Job Summary - Director, Claims Administration The Director of Claims Administration is responsible for the accurate, timely and efficient adjudication and payment of claims for all product lines at ...
Job Summary - Director, Claims Administration The Director of Claims Administration is responsible for the accurate, timely and efficient adjudication and payment of claims for all product lines at ...
Job Summary - Director, Claims Administration The Director of Claims Administration is responsible for the accurate, timely and efficient adjudication and payment of claims for all product lines at ...
Job Summary - Director, Claims Administration The Director of Claims Administration is responsible for the accurate, timely and efficient adjudication and payment of claims for all product lines at ...
Achieve revenue targets by collaborating closely with the direct sales force and providing high ... servicing, claims). * C-Suit Network and Commercial Acumen: Experience in GTM, management ...
Achieve revenue targets by collaborating closely with the direct sales force and providing high ... servicing, claims). * C-Suit Network and Commercial Acumen: Experience in GTM, management ...
Bachelor's degree or direct equivalent experience with property/casualty claims handling * Ability to organize data, multi-task and make decisions independently * Above average communication skills ...
Bachelor's degree or direct equivalent experience with property/casualty claims handling * Ability to organize data, multi-task and make decisions independently * Above average communication skills ...
Bachelor's degree or direct equivalent experience with property/casualty claims handling * Ability to organize data, multi-task and make decisions independently * Above average communication skills ...
Bachelor's degree or direct equivalent experience with property/casualty claims handling * Ability to organize data, multi-task and make decisions independently * Above average communication skills ...
Bachelor's degree or direct equivalent experience with property/casualty claims handling * Ability to organize data, multi-task and make decisions independently * Above average communication skills ...
Bachelor's degree or direct equivalent experience with property/casualty claims handling * Ability to organize data, multi-task and make decisions independently * Above average communication skills ...
... by direct Manager What we require you have... High school diploma or GED Bachelor's degree preferred Experience in dental insurance claims is a plus Analytical and problem solving skills with a ...
... by direct Manager What we require you have... High school diploma or GED Bachelor's degree preferred Experience in dental insurance claims is a plus Analytical and problem solving skills with a ...
Other tasks as requested by direct Manager What we require you have... * High school diploma or GED * Bachelor's degree preferred * Experience in dental insurance claims is a plus * Analytical and ...
Other tasks as requested by direct Manager What we require you have... * High school diploma or GED * Bachelor's degree preferred * Experience in dental insurance claims is a plus * Analytical and ...
Field Claims Representative
Troy, MI · On-site
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Field Claims Representative
Troy, MI · On-site
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Director, Mass Torts - Disputes, Claims & Investigations
Detroit, MI · On-site
$145K - $300K/yr
Job Title - Director, Mass Torts Impact You'll Make Lead complex client engagements within Stout's Disputes, Claims, and Investigations group, with a focus on mass tort claims. Provide value-added ...
Director, Mass Torts - Disputes, Claims & Investigations
Detroit, MI · On-site
$145K - $300K/yr
Job Title - Director, Mass Torts Impact You'll Make Lead complex client engagements within Stout's Disputes, Claims, and Investigations group, with a focus on mass tort claims. Provide value-added ...
Job Title - Director, Mass Torts Impact You'll Make Lead complex client engagements within Stout's Disputes, Claims, and Investigations group, with a focus on mass tort claims. Provide value-added ...
Job Title - Director, Mass Torts Impact You'll Make Lead complex client engagements within Stout's Disputes, Claims, and Investigations group, with a focus on mass tort claims. Provide value-added ...
Field Claims Representative
Portage, MI · On-site
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Field Claims Representative
Portage, MI · On-site
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Field Claims Representative
Adrian, MI · On-site
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Field Claims Representative
Adrian, MI · On-site
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Job Title - Director, Mass Torts Impact You'll Make Lead complex client engagements within Stout's Disputes, Claims, and Investigations group, with a focus on mass tort claims. Provide value-added ...
