div class="col col-xs-7 description" id="job-description">| This position is intended to provide billing and claims management support to Alivi Specialty Networks and Business Process Outsourcing (BPO) Services. The Medical Claims Examiner will ensure all claims received comply with all health plan, regulatory, contractual, compliance, and Alivi billing guidelines and processes. |
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| DUTIES & RESPONSIBILITIES |
- Responsible for accurate and timely adjudication of professional and institutional claims according to state and federal regulations.
p>In the event of an emergency or disaster, an employee may be required to respond promptly to duties and responsibilities as assigned by the employee's department, the County's Office of Emergency Management, or County Administration. This position will assist forensic toxicologists with laboratory duties working with biological samples and specimens to include administrative duties preparing reports and ensuring safety. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. The primary purpose of this job is to handle claims from coverage enquiry through legal liability assessment (where relevant) and quantum analysis, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders. Preferred Qualifications: Preference will be given to applicants with a bachelor's degree (or an equivalent combination of education and work experience - such as an Associate's degree with two years of work experience, or a high school diploma with four years of work experience), in one or more of the following fields: 1) Managing a caseload for an insurance, disability, vocational, social work or government program. Your Specific Responsibilities: This is entry level professional work researching, developing, compiling, analyzing, and rendering independent decisions relative to Social Security Disability Insurance, Supplemental Security Income and/or Medically Needy disability claims filed in the State of Florida. TALLAHASSEE, FL12 days ago p>Preferred: Preference will be given to applicants with a bachelor's degree (or an equivalent combination of education and work experience - such as an Associate's degree with two years of work experience, or a high school diploma with four years of work experience), in one or more of the following fields: 1) Managing a caseload for an insurance, disability, vocational, social work or government program. Your Specific Responsibilities: This is entry level professional work researching, developing, compiling, analyzing, and rendering independent decisions relative to Social Security Disability Insurance, Supplemental Security Income and/or Medically Needy disability claims filed in the State of Florida. TALLAHASSEE, FL30+ days ago Preferred Qualifications: Preference will be given to applicants with a bachelor's degree (or an equivalent combination of education and work experience - such as an Associate's degree with two years of work experience, or a high school diploma with four years of work experience), in one or more of the following fields: 1) Managing a caseload for an insurance, disability, vocational, social work or government program. Your Specific Responsibilities: This is entry level professional work researching, developing, compiling, analyzing, and rendering independent decisions relative to Social Security Disability Insurance, Supplemental Security Income and/or Medically Needy disability claims filed in the State of Florida. Claim adjudication requires interaction with employers, claimants, medical providers, and other parties to ensure adequate medical treatment is provided utilizing company resources in a cost-effective manner. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Cape Coral, FL11 days ago p>The City of Cape Coral is the seventh largest city in Florida, has over 1,500 full-time employees, provides various career path opportunities, and offers a robust training and development program for improving current talents, developing new skills, and building effective business relationships. - Current State of Florida Mechanical Inspector, Mechanical Plans Examiner, Plumbing Inspector, or Plumbing Plans Examiner certification; or equivalent ICC certification with the ability to obtain Florida certification through reciprocity preferred.
p>Special Note: CERTIFICATION OF STRUCTURAL PLANS EXAMINER: To be eligible for appointment as a Structural Plans Examiner, an individual shall be certified by the Board of Rules and Appeals and shall be a Florida licensed professional engineer who has obtained such license by examination under the structural discipline or who obtained licensure prior to March 1, 1993, by examination in either the civil/structural or civil/structural/sanitary categories and who has practiced as a structural engineer within the jurisdiction of this Chapter for a period of 5 years. This is highly skilled inspections, enforcement and supervisory work in the examination, review, analysis, approval and/or disapproval of plans to ensure compliance with the Florida Building Code and other applicable codes and regulations as it relates to building and/or structural plans examining. Plant City, FL30+ days ago p>Additional Competencies: - All SAGE Third Party CDL Examiners must have knowledge, skill, and actual performance abilities that far exceed the abilities identified in the objectives of the position.
- Knowledge/Skill: Demonstrated knowledge of the principles and practices of safe truck driving and all of the laws and regulations covering tractor-trailer interstate operations.
Jacksonville, FL30+ days ago p>Additional Competencies: - All SAGE Third Party CDL Examiners must have knowledge, skill, and actual performance abilities that far exceed the abilities identified in the objectives of the position.
- Knowledge/Skill: Demonstrated knowledge of the principles and practices of safe truck driving and all of the laws and regulations covering tractor-trailer interstate operations.
