Lansing, Michigan, United States · On-site
SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job) The primary responsibility of this role is to create, maintain, and build a repository of provider panels adhering to state specific regulatio…
Skills: Workers compensation, Claims processing, Medical terminology, Legal terminology, Data entry
Lansing, Michigan, United States · On-site
SUMMARY: The Medical Only Claims Specialist I is an entry level claims role. The incumbent is expected to be proficient with the Claims unit, policies, processes, procedures, and terminology. The Medical Only Claims Spec…
Skills: Workers' compensation claims, Claims investigation, Medical treatment management, Return-to-work coordination, Regulatory compliance
Lansing, Michigan, United States · Remote OK
$56k–$94k/yr
SUMMARY: This position will provide legal assistance to the attorneys representing the Enterprise in all aspects of legal case preparation and file management including legal research; analyzing law sources such as statu…
Skills: Legal research, Case management, Document drafting, Workers' compensation, Medical record review
Detroit, Michigan, United States · Hybrid
$83k–$139k/yr
Departmental Summary: This position supports Medicare Part D pharmacy quality and medication adherence initiatives through data analysis, reporting, dashboard development, and operational support. Responsibilities includ…
Skills: SQL, Python, Spark SQL, Databricks, SAS
Detroit, Michigan, United States · Hybrid
$74k–$123k/yr
The Expert Analyst is responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. This role also coordinates projects for senior management. De…
Skills: Data Analysis, SQL, SAS, Excel, Trend Analysis
Lansing, Michigan, United States · Remote OK
$57k–$95k/yr
SUMMARY This is the intermediate level of the claim handler career path. Handles moderate to difficult claims. Exercises progressively more discretion in the determination of compensability of claims. Considers many fact…
Skills: Workers' compensation claims, Claims investigation, Negotiation, Compensability determination, Medical bill management
Detroit, Michigan, United States · Hybrid
$60k–$101k/yr
SUMMARY The Actuarial Analyst is responsible for performing specific actuarial related tasks under general supervision. Actuarial areas include but are not limited to valuations, financial reporting and forecasting, tren…
Skills: Actuarial science, Financial reporting, Forecasting, Trend analytics, Pricing
Lansing, Michigan, United States · Remote OK
$57k–$95k/yr
SUMMARY The Client Relations Specialists (CRS) ensure customer satisfaction for our larger multi-location accounts that have multiple loss control and claims contacts. The role is for the TCC department. The Client Relat…
Skills: Customer satisfaction, Account management, Risk management, Problem-solving, Communication
Lansing, Michigan, United States · Remote Solely
$57k–$95k/yr
SUMMARY This is the intermediate level of the claims handling career path responsible for managing a caseload of Michigan No-Fault Personal Injury Protection (PIP) claims of moderate to high complexity. The Claim Represe…
Skills: Claims handling, Michigan No-Fault law, Coverage analysis, Compensability determination, Exposure evaluation
Lansing, Michigan, United States · On-site
SUMMARY: Primarily responsible for providing customer service and underwriting technical support to agencies and policyholders related to underwriting rules, procedures and regulations, policy, and audit information. Rev…
Skills: Underwriting, Customer service, Workers compensation, Policy administration, Audit support
Westerville, Ohio, United States · Hybrid
$54k–$91k/yr
SUMMARY: Reviews, analyzes, approves or rejects complex business within letter of authority. Serve as liaison with company personnel regarding company business opportunities and problem resolution. Responsible for provid…
Skills: Underwriting, Workers' compensation insurance, Business development, Risk analysis, Pricing strategy
Lansing, Michigan, United States · On-site
SUMMARY: In addition to fulfilling the primary responsibilities of a Renewal Specialist, this role will also focus on serving as a lead worker in the Renewal Specialist department by assisting with quality, compliance an…
Skills: Underwriting, Mentoring, Compliance, Quality Assurance, Workers Compensation
Lansing, Michigan, United States · Remote OK
$122k–$203k/yr
SUMMARY The Program Business Development Manager is responsible for identifying, evaluating, and advancing new delegated underwriting authority program opportunities. This role requires deep understanding of portfolio-le…
Skills: Delegated Underwriting Authority, Portfolio Underwriting, Risk Management, Financial Modeling, Due Diligence
Lansing, Michigan, United States · Remote OK
$85k–$135k/yr
Responsible for providing consultation and training to employers regarding safety matters. Develop business partnership and ambassador-type relationship with insured policyholders. Evaluate physical premises, equipment, …
Skills: Loss control, Risk selection, Safety training, Workers compensation, Hazard identification
Lansing, Michigan, United States · Remote Solely
$64k–$106k/yr
