As a medical claims representative you’ll keep the medical claims process efficient and supportive for our customers. Focusing on personal injury protection medical coverage, you’ll analyze accident details, medical records and terminology. You’ll adjust complex claims while maintaining solid relationships with customers. Additionally, you’ll negotiate with providers and attorneys to bring claims to settlement.

This is a hybrid role. You’ll be expected to report to an office about four days per month for important meetings, training, and collaboration and will have the benefit of continued coaching from a supportive team. If you prefer an in-office environment, you’re welcome to work in the office more than four days per month.

Duties & responsibilities

• Review and research the policy contract, regulation, and cause of injury to make coverage decisions
• Reviews and researches "other economic loss" claims, attendant care, transportation cost, and more to resolve claims accurately
• Identify, review, and research wage loss expenses and documentation for payment consideration
• Conduct research to better understand medical records and establish any correlation to a motor vehicle accident
• Investigates coverage, liability, fraud, injury causation and subrogation issues

Must have qualifications

• Bachelor's degree or higher or a combined total of five years of work experience and/or college education
• One year of medical claims handling or work in the insurance industry
• Work or educational experience must include:
  • Making decisions
  • Solving problems
  • Planning, prioritizing and organizing
  • Effectively communicating verbally and in writing
  • Customer service
• Successfully obtain and maintain required state licenses

Compensation 

• Commensurate with experience and office location, salary range for Plymouth and Sterling Hts, MI offices $62,000-$66,000/year; all other Michigan offices $55,000-$61,000/year
• Gainshare bonus up to 16% of your eligible earnings based on company performance

Benefits       

• 401(k) with dollar-for-dollar company match up to 6%
• Medical, dental & vision, including free preventative care
• Wellness & mental health programs
• Health care flexible spending accounts, health savings accounts, & life insurance
• Paid time off
• Paid & unpaid sick leave where applicable, as well as short & long-term disability
• Parental & family leave; military leave & pay
• Diverse, inclusive & welcoming culture with Employee Resource Groups
• Career development & tuition assistance

Equal Opportunity Employer