Job Title - Director, Mass Torts Impact You'll Make Lead complex client engagements within Stout's Disputes, Claims, and Investigations group, with a focus on mass tort claims. Provide value-added ...
Job Title - Director, Mass Torts Impact You'll Make Lead complex client engagements within Stout's Disputes, Claims, and Investigations group, with a focus on mass tort claims. Provide value-added ...
Job Title - Director, Mass Torts Impact You'll Make Lead complex client engagements within Stout's Disputes, Claims, and Investigations group, with a focus on mass tort claims. Provide value-added ...
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Field Claims Representative
Saginaw, MI · On-site
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Field Claims Representative
Saginaw, MI · On-site
Bachelor's degree or direct equivalent experience handling property and casualty claims * A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Director, Mass Torts - Disputes, Claims & Investigations
Detroit, MI · On-site
$145K - $300K/yr
Job Title - Director, Mass Torts Impact You'll Make * Lead complex client engagements within Stout's Disputes, Claims, and Investigations group, with a focus on mass tort claims. * Provide value ...
Director, Mass Torts - Disputes, Claims & Investigations
Detroit, MI · On-site
$145K - $300K/yr
Job Title - Director, Mass Torts Impact You'll Make * Lead complex client engagements within Stout's Disputes, Claims, and Investigations group, with a focus on mass tort claims. * Provide value ...
Direct Claims information
What are direct claims?
Direct claims refer to insurance claims that are filed directly by the policyholder with their own insurance company, rather than going through a third party or the at-fault party's insurer. This process is common in situations like auto accidents, where the policyholder seeks compensation for damages or losses under their own policy. Direct claims help streamline the process, reduce delays, and ensure the policyholder receives prompt assistance and settlements. They are often associated with 'first-party' insurance coverage, such as collision, comprehensive, or health insurance claims.
What are some common challenges faced by professionals in Direct Claims roles, and how can they effectively manage these challenges?
Professionals in Direct Claims often face the challenge of balancing a high volume of claims with the need for thorough investigation and timely resolution. Managing customer expectations and handling sensitive situations, such as denied claims or complex cases, can also be demanding. Effective communication, strong organizational skills, and staying updated on policy guidelines are crucial for success. Building collaborative relationships with adjusters, underwriters, and other departments helps ensure accurate and efficient claims processing.
What are the key skills and qualifications needed to thrive as a Direct Claims Specialist, and why are they important?
To thrive as a Direct Claims Specialist, you need a solid understanding of insurance policies, claims processes, and relevant legal regulations, often supported by a degree in business, finance, or a related field. Familiarity with claims management software, customer relationship management (CRM) systems, and sometimes industry certifications like AIC or CPCU is typical. Exceptional attention to detail, problem-solving abilities, and strong communication skills set top performers apart in this role. These skills and qualifications ensure claims are processed accurately and efficiently, leading to customer satisfaction and minimized risk for the insurer.
What is the difference between Direct Claims vs Claims Adjuster?
| Aspect | Direct Claims | Claims Adjuster |
|---|---|---|
| Credentials | Insurance license, knowledge of policies | Insurance license, sometimes certifications like AIC or CPCU |
| Work Environment | Customer service, office or remote | Fieldwork, office, or remote |
| Employer & Industry | Insurance companies, agencies | Insurance companies, third-party administrators |
| Search & Comparison Intent | Understanding direct claims handling | Evaluating claims adjustment roles |
Direct Claims professionals primarily handle claims directly from policyholders, focusing on processing and resolving claims within the insurance company. Claims Adjusters evaluate, investigate, and settle claims, often working in the field or remotely. Both roles require insurance licensing, but Claims Adjusters may have additional certifications. While their work overlaps in claims processing, Direct Claims roles are more customer-facing, whereas Claims Adjusters focus on assessment and negotiation.