We” Focused: Characteristics - Supportive, positive, helpful, humble, team player, respectful, open and honest, constructive communicator, values the team higher than the individual, composed, assumes the best. Highly Focused on Results:Characteristics - Responsive, efficient, results orientated, data and deadline driven, problem solver, positive approach, detail oriented, hardworking, reliable. To perform inspections of both residential (1‑ & 2‑family dwellings) and commercial/multifamily buildings to ensure that construction, renovation, alteration, repair, demolition, and installation of building systems comply with the Florida Building Code and applicable local technical amendments. Public Agency Resources (PARS), a subsidiary of Willdan Group Inc., has an opening for a full-time Commercial/Residential Inspector in Space Coast/Brevard County, FL area. Clearwater, FL30+ days ago p>Education and Experience: High School Diploma or GED and three (3) years of professional level experience in the field of construction or a related field, building inspection, or plans review, corresponding to the State of Florida Department of Business and Professional Regulation (DBPR) licensing category; must meet qualifications as established by the latest revisions of the State of Florida Chapter 468, Florida Statutes, and Division 61G19, Florida Administrative Code; OR an equivalent combination of education, training, and experience may be considered. - Reviews architectural and engineering plans for permit applications in flood zones; demonstrates strong technical knowledge regarding flood zone requirements and ensures that all permit applications are accurately submitted and reflect important information; maintains, edits, and updates records for flood zone construction projects.
During an emergency, employees may temporarily be assigned to work and perform duties outside the normal scope of their position, location and work schedule to fit the needs of the County and its citizens. Graduate of an accredited high school or possession of an acceptable equivalency diploma, and a minimum of five (5) years of experience in the building construction profession or trades. ul>Customer Interaction: Consult with involved parties (customers, other carriers, attorneys, medical providers), secure medical information, and review insurance contracts, associated reports, and billing documentation. You will investigate medical necessity, determine casualty, evaluate the validity of personal injury insurance claims, and monitor case files over the course of treatment. We're seeking outstanding associates who want to kickstart a fulfilling career with one of the fastest-growing auto insurers in the U.S. As a PIP Claims Examiner, you will investigate medical necessity and determine casualty. We are looking for Personal Injury Protection (PIP) Claims Examiners in our Tampa, FL office to deliver our promise to be there and assist our customers throughout the often complicated medical aspects of auto insurance claims. div>Qualified candidates must have: - Current licensure, certificate of medical training (e.g., RN, LPN, Med Tech, Medical Assistant and Paramedics) as required by your state for completion of phlebotomy services.
- The position requires excellent communication, organization, and technical skills: the interpersonal skills to interface extensively with clients, management, and office staff, as well as a high level of courtesy, tact, and professionalism.
Conversions are subject to the following: A minimum of 96 unused sick leave hours accrued prior to hours being converted, total eligible sick leave hours to be converted shall be reduced hour-for-hour by any sick leave hours utilized during the eligible benefit period, and conversion subject to annual leave accrual cap. Graduation from an accredited institution holding a Bachelor or Associate of Science Degree in Engineering, Architecture or Building Construction may be credited for two (2) years for Bachelor Degree or one (1) year for an Associate Degree of the required five (5) years of combined experience for the Structural discipline. Broward County, FL30+ days ago p>Our employees are our greatest asset, with exceptionally certified individuals in all departments, including Planning & Zoning, Code Enforcement, Fire Prevention, and Engineering, as well as full-service and supplemental Building Department services. - Conduct detailed plumbing plan reviews, including review of engineered drawings, system layouts, load calculations, medical gas systems, grease interceptors, storm drainage, and specialty plumbing systems.
Conversions are subject to the following: A minimum of 96 unused sick leave hours accrued prior to hours being converted, total eligible sick leave hours to be converted shall be reduced hour-for-hour by any sick leave hours utilized during the eligible benefit period, and conversion subject to annual leave accrual cap. - Ability to establish and maintain effective working relationships with management, City officials, supervisors, co-workers, other City employees, vendors, the general public and other outside organizations with the goal of fostering positive employee relations and employee morale.
