The Senior Member Advocate is a vital role in ensuring service excellence to Zelis clients and their members. The Senior Member Advocate is proficient in and supports all Preservice Outreach, Balance Bill Resolution, and No Surprises Act assignment categories. This position requires the ability to act independently within the scope of assigned duties and responsibilities

Promptly investigate all assigned claims for coverage, liability, damages, subrogation and contribution Ensures timely disposition of all claims in accordance with regulatory and statutory requirements Within granted authority, establish appropriate loss and expense reserves with documented rationale Maintain and adjust reserves over the life of the claim to reflect chang

Claims Specialist Workers Compensation Requisition ID 2024 24902 Job Locations US FL Tampa Position Type Regular Full Time Category Claims Business Unit BUS_TPA US Excellence In Everything We Touch Position Summary Administers and resolves non complex short term claims of low monetary amounts, including medical only claims. Documents and monitors open case inventory and e

Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) Alerts Supervisor and Special Investigations Unit to potentially suspect claims Ensures timely denial or payment of benefits in accordance with jurisdi

Under the direction of the Branch Manager or Field Leader, the Mobile Examiner's primary responsibility is to provide coverage in the field ensuring that mobile exams are completed accurately and on time. Maintain a safe and professional environment for applicants, clients, and employees, perform with confidence all aspects of an insurance exam, including specimen collect

Investigates, evaluates and resolves Commercial Automobile, and General Liability claims for self insured and unbundled clients. Provides a superior level of customer service to internal and external business partners. Administers and resolves claims in a timely manner and in accordance with client, company and regulatory guidelines. This position is typically assigned cl

The position is responsible for the investigation, evaluation, negotiation and settlement of personal and commercial claims of moderate complexity, including dispute resolution and/or recovery. This position requires successful completion of Citizens Fundamentals Claims School, which includes obtaining an overall passing score. ESSENTIAL FUNCTIONS THE FOLLOWING ARE THE US

Who We Are Join a team that puts its People First! Since 1889, First American (NYSE FAF) has held an unwavering belief in its people. They are passionate about what they do, and we are equally passionate about fostering an environment where all feel welcome, supported, and empowered to be innovative and reach their full potential. Our inclusive, people first culture has e

Auto Claim Representative II Florida The Auto Club Group What you will do The Auto Club Group is seeking prospectiveClaim Representative IIwho canwork under normal supervision with an intermediate level approval authority to handle moderately complex claims within Claim Handling Standards in the field or inside units, resolve coverage questions, take statements and establ

Providing prompt contact with parties involved in claims within 24 hours of the first report. Conducting timely coverage analysis and communication with the insured based on policy information, facts, and allegations. Exercising proper judgment and decision making to analyze claims exposure, determine the course of action, and appropriately settle claims. Investigating cl

Must reside in the State of Florida preferably near the Tampa Bay area. Work Environment This is a hybrid work arrangement (time spent in office and remote). Depending on the employee's role and leadership's assessment, some employees will come in to an ACG facility on a weekly basis, a monthly basis, or on an "as needed" basis for key meetings and collaborative activitie

The Claims Settlement Specialist supports claim settlement with providers through post payment negotiation. The Claims Settlement Specialist will be responsible for handling provider telephone calls regarding the payment amount paid to a provider by a payor based on Zelis data points. During this call, the Claims Settlement Specialist must understand (1) the procedures bi