Remote Medicare Claims Processing Jobs in Appleton, WI

Position Compensation Range:

Pay Rate Type:

Compensation may vary based on the job level and your geographic work location. Relocation support is offered for eligible candidates.

Primary Accountabilities

• Investigates origin and cause of claims by contacting the appropriate parties including insureds, claimants, agents, attorneys, contractors, experts, special investigation unit, other adjusters, public personnel, etc.
• Identifies complex issues and seeks assistance as needed. Handles claims on a good faith basis.
• Handles both 1st party and 3rd party claims under multiple policy types and numerous endorsements.
• Conducts on-site inspections when needed, evaluates damages, and handles claim negotiations with insureds, claimants, attorneys, public adjusters.
• Responds to customer inquiries, makes appropriate decisions and closes file as needed.
• Interprets and determines policies, leases, by-laws, declarations, articles and contract coverages and applies to all parties for assigned losses.
• Proactively provides all parties with claim process and status as appropriate; answers questions or redirects to other areas.
• May be required to complete other assignments, job duties, or participate in projects based upon skills, achievements, or experience.

Specialized Knowledge & Skills Requirements

• Demonstrated experience providing customer-driven solutions, support, or service.
• Demonstrated experience handling 1st and 3rd party, multi-line claims across our operating territories, or other equivalent experience.
• Demonstrated experience handling moderately complex claims, or other equivalent experience.
• Solid knowledge and understanding of policies and endorsements related to casualty coverages, or other equivalent knowledge.
• Solid knowledge and understanding of each phase of the claim handling process, or other equivalent knowledge.

Experience with Xactimate preferred.

Licenses

• Valid driver's license required plus an acceptable driving record.
• Obtain state specific property casualty claims licensing as required.

Travel Requirements

• Up to 50%.
• Catastrophe duty up to 75% as applicable.

Physical Requirements

• Ascending or descending ladders, stairs, scaffolding, ramps, poles and the like. This position may require employees to visit areas that have a higher hazard than a typical office such as customer homes, body shops, or other locations.
• Moving self in different positions to accomplish tasks in various environments including tight and confined spaces.
• Adjusting or moving objects up to 50 pounds in all directions.

Working Conditions

• Low temperatures.
• High temperatures.
• Outdoor elements such as precipitation and wind.
• Noisy environments.
• Hazardous conditions.
• Poor ventilation.
• Small and/or enclosed spaces.

• To ensure a strong start, all employees participate in our New Employee Orientation during their first week. This experience is held in person at our Madison, WI Headquarters or one of our AmFam core locations to help you connect with our mission, meet key team members and build relationships that support your growth. At times, sessions may be delivered virtually based on scheduling and availability.
• Offer to selected candidate will be made contingent on the results of applicable background checks
• Offer to selected candidate is contingent on signing a non-disclosure agreement for proprietary information, trade secrets, and inventions
• Sponsorship will not be considered for this position unless specified in the posting

#LI-Remote

We provide benefits that support your physical, emotional, and financial wellbeing. You will have access to comprehensive medical, dental, vision and wellbeing benefits that enable you to take care of your health. We also offer a competitive 401(k) contribution, a pension plan, an annual incentive, 9 paid holidays and a paid time off program (23 days accrued annually for full-time employees). In addition, our student loan repayment program and paid-family leave are available to support our employees and their families. Interns and contingent workers are not eligible for American Family Insurance Group benefits.

We are an equal opportunity employer. It is our policy to comply with all applicable federal, state and local laws pertaining to non-discrimination, non-harassment and equal opportunity. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law.

American Family Insurance is committed to the full inclusion of all qualified individuals. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please email AskHR@AmFam.com to request a reasonable accommodation.