What are popular job titles related to Direct Claims jobs in Michigan? For Direct Claims jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Direct Claims jobs in Michigan look for? The top searched job categories for Direct Claims jobs in Michigan are:
- Remote Liberty Mutual Claims Adjuster
- Entry Level Workers' Compensation Claims Adjuster
- Work From Home Tpa Claims Adjuster
- Freelance Car Insurance Claims Adjuster
- Remote Aig Claims Adjuster
- Remote International Claims Adjuster
- Medical Claim Adjuster
- Virtual Remote Claims Manager
- Remote 1099 Claims Adjuster
- Remote Workers' Compensation Claims Adjuster
What cities in Michigan are hiring for Direct Claims jobs? Cities in Michigan with the most Direct Claims job openings:
Full-time
Medical, Retirement
Posted 29 days ago
Corewell Health rating
6.9
Based on 766 frontline employees who took The Breakroom Quiz
449th of 886 rated healthcare providers
Job description
Job Summary - Director, Claims Administration
The Director of Claims Administration is responsible for the accurate, timely and efficient adjudication and payment of claims for all product lines at Priority Health. The leader is accountable for claim inventory, claim speed to process, claim auto adjudication rate, claim examiner quality scores, coordination of benefits savings, and third party liability savings.
Essential Functions - Director, Claims Administration
Qualifications - Director, Claims Administration
Physical Demands - Director, Claims Administration
How Corewell Health cares for you
Primary Location
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Department Name
Quality and Payment Integrity Administration - PH Managed Benefits
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
9:00 a.m. to 5:00 p.m.
Days Worked
Monday through Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
The Director of Claims Administration is responsible for the accurate, timely and efficient adjudication and payment of claims for all product lines at Priority Health. The leader is accountable for claim inventory, claim speed to process, claim auto adjudication rate, claim examiner quality scores, coordination of benefits savings, and third party liability savings.
Essential Functions - Director, Claims Administration
- Lead and develop a high performing claims adjudication team. Assure proper staffing levels.
- Implement goals setting, monitoring and achieving service-levels, medical trend management savings, and unit costs.
- Ensure functions to meet or exceed corporate standards for accuracy and timeliness of claim payment.
- Foster and maintain relationships with other departments to ensure that claims processes and procedures efficiently support other departments, products and overall customer service. Service on corporate committees as directed.
- Initiate process improvement and cost-saving measures. Foster an environment that allows for continuous improvement.
- Develop multi-year roadmaps and meet targets for unit costs, service levels, coaching and development, and other goals as developed.
- Effectively communicate issues and concerns through verbal and written communications. Effectively communicate operational issues and concerns to leadership.
- Ensure compliance with state and federal rules and regulations such as HIPAA, Department of Labor, ERISA, Michigan HMO Legislation, Medicaid, MiChild and Medicare.
Qualifications - Director, Claims Administration
- Required Bachelor's Degree or equivalent education and experience
- 10 years of relevant experience Prior management experience Required
- 2 years of relevant experience Prior claims administration management experience Preferred
- Health care plan claims experience strongly preferred.
Physical Demands - Director, Claims Administration
- Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
- Waist to Waist > 5 lbs: Seldom up to 10 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 10 lbs
- Bilateral Carry > 5 lbs: Seldom up to 10 lbs
- Unilateral Carry > 5 lbs: Seldom up to 10 lbs
- Pushing Force > 5 lbs: Seldom up to 10 lbs
- Pulling Force > 5 lbs: Seldom up to 10 lbs
- Sitting: Frequently
- Standing: Occasionally
- Walking: Occasionally
- Forward Bend - Standing: Seldom
- Forward Bend - Sitting: Occasionally
- Trunk Rotation - Standing: Seldom
- Trunk Rotation - Sitting: Occasionally
- Reach - Above Shoulder: Seldom
- Reach - at Shoulder or Below: Seldom
- Handling: Occasionally
- Forceful Grip > 5 lbs: Seldom
- Forceful Pinch > 2 lbs: Seldom
- Finger/Hand Dexterity: Frequently
How Corewell Health cares for you
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Department Name
Quality and Payment Integrity Administration - PH Managed Benefits
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
9:00 a.m. to 5:00 p.m.
Days Worked
Monday through Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
What Corewell Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Corewell Health
Sourced by ZipRecruiter
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Grand Rapids, MI, US