The telephonic RN Case Manager position is responsible for utilizing the nursing process in the development of member treatment plans. The Case Manager will establish member goals and implement interventions to optimize …
Skills: Case Management, Nursing Process, Telephonic Assessment, Care Coordination, Chronic Disease Management
Lansing, Michigan, United States · Hybrid
$82k–$138k/yr
Corporate Audit and Advisory Services (CAAS) takes a proactive approach to auditing by providing consulting services to business units through value-added reviews of systems, business processes, financial and operating c…
Skills: Internal Auditing, Risk Assessment, Internal Controls, Business Process Consulting, CISA
Lansing, Michigan, United States · Remote OK
$48k–$81k/yr
SUMMARY: Claim Representative I: This is the entry level professional claim handler. Handles medical only and indemnity benefits. Exercises some discretion in the determination of compensability of claims. Considers many…
Skills: Workers' Compensation Claims, Claim Investigation, Negotiation, Case Management, Medical Terminology
Lansing, Michigan, United States · On-site
SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job) The Medical Only Claims Specialist I is an entry level claims role. The incumbent is expected to be proficient with the Claims unit, policies,…
Skills: Workers Compensation Claims Management, Medical Treatment Program Management, Case Law Analysis, Reserve Calculation, Subrogation Investigation
Lansing, Michigan, United States · On-site
SUMMARY: Primarily responsible for evaluation, approval, completion, and processing of mail audits and reviewing phone audits in a multi-functional business unit. Provides direct customer service via phone, fax, and e-ma…
Skills: Premium Audit, Payroll Analysis, Customer Service, Underwriting Rules, Workers Compensation Classifications
Detroit, Michigan, United States · Hybrid
$65k–$109k/yr
The Graphic Design Specialist is an integral part of the Emergent Holdings communications team and will manage projects from ideation and design to production with adherence to the Emergent Holdings brand standards and t…
Skills: Adobe Creative Suite, Illustrator, In-Design, WordPress, HTML
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The Panel Coordinator is responsible for creating, maintaining, and building provider panels that comply with state-specific workers' compensation regulations. They act as a primary point of contact for agents, insured parties, and physician offices to ensure accurate and timely panel delivery.
Candidates must have a high school diploma or G.E.D. and at least three years of experience in workers' compensation, including two years of technical claims or medical environment knowledge. Proficiency in Microsoft Office and strong research and communication skills are required.
SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job)
The primary responsibility of this role is to create, maintain, and build a repository of provider panels adhering to state specific regulations. This position will submit panels to agents, insured’s, and internal customers. Daily contacts include internal staff at all levels, and external customers such as agents, insured and physician offices..
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
· Track production statistics. Develops and maintains, databases and filing systems used for storing panels and postings.
· Provide first line contact with physician offices to validate specialty, demographic information, and acceptance on injured workers at all participating locations.
· Responds to inquiries from agents, insureds and brands, includes answering general questions, accommodating special request and sending completed panels
· Create provider panels using our Care Analytics tool or other available resources.
· Responsible for research using Google, MapQuest and other search engines available on the internet.
· Update provider list for non-panel states.
· Keep up to date with rule changes that impact provider panels in all states.
· Select appropriate physicians by specialty as required by the state regulations.
· Ensure accuracy and completeness of provider panels.
· Meet established timelines for completion of panel request.
· Provide or assist training sessions for team and other business units as necessary.
· Log provider panel requests and monitor timely delivery of panels.
· Research and supplement panels with new providers in areas where there is little to no coverage of preferred providers.
· Monitor provider panel age and update provider panels with new information when expired or within 3 to 6 months from last verification date.
· Work with corporate medical director to assist with certification of MPNs or other network systems required by the state.
· Participate in Medical Review Board to stay current on providers that are not treating to company standards.
· Mitigate risks of fines for inaccurate or missing panel postings.
· Facilitate sharing of panels between brands to minimize redundancy and to consolidate efforts for the enterprise.
· Ensure compliance with statutory changes as they relate to provider panels.
· Maintain confidentiality.
· Verify that licensure and NPI is current for all care analytic physicians being evaluated for use on our panels or postings.
