure activities in the claims management system
• Negotiate claim resolutions
• Handle homeowner/CAT claims valued over $100,000, unlivable insured properties and total losses
• Investigate claims requiring extensive coverage analysis and assistance from experts, engineers or specialized vendors
• Scope and prepare large restoration estimates using investigative and estimation tools
• Review contractor estimates
• Provide oversight of assigned claims, member communication, expert/resource coordination and restoration project schedules
• Handle claims involving adverse third parties, litigation and alternative dispute resolution
• Assist the Claim Manager with file reviews and training
• Travel to territories throughout Michigan for field assignments and property inspections

Claim Specialist jobs in Michigan

Senior Claim Specialist