The ideal candidate will proactively manage claims through timely contact, thorough investigation, coverage analysis, damage evaluation, reserving, negotiation, and disposition while maintaining exceptional file quality and customer satisfaction. The Claims Examiner/Desk Adjuster investigates, evaluates, reserves, negotiates, and settles assigned homeowners property claims in accordance with company Best Practices and regulatory requirements. Make your mark in Claims Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. Reimagining insurance to make a bigger difference to the world American International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the worlds most far-reaching property casualty networks. Jacksonville, FL30+ days ago li>Ensures facilities or work areas are neat, clean and in good repair, takes appropriate action to advise Manager or Supervisor of required repairs and maintenance; Disposes of biohazard containers when scheduled. 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. Miami Lakes, FL30+ days ago li>Ensures facilities or work areas are neat, clean and in good repair, takes appropriate action to advise Manager or Supervisor of required repairs and maintenance; Disposes of biohazard containers when scheduled. 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. Broward County, FL30+ days ago li>Conducts field inspections of air-conditioning and heating systems, insulation, pressure and process piping, refrigeration, cooling towers, pneumatic tube conveyors, medical gases, industrial and commercial ventilating systems, commercial kitchen exhaust systems, spray booths, fire sprinkler systems, and similar equipment and mechanical systems. Our employees are our greatest asset, with exceptionally certified individuals in all departments, including Planning & Zoning, Code Enforcement, Fire Prevention, and Engineering, as well as full-service and supplemental Building Department services. Green Cove Springs, FL, FL30+ days ago Must pass an extensive background check, drug screening, have a valid driver’s license and maintain access to reliable transportation. Job Description: Responsible for providing timely, trauma-informed, forensic medical care as needed to sexual assault survivors. This role is ideal for an experienced title examiner who enjoys solving complex title issues, collaborating with internal teams, and mentoring others while continuing to grow professionally within the industry. Note: If you currently are employed by Old Republic Title (or one of its wholly owned affiliated companies) please get in touch with your human resources representative regarding the application process. Successful achievement of industry designations (INS, IEA, AIC, ARM, SCLA, CPCU) or I-Lead or other Management Training Minimum of 10 years of claims handling experience or equivalent combination of education and experience Experience handling high exposure construction bodily injury and property damage claims Market leading specialist knowledge within casualty construction lines Expert policy language skills enabling accurate and consistent policy wording interpretation Experience in negotiation, mediation and arbitrations Experience in conducting technical claims audits and effectively following up on findings Ability to manage claims outside of local jurisdiction where appropriate, including understanding of laws and regulations Strong senior stakeholder management experience, both internal (underwriting, distribution, actuarial, finance and executive management) and external (brokers, major account clients) Ability to influence claims stakeholders and to effectively direct claims strategy Ability to lead within a team environment Strong presentation skills Excellent written and oral communication skills Strong analytical and problem solving skills Strong organization and time management skills Ability to deliver outstanding customer service Intermediate skills in Microsoft Office products (Excel, Outlook, Power Point, Word) Ability to work in a team environment Strong desire for continuous improvement Markel offers hybrid working schedules of 3 days in the office and 2 days remote. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. The primary purpose of this job is to handle claims from coverage enquiry through legal liability assessment (where relevant) and quantum analysis, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders. TALLAHASSEE, FL27 days ago The Insurance Examiner II is responsible for the analysis, examination and/or investigation of patterns and practices of unreasonable delay in claims handling; timeliness and accuracy of payments to injured workers and reports under sections 440.13, 440.16, 440.185, and 440.20, Florida Statutes (F.S.), and Rules 69L-3 and 69L-56, Florida Administrative Code (F.A.C.). BRIEF DESCRIPTION OF DUTIES: This is work conducting on-site field audits, desk audits, and re-audits of insurers to ensure proper practices relating to workers' compensation claims handling procedures and monitoring the business practices of insurance companies to ensure their compliance with the workers' compensation law and administrative rules. Boca Raton, FL14 days ago p>We are seeking experienced professionals to join our Workers' Compensation team in two key roles: Senior Claim Examiner and Lead Claim Examiner. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. p>Note: If you currently are employed by Old Republic Title (or one of its wholly owned affiliated companies) please get in touch with your human resources representative regarding the application process. In this role, you will be responsible for searching and examining commercial title records and preparing accurate title commitments and reports in a timely manner. Examine commercial title records and prepare title commitments and Owner & Encumbrance reports Conduct legal research related to property taxes, liens, judgments, bankruptcies, and other encumbrances Partner with underwriting to resolve title objections and secure necessary approvals Communicate directly with clients to address title-related matters Review closing documentation to ensure compliance with underwriting and title requirements Analyze risk and apply sound legal judgment to real estate transactions. Juris Doctor from an accredited law school Active bar license required 0-3 years of experience preferred, ideally in real estate, title, or related transactional practice Strong analytical and problem-solving skills Excellent written and verbal communication skills Professional, client-facing demeanor Ability to thrive in a structured, fully in-office environment A collaborative mindset with eagerness to learn and grow. li>Comprehensive Claims Management: Independently investigate and evaluate Commercial Auto, PIP, and General Liability