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Director Remote Claims Jobs in Michigan (NOW HIRING)

micro1 AI

Compliance Officers

Warren, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Compliance Officers

Sterling Heights, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Regulatory Affairs Specialist

Grand Rapids, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Compliance Officers

Dearborn, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Regulatory Affairs Specialist

Detroit, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Regulatory Affairs Specialist

Lansing, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Compliance Officers

Grand Rapids, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Regulatory Affairs Specialist

Warren, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Compliance Officers

Lansing, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Compliance Officers

Detroit, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Regulatory Affairs Specialist

Ann Arbor, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Regulatory Affairs Specialist

Dearborn, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

micro1 AI

Compliance Officers

Ann Arbor, MI · Remote

$50 - $80/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... Preferred Qualifications * 5+ years of direct regulatory affairs experience at a sponsor, CRO, or ...

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Showing results 21-40

All JobsClaims JobsDirector Remote Claims JobsDirector Remote Claims Jobs in Michigan

Director Remote Claims information

What does a director remote claims do?

A Director of Remote Claims oversees the operations and management of claims processing teams that work remotely, often for insurance or healthcare organizations. They develop strategies to improve efficiency, ensure compliance with policies and regulations, and monitor claim resolution metrics. Additionally, they are responsible for staff training, quality assurance, and implementing technology solutions to streamline remote workflows. Their role is crucial in ensuring that claims are handled accurately and promptly, even when teams are distributed across various locations.

What are the key skills and qualifications needed to thrive as a director remote claims, and why are they important?

To thrive as a Director of Remote Claims, you need in-depth knowledge of insurance claims processes, strong leadership experience, and typically a bachelor's degree in business, insurance, or a related field. Familiarity with claims management software, data analytics tools, and relevant certifications such as CPCU (Chartered Property Casualty Underwriter) are highly valuable. Exceptional communication, problem-solving, and team management skills help ensure effective oversight and support of remote teams. These skills and qualifications are crucial for maintaining efficient claims operations, ensuring regulatory compliance, and delivering excellent customer service in a remote environment.

What are some common challenges faced by a director remote claims and how can they be addressed?

A Director of Remote Claims often encounters challenges such as ensuring consistent communication across distributed teams, maintaining high productivity, and upholding compliance standards in a remote environment. Addressing these requires implementing robust digital collaboration tools, setting clear performance metrics, and conducting regular training on regulatory requirements. Building a strong remote culture through frequent check-ins and transparent leadership also helps foster team cohesion and accountability.

What is the difference between Director Remote Claims vs Claims Manager?

AspectDirector Remote ClaimsClaims Manager
CredentialsBachelor's degree, industry certifications (e.g., CPCU, ARM)Bachelor's degree, industry certifications often preferred
Work EnvironmentRemote leadership role overseeing multiple teamsRemote or on-site, managing claims staff directly
ResponsibilitiesStrategic planning, policy development, high-level oversightDaily claims processing, team supervision, customer service
Industry UsageCommon in insurance companies, large organizationsWidely used in insurance, healthcare, and related sectors

The main difference between a Director Remote Claims and a Claims Manager lies in scope and responsibilities. The Director focuses on strategic leadership and high-level oversight, while the Claims Manager handles daily operations and team management. Both roles require relevant industry certifications and can be remote, but the Director typically oversees multiple teams or departments.

What are the most commonly searched types of Remote Claims jobs in Michigan?

The most popular types of Remote Claims jobs in Michigan are:

What are popular job titles related to Director Remote Claims jobs in Michigan?

For Director Remote Claims jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Director Remote Claims jobs in Michigan look for?

The top searched job categories for Director Remote Claims jobs in Michigan are:

What cities in Michigan are hiring for Director Remote Claims jobs?

Cities in Michigan with the most Director Remote Claims job openings:

Director Remote Claims jobs near you

Government Programs Appeals and Grievances Research Specialist

Delta Dental of Michigan

Okemos, MI • On-site, Remote

Full-time

Medical, Dental

Posted 11 days ago

Job description

Job Title:
Government Programs Appeals and Grievances Research Specialist
Number of Positions:
9
Location:
Okemos, MI
Location Specifics:
Fully Remote
Job Summary:
Candidates must reside in Michigan within a reasonable commuting distance of our Okemos, MI office for team meetings, collaborative sessions, and training.
At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.
At Delta Dental, we celebrate our All In culture. It's a mindset, feeling and attitude we wrap around all that we do - from taking charge of our careers, to helping colleagues and lending a hand in the community.
Position Description:
To direct and assist in the resolution of dental benefit determinations and analysis of provider and subscriber referrals, provider billing and treatment records analysis, and to support the fraud & abuse program.
Primary Job Responsibilities:
  • Researches, analyzes, and resolves cases for government programs members involving compliance issues including but are not limited to balance billing, non-delivery of care, quality of care, personality disputes, anti-fraud hotline, internal referrals, and appeals. Case research may include but is not limited to, contract review and analysis, data analysis, records audit, and interviews with external customers.
  • Works closely with the Legal and Compliance team and Customer Service to complete cases in accordance with government program and client requirements. This includes closely monitoring workflow to ensure complaints are resolved within case specific turn-around times, applicable rights are provided, and requirements for manner and content of notice to customers are met.
  • Performs case reviews for clients who have elected to handle their own appeals and grievances communicating directly with clients, Delta Dental affiliate plans and account managers. Assists clients by facilitating adjustments, record requests and exception claim payments as needed.
  • Communicates to internal and external customers to obtain necessary information and relay actions taken and the resolution of cases.
  • Prepares dental claims so appropriate determinations can be finalized with correct procedure policies and bypasses in place, adjudicates claims, analyzes documents, and maintains claims records, as well as coordinates adjustments on difficult claims and inquiries.
  • Maintains thorough case documentation in the appeal and grievance case management system.
  • Coordinates data to be used by internal or external parties including audits, hearings and for use by legal counsel when necessary. Participates in audits and hearings as necessary, including sample preparation and presentation.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
#LI-Remote
Minimum Requirements:
Position requires an associate's degree in accounting, business administration, criminal justice, dental assisting or hygiene, or a related field and four years of experience in a position requiring knowledge of dental terminology, dental procedure codes, or dental office billing and record keeping practices within a provider office, administering dental benefit contracts within the insurance industry, or identifying, analyzing, and resolving compliance issues based on policies and procedures outside of the insurance industry. Previous experience supporting an anti-fraud/abuse program preferred. Will accept any suitable combination of education, training, or experience.
Position also requires knowledge of word processing, spreadsheet, and database applications; strong verbal and written communication skills; strong analytical skills; the ability to work independently and as part of a team; the ability to manage multiple assignments with competing deadlines; and the ability to identify and resolve problems using independent judgment.
The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

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