Seeking Bodily Injury Claims Adjusters! Morgan & Morgan, P.A.Seeking Bodily Injury Claims Adjusters!Miami, FloridaThis employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. From attorneys in all 50 states, to client support staff, creative marketing to operations teams, every member of our firm has a key role to play in the winning fight for consumer rights.
Senior Claims Advocate GallagherSenior Claims AdvocateMiami, FloridaFull timeKey responsibilities include: Consulting with clients and brokers on claims and coverage issues; Facilitating and attending client meetings and claims reviews; and Negotiating changes in reserves for a positive client outcome as appropriate by line of coverage. Gallagher's Claims and Risk Consulting team includes more than 100 safety and risk control professionals across the country with in-depth knowledge of current and emerging regulations, safety and health management, and operational exposures.
Specialist, Health Claims Carnival Global BrandSpecialist, Health ClaimsMiami, FLCarnival Corporation & plc is the world’s largest leisure travel company, our mission to deliver unforgettable happiness to our guest through our diverse portfolio of leading cruise brands and island destinations, including Carnival Cruise Line, Holland America Line, Princess Cruises, and Seabourn in North America and Australia; P&O Cruises and Cunard Line in the United Kingdom; AIDA in Germany; Costa Cruises in Southern Europe. The Specialist, Health Claims serves as a key liaison between case management team, healthcare providers, insurance carrier, and internal stakeholders to facilitate timely claim resolution, monitoring high-cost cases, validate supporting documentation, and maintain appropriate financial reviews.
Epic Claims Analyst III StratAcuity Staffing Partners IncEpic Claims Analyst IIIFlorida, FLRemote$100,000–$120,000 / yearIn terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. The ideal candidate will have deep expertise in Epic Claims workflows, healthcare billing operations, and reimbursement processes, along with Epic certification in either Hospital Claims or Professional Claims.
Claims Negotiation Manager CVS Health CorpClaims Negotiation ManagerFL$66,330–$145,860 / yearDemonstrated expertise in the No Surprises Act (NSA), out-of-network reimbursement methodologies, provider billing practices, and healthcare claims adjudication, with the ability to interpret complex regulations, evaluate claim and reimbursement disputes, guide negotiation strategies, ensure compliance, and drive favorable financial and operational outcomes. Lead daily negotiation operations while partnering closely with Product, Operations, Compliance, Analytics, and Client teams to enhance negotiation strategies, support product development, drive operational excellence, and ensure compliance with federal and state regulations.
Claims Team Lead, Auto | Remote Sedgwick Claims Management Services, Inc.Claims Team Lead, Auto | RemoteFLRemotePRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and technical staff for liability claims for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. Skills & knowledge: thorough knowledge of claims management processes and procedures for multiple product lines, excellent oral and written communication, including presentation skills, PC literate, including Microsoft Office products, leadership/management skills, analytical and interpretive skills, ability to work in a team environment, and the ability to meet or exceed Performance Competencies.
Claims Team Lead, Auto Sedgwick Claims Management Services, Inc.Claims Team Lead, AutoFLPRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and staff for liability claims for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. Skills & knowledge: thorough knowledge of claims management processes and procedures for multiple product lines, excellent oral and written communication, including presentation skills, PC literate, including Microsoft Office products, leadership/management skills, analytical and interpretive skills, ability to work in a team environment, and the ability to meet or exceed Performance Competencies.
Claims Team Lead - Liability Bodily Injury Sedgwick Claims Management Services, Inc.Claims Team Lead - Liability Bodily InjuryFLPRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and technical staff for liability claims for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. Skills & knowledge: thorough knowledge of claims management processes and procedures for multiple product lines, excellent oral and written communication, including presentation skills, PC literate, including Microsoft Office products, leadership/management skills, analytical and interpretive skills, ability to work in a team environment, and the ability to meet or exceed Performance Competencies.
Government Claims Admin 2, Remote, Business Office, FT, 08A-4:30P Baptist Health South Florida IncGovernment Claims Admin 2, Remote, Business Office, FT, 08A-4:30PMiami, FLRemote$20.62–$26.19 / hourBaptist Health is the region''s largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. Our approach is rooted in a "grow our own" philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including: Career growth and development opportunities, with clear pathways and ongoing support.
Director of Product Management - Claims & Customer Service JM Family Enterprises, Inc.Director of Product Management - Claims & Customer ServiceDeerfield Beach, FLDirector of Product Management - Claims & Customer Service leads the Claims & Customer Service product portfolio by partnering with business leaders to identify, prioritize, and deliver technology-driven capabilities that improve customer experience, automate service operations, and create measurable business value. We are committed to recruiting, hiring, retaining, and promoting qualified associates without regard any characteristic protected by law - whether actual or perceived - including race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity gender expression, sexual orientation, marital status, military service, veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, provincial, or local law.
