Insurance/Claims Adjuster

Job Position: Insurance/Claims AdjusterLocation: Remote with base in Ypsilanti, MI 48198Description: Insurance and Claims AdjusterThis is a full time remote position for approximately 3-4 monthsShift: 8 am - 4:30 pm, 1/2 hour unpaid lunchPay Rate: $ 25 - $30 per hour based on experienceJob Description: Key tasks include processing a administering Family and Medical Leave Act claims, coordinating second opinion independent medical examinations and conducting Fitness for Duty evaluations.This role involves providing comprehensive support for cvarious claims-rlated activities, ensuring that all processes are managed effeciently and in compliance with relevant polilcies and regulations.Key Responsibilities:Manage non-complex medical claims for faculty and staff, applying strategies to optimize return-to-work efforts and minimize duration of disability.Assess the severity and duration of employee disability and advise departments, referring complex cases to a specialized case manager as needed.Analyze medical records and employment information to manage medical treatment protocols and assess employee disability status effectively.Authorize benefit payments and establish case reserves, ensuring financial obligations are met.Identify treatment or disability cases outside established guidelines, implementing remedial actions to align with institutional standards.Maintain appropriate diary controls and follow up within 48 hours to ensure timely progress on cases.Customer ServiceRespond to inquiries and explain policies and procedures to faculty and staff, ensuring they understand their claims and benefits.Promote customer service standards, ensuring confidentiality, making appropriate payments, and maintaining timely communication.Conduct customer service meetings to discuss service successes, identify gaps, and create opportunities for improvement, implementing corrective measures as needed.Ensure timely and professional communication with departments and claimants, fostering trust and transparency in all interactions.ReportingProvide administrative support, including data entry and the preparation of state forms, ensuring accurate and compliant documentation.Establish and maintain case reserves, providing detailed financial reporting and claim analysis for ongoing monitoring and assessment.Lead and participate in special projects and initiatives, tracking progress and reporting findings to relevant stakeholders.Attend departmental meetings to ensure service commitments are met and expectations are clearly communicated.CollaborationCollaborate with team members, treatment providers, employees, and departments, facilitating care and ensuring best practices in return-to-work plans.Identify cases with barriers to return-to-work and facilitate stakeholder meetings to collaboratively address these issues.Inform departments of restrictions and work with them to recommend suitable accommodations for employees.Visit departments and job sites to address employment concerns and develop practical solutions that benefit all parties involved.Build collaborative relationships with university departments, focusing on employee health, benefits, disability, and return-to-work services to ensure cohesive management of employee welfare.Work cooperatively with others towards achieving common goals, emphasizing team-oriented interactions and supporting team members during absences.Required QualificationsA high school diploma is required.Strong problem-solving, interpersonal, and communication skills are essential.Ability to prioritize, handle multiple tasks, delegate work, and meet deadlines is necessary.Must be capable of working with minimal supervision and comfortably seeking guidance when needed.Proficient with Adobe, Google, and Microsoft Office Suite applications.Excellent customer service skills are a must.Willingness to collaborate effectively as part of a team.Desired QualificationsKnowledge and understanding of FMLA administration.Experience in medical claims adjusting and/or other insurance related background.Experience and familiarity with claims risk management information systems