subject_line
J&A/OccuSure Claims
Service Inquiry
All information fields with a
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asterisk * are required.
Your Name
*
Company Name
*
Phone Number
*
Work Email
*
State(s) Inquiry Requested
*
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Type of Business
*
Self-Insured Client
Guaranteed Cost Client
Large Deductible Client
Carrier
Retail Agency
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All Others
In which services are your interested?
*
Claims Handling
Risk Management/Safety
Claims Advocacy
Medical Bill Review
Medical Canvassing
Nurse Case Management
All TPA Services
Additional information
Thank you
The information you provide will be used in accordance with the terms of our privacy policy.