Claims Quality Business Analyst DOCTORS HEALTHCARE PLANS, INC.Claims Quality Business AnalystCoral Gables, FLFull timeLead implementation of regulatory, benefit, and operational changes affecting RA/EOB content, claims reason codes, remark codes, notices, and member/provider-facing explanations. Position Purpose: The Claims Quality Business Analyst is responsible for analyzing claims operations, payment accuracy, compliance requirements, and quality performance metrics to identify opportunities for operational improvement, regulatory compliance, and member/provider satisfaction.
Medicaid Claims Examiner DOCTORS HEALTHCARE PLANS, INC.Medicaid Claims ExaminerCoral Gables, FLPosition Purpose: The Medicaid Claims Examiner is responsible for reviewing, analyzing, processing, and adjudicating Medicaid claims to ensure compliance with federal and state regulations, provider contracts, and health plan policies. Collaborating with provider relations and other departments, as necessary for timely encounter resubmission to the Agency for Healthcare Administration.
Casualty Claims Examiner AssuranceAmerica CorporationCasualty Claims ExaminerFLThe Casualty Claims Examiner will work alongside claims management, providing direction and oversight ensuring that compliance with best practices and state/local guidelines. Management reserves the right to add to, modify, or change the work assignments of the position as business needs dictate.
EPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full Time SolutionHealthEPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full TimeFLEpic Application Analysts 2-4 require current Epic training status (certification, accreditation, and/or proficiency) in primary application required, with a combination of current Epic training statuses in additional area(s) in application maintenance and development required in upper levels. Ideal candidates will possess strong experience as analyst with expert knowledge and experience in leading system analysis with special emphasis on system methodologies, projects management and business process reengineering related to information systems required.
NewSupervisor, Claims Centene Corporation GroupSupervisor, ClaimsFL$56,200–$101,000 / yearPosition Purpose: Oversee the day-to-day work functions of the assigned claims area, provide technical and leadership support to staff to resolve complex issues. Process improvement, cost control to process medical claims accurately and timely and serve as a liaison between internal customers, vendors and other stakeholders involved in the claims life cycle.
Claims Operations, Senior Manager Meritain TPA, Remote CVS Health CorpClaims Operations, Senior Manager Meritain TPA, RemoteFLRemote$75,400–$182,549 / yearProvides strategic leadership and oversight to ensure exceptional customer experiences and satisfaction by developing and implementing service strategies, managing a team of Claims Operations resources, monitoring service quality and performance metrics, resolving escalated customer issues, and collaborating with other departments to enhance service across all stakeholder groups. Applies leadership skills, customer-centric mindset, and problem-solving abilities to drive customer loyalty, retention, and advocacy while promoting a positive and service-oriented culture within the organization.
Lost Time Claims Specialist II (FL & GA University of Pittsburgh Medical CenterLost Time Claims Specialist II (FL & GAFLPrevious experience with the reserving and adjudication of the following: Workers' compensation lost time claims, Workers' compensation claim investigations (including subrogation and compensability decisions. The Lost Time Claims Specialist 2 will apply litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company.
Claims Adjudicator Miami Jewish Health Systems IncClaims AdjudicatorMiami, FLCompletes all medical claims adjudication tasks twice monthly including, tracking all claims in system, verifying referrals/authorizations, entering new providers, working expectations generating remittance notices, file transmissions and mailing checks per established department protocol. Position is key to PACE's revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for accurate capitation reimbursement from Medicaid and Medicare, generating accruals for Accounting.
Specialist, Health Claims Carnival Corp LtdSpecialist, Health ClaimsMiami, FLCarnival Corporation & plc is the world's largest leisure travel company, our mission to deliver unforgettable happiness to our guest through our diverse portfolio of leading cruise brands and island destinations, including Carnival Cruise Line, Holland America Line, Princess Cruises, and Seabourn in North America and Australia; P&O Cruises and Cunard Line in the United Kingdom; AIDA in Germany; Costa Cruises in Southern Europe. The Specialist, Health Claims serves as a key liaison between case management team, healthcare providers, insurance carrier, and internal stakeholders to facilitate timely claim resolution, monitoring high-cost cases, validate supporting documentation, and maintain appropriate financial reviews.
NewClaims Mitigation Manager JM Family Enterprises, Inc.Claims Mitigation ManagerDeerfield Beach, FLWe are committed to recruiting, hiring, retaining, and promoting qualified associates without regard any characteristic protected by law - whether actual or perceived - including race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity gender expression, sexual orientation, marital status, military service, veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, provincial, or local law. Drive measurable mitigation outcomes by improving dealer progression, reducing avoidable claims impact, strengthening inspection discipline, increasing quality mitigation touchpoints, and supporting improvement in excess loss trends where dealer behavior can be influenced.