claims to ensure high-quality outcomes. As a Claims Examiner II, you will manage and resolve complex Commercial Auto, No-Fault/PIP, and General Liability claims from initial intake through final disposition. New Port Richey, FL28 days ago EDUCATION, TRAINING AND EXPERIENCE: Graduation from an accredited College or University with a Bachelors Degree in Architecture, Building Construction, or a related field and five (5) years of experience as a Commercial Plans Examiner OR an Associate degree and seven (7) years of experience as a Commercial Plans Examiner OR graduation from high school or possession of an acceptable equivalency and ten (10) years experience as a Commercial Plans Examiner. I hereby acknowledge that Pasco County BOCC is a drug-free workplace in accordance with Federal and Florida law, and consent to pre-employment drug/alcohol testing, and agree to abide by the program and policy if employed by Pasco County BOCC. Palm Beach, Florida30+ days ago The law also ensures that projects using private provider save money on permitting fees charged by the governing municipality. Tew & Taylor partners with homeowners and home builders across Florida to provide private plan review, inspections, and permitting management. About Private Provider Enacted October 1, 2002, and then revised on July 1, 2006, F.S. §553.791 provides that homeowners "may elect to use a private provider to provide plans review or required building inspections, or both." Boynton Beach, FL18 days ago p>Performs field inspections of new/existing buildings during the construction process for compliance with applicable building codes and ordinances; compares actual work to planned work to ensure compliance with approved construction plans; inspects new/remodeled single-family homes, multi-family homes, commercial buildings, industrial buildings, businesses, and accessory building and improvements. Communicates with supervisor, employees, other departments, city officials, code enforcement personnel, law enforcement personnel, architects, contractors, engineers, consultants, agents, the public, and other individuals as needed to coordinate work activities, review status of work, exchange information, or resolve problems. An employee in this classification is responsible for performing various technical activities of average difficulty, including conducting inspections of construction work and conducting reviews of residential, commercial, and industrial building construction plans and specifications submitted for review and approval by the Building Inspection Division. Under the general supervision of the Chief Building Inspector, an employee in this classification performs assignments that require considerable initiative and independent judgment in interpreting building codes, zoning regulations, and flood control ordinances. Jacksonville, FL29 days ago If you receive a message from someone posing as a Fortegra recruiter via text message, WhatsApp, Telegram or other messaging platform, please report it as phishing and block the sender. Fortegra has recently been made aware of unauthorized communications regarding career opportunities by individuals not associated with Fortegra or our recruitment team. li>Must have a valid Florida State Fire Marshals Office Fire Safety Inspector certification by date of hire and must possess or obtain NFPA Certified Fire Plan Examiner (CFPE) certification within 12 months or as agreed upon at time of hire; or must have a valid Florida State Building Code Administrator certification by date of hire and must possess or obtain a valid Florida State Fire Marshals Office Fire Safety Inspector certification and must possess or obtain NFPA Certified Fire Plan Examiner (CFPE) certification within 12 months or as agreed upon at time of hire. Specialized, technical work relating to all phases and types of fire protection plans and systems, review of building plans for code compliance and conduct fire and life safety inspections in all types of new construction, remodels and existing structures. Boca Raton, FL30+ days ago li>Communicates with internal managed care and medical resources to ensure coordination with medical providers, injured workers and employers in developing return to work strategies and treatment plans. The Lead Claims Examiner is responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds, claimants and medical providers. p>Qualifications • 5+ years experience as a Workers Comp adjuster • MS Office experience (Work, Excel, Outlook) • Effective negotiation skills • Strong verbal and written communication skills • Ability to prioritize work load to meet deadlines • Ability to manage multiple tasks in a fast-paced environment. The adjuster is responsible for the prompt and efficient examination, investigation, settlement or declination of worker's compensation insurance claims through effective research, negotiation and interaction with insures, and claimants, ensuring that company resources are utilized in a cost-effective manner in the process. Boca Raton, FL28 days ago p>AmTrust is a major player in the commercial P&C market and the third largest workers'' compensation provider in the U.S. Our small business insurance product suite continues to expand with Cyber, BOP, Employment Practices Liability Insurance (EPLI), Package and other core coverages and capabilities, including more middle-market and large accounts. Exposed to facets like Underwriting, Loss Control, Managed Care, and SIU, Claims opens diverse career paths with technical and leadership growth-perfect for making an impact and building a lasting career. AmTrust is a major player in the commercial P&C market and the third largest workers'' compensation provider in the U.S. Our small business insurance product suite continues to expand with Cyber, BOP, Employment Practices Liability Insurance (EPLI), Package and other core coverages and capabilities, including more middle-market and large accounts. Exposed to facets like Underwriting, Loss Control, Managed Care, and SIU, Claims opens diverse career paths with technical and leadership growth-perfect for making an impact and building a lasting career. Boca Raton, Florida29 days ago Overview: AmTrust is a major player in the commercial P&C market and the third largest workers' compensation provider in the U.S. Our small business insurance product suite continues to expand with Cyber, BOP, Employment Practices Liability Insurance (EPLI), Package and other core coverages and capabilities, including more middle-market and large accounts. Exposed to facets like Underwriting, Loss Control, Managed Care, and SIU, Claims opens diverse career paths with technical and leadership growth—perfect for making an impact and building a lasting career.
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