· Responsible for completing special projects as requested by agents, insured and brands. This includes the need for multi-lingual posting or panels.
· Receives returned pharmacy cards and completes necessary follow-up to get the pharmacy card sent out to the injured worker at their correct address.
This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.
Relevant combination of education and experience may be considered in lieu of degree.
A. EDUCATION REQUIRED: (Brief paragraph detailing the minimum education required, including certifications) Do not state preferred qualifications.
High school diploma or G.E.D required with additional training or college-level course work in workers’ compensation or insurance.
B. EXPERIENCE REQUIRED: (Minimum experience required to perform this job) Do not state preferred experience.
Minimum three years workers compensation experience, including two years of demonstrated technical knowledge in a claims or medical environment (i.e. applying relevant workers compensation laws, regulations, guidelines, and/or policies) required. One year customer service experience exchanging information and answering and resolving inquiries over the phone required.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
· Knowledge of medical provider specialties.
· Knowledge of medical terminology and legal terminology.
· Ability to read, analyze and interpret contracts and governmental regulations.
· Ability to establish workflows, manage multiple projects and meet necessary deadlines while maintaining composure during stressful situations occurring as a result of workloads and/or deadlines.
· Ability to research information in multiple systems including various mappings sites.
· Ability to solve problems.
· Ability to work independently in a multi-functional business unit.
· Excellent customer service skills
· Excellent telephone etiquette
· Knowledge of computers, word processing and spreadsheet software with ability to enter accurately at 50 WPM.
· Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.
· Excellent organizational skills and ability to prioritize work.
· Excellent oral and written communication skills with a high degree of quality and accuracy.
· Knowledge of workers compensation industry
· Ability to establish a rapport and maintain an effective working relationship with both internal and external customers.
· Understanding of enterprise, company, and departmental operations.
· Ability to make competent, independent decisions.
· Ability to take initiative/ownership of the process of creating provider panels.
C. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE, AND/OR ABILITIES PREFERRED: (Briefly detail the preferred education, experience, skills, knowledge, and/or abilities desired to perform this job, including certifications). These are in addition to the required qualifications - Do not state required qualifications.
· Knowledge of multi-state claims processing.
· Experience handling claims in multiple states.
· Industry designation.
REQUIRED TESTING: (For HR use only)
Intermediate Excel, Intermediate Word, Intermediate Windows, Reading Comprehension, 50 wpm and Proofreading
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.
Making lives healthier, safer and better — together
Emergent Holdings’ elite team makes lives, companies and communities better! Emergent Holdings is driven by a singular goal — improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions and services to support our key stakeholders — individuals, employers, providers and strategic partners — improving the health and safety of the people and places we serve. At Emergent Holdings, we’re inspired to create, to challenge the status quo, to think not just about what our customers need now, but what they will need in the future. We are strategic thinkers. We are industry innovators. We are market trendsetters. Together, we are Emergent Holdings. Our team of established industry experts embraces a culture of innovation and entrepreneurial spirit. That means we’re focused on innovation, on leading and shaping our markets and improving health and safety for our customers and communities. For our customers, the result is a suite of solutions, services and products delivered ahead of market needs — and in anticipation of member demands. We are tireless in our pursuit of the exceptional, and our companies deliver optimal customer experiences and improve people’s lives every day, by making workplaces safer and delivering affordable, solutions-focused healthcare services.
Offices: 200 N Grand Ave, Lansing, Michigan 48933, US
Making lives healthier, safer and better — together
Emergent Holdings’ elite team makes lives, companies and communities better! Emergent Holdings is driven by a singular goal — improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions and services to support our key stakeholders — individuals, employers, providers and strategic partners — improving the health and safety of the people and places we serve. At Emergent Holdings, we’re inspired to create, to challenge the status quo, to think not just about what our customers need now, but what they will need in the future. We are strategic thinkers. We are industry innovators. We are market trendsetters. Together, we are Emergent Holdings. Our team of established industry experts embraces a culture of innovation and entrepreneurial spirit. That means we’re focused on innovation, on leading and shaping our markets and improving health and safety for our customers and communities. For our customers, the result is a suite of solutions, services and products delivered ahead of market needs — and in anticipation of member demands. We are tireless in our pursuit of the exceptional, and our companies deliver optimal customer experiences and improve people’s lives every day, by making workplaces safer and delivering affordable, solutions-focused healthcare services.
Offices: 200 N Grand Ave, Lansing, Michigan 48933, US
