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Provide recommendations to branch offices and VP Claims based on counsel opinions. Review and analyze substantive documents/reports drafted by coverage counsel - complaints, answers, initial case evaluations, initial discovery disclosures, deposition summaries, pre-trial reports.
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Applying problem-solving techniques as it relates to dispute resolution to include, but not limited to, HMSA's provider contract definition, application of payment or medical policies, provider operations that involve posting claims payments, and complaints made through the Insurance Commissioner's office within timeframes required by the Insurance Division or by HMSA as stated in the provider contract.
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Responsible for making coverage determinations for liability claims submitted under policies for which AmTrust North America is the claims administrator. The job entails providing guidance to claim adjusters, supervisors and managers concerning coverage for claims under policies as well as approving coverage positions prior to issuance and acting as the coverage adjuster on litigated coverage claims.
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Works closely with the Worker’s Compensation Manager to ensure that legal counsel is brought in when appropriate and assists counsel on any litigated claims. A minimum of 1-2 years of Pennsylvania Workers’ Compensation experience with direct adjudication, supervision, and administration of workers’ compensation claims with an insurance company, TPA or self-insured company.
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We are in search of a skilled Insurance Claims Estimator who will play a critical role in assessing water damage, creating precise restoration plans, and generating accurate cost estimates tailored for insurance claims.
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Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. Desired Skills & Experience A minimum of three years of insurance claims related experience.
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The Claims Attorney will be responsible for overseeing the management of a segment of the professional liability claims, conducting thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.
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These procedures involve assembling required equipment, locating an accessible vein, disinfecting the area, performing venipuncture, treating the puncture site, labeling blood containers, and managing patient or donor reactions.
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Builds alliances with other departments responsible for functional aspects of the BH/HARP including but not limited to Quality Management, Utilization Management, Case Management, Sales, Eligibility, Core System Operations, Provider Network Operations, Member Services/Experience Services, Claims, Analytics & Reporting, and Finance to ensure collaboration, efficiency, issue resolution and operational excellence.
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Investigates complaints of crimes, either as a uniformed officer or a plain clothes detective, including gathering evidence at crime scenes and locating and questioning witnesses. Work normally involves patrol, investigation, traffic enforcement, resolving complaints, and report writing duties.
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Total Loss Support Representative Are you an experienced Auto Claims Adjuster or Auto Claims Support Representative looking for an opportunity that does not require inspecting vehicles? What You'll Do: In this role, you will be responsible for: responding to incoming calls, emails, faxes, or mail relating to total loss auto claims; contacting lienholders to obtain loan pay-off, lien release, and provide necessary GAP documents; contacting vehicle owners and salvage vendors in regard to title document corrections; total loss auto claim assignment; and managing salvage vehicle inventory.
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Manages a book of complex primary, direct excess, and reinsurance claims involving Public Sector risks, including property damage, professional liability, general liability, automobile, school board legal liability, employment practices liability, law enforcement liability, public officials liability exposures.
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BLD - Bachelor's Level Degree (Required) Clinical Compliance, Healthcare Administration, Healthcare Complaints/Appeals, Risk Management. Oversee facility/division's risk management activities, which include coordinating insurance coverage and risk financing, managing claims against the division/facility, interfacing with claims adjusters and defense legal counsel.
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Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area. Emphasis on Marine Liability, Hull, Blue water and brown water claims, Jones Act, General Average and Ocean Cargo Claims experience preferred.
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As a Claims Specialist focusing on auto claims, you'll work closely with our Director of Risk & Insurance, engaging with departments like Safety, Operations, Compliance, and Fleet to streamline our auto claims process.
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claims complaints locating jobs Company: Metroplus Health Plan
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