Senior Claims Examiner Workers Compensation Requisition ID 2024 25103 Job Locations US OH Cleveland | US IL Lake Zurich | US Position Type Regular Full Time Category Claims Business Unit BUS_TPA US Excellence In Everything We Touch Position Summary Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within es

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

The Surety Bond Claims Senior Analyst investigates, evaluates coverage, determines liability, sets reserves, and settles surety bond claims of low to moderate complexity and moderate risk. When a claim occurs, the Surety Bond Claims Senior Analyst plays a crucial role in assessing the validity of the claim and facilitating the resolution process. This role evaluates recov

Reviews and evaluates appeal requests and electronic inquiries in order to identify and classify member and provider appeals and Ohio Department of Insurance (ODI) inquiries. Using internal systems, determines eligibility, benefits, and prior activity related to the claims payment or service denial issues related to appeal requests. Completes cases within State and Federa

Premium Auditor I Job Locations US OH Cleveland Requisition ID 2023 15380 Category Operations Premium Audit Position Type Regular Full Time Overview The Premium Auditor I performs audits of low to moderate complexity ensuring the accuracy of earned premium risk calculations. Investigates and verifies the premium base exposures according to policy contract terms, manual ru

The Surety Bond Claims Analyst investigates, evaluates coverage, determines liability, sets reserves, and settles surety bond claims of low complexity and low risk. When a claim occurs, the Surety Bond Claims Analyst plays a crucial role in assessing the validity of the claim and facilitating the resolution process. This role evaluates recovery potential and institutes su

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

The Customer Operations Quality and Training Specialist is responsible for training new and existing associates within the Healthcare Customer Operations group. During training sessions, you will train on systems and processes, coach associates, and provide performance feedback to Department Managers. Outside of training sessions, you will be responsible for continuously

The Claims Senior Representative serves as a technical expert on claims adjusting and handles material damage, negligence, compensability, damage, and coverage issues. The role determines coverage and investigates, analyzes, negotiates, and settles claims not requiring outside investigation. The role delivers quality customer service in a high volume, moderate complexity

This team does the following for both Aultman Hospital and Aultman Orrville Hospital The clinical charge capture team is responsible for the review of all outpatient observation, and inpatient to calculate and capture all documented observation hours according to current CMS guidelines and all drug administration/infusion charges according to coding guidelines. This team