Claims Examiner Heritage Insurance Holdings IncClaims ExaminerSunrise, FLThe 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.
Claims Processing Representative Humana IncClaims Processing RepresentativeFL$40,000–$52,300 / yearTo ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended. NOTE: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.
Claims Auditor Independent Living Systems LLCClaims AuditorMiami, FLILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors.
NewSenior Claims Consultant Hub International LtdSenior Claims ConsultantMiami, FLABOUT HUB INTERNATIONAL: HUB International Limited ("HUB") is one of the largest global insurance and employee benefits brokers, providing a broad array of property, casualty, risk management, life and health, employee benefits, investment and wealth management products and services. Excellent oral & written communication skills, with the ability to clearly articulate coverage positions, challenge carrier arguments, and guide clients through complex claims.
Adjuster, Claims Molina Healthcare IncAdjuster, ClaimsFLProvides support for claims adjustment activities including administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. At least 1 year of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience.
Claims Representative, Auto Sedgwick Claims Management Services, Inc.Claims Representative, AutoFL$50,000–$55,000 / yearMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy.
Claims Associate - Workers Compensation | Med Only | Jurisdiction: NY and PA | Licensing: NY Licensing preferred Sedgwick Claims Management Services, Inc.Claims Associate - Workers Compensation | Med Only | Jurisdiction: NY and PA | Licensing: NY Licensing preferredFL$18.06–$22 / hourMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.
Claims Examiner - Workers Compensation | Dedicated Account | Jurisdiction/Licensing: FL - Required (Remote) Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation | Dedicated Account | Jurisdiction/Licensing: FL - Required (Remote)FLRemoteMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. To analyze workers compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Claims Assistant Sedgwick Claims Management Services, Inc.Claims AssistantFLRemoteMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.
Senior Data Engineer - EDI Claims Processing NationsBenefits LLCSenior Data Engineer - EDI Claims ProcessingPlantation, FLThis role is responsible for designing, developing, and maintaining enterprise-scale healthcare data integration solutions focused on HIPAA X12 EDI transactions, Medicaid encounters, and CMS compliance. Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction.
Claims Attorney (Municipal Entities) HCC Life Insurance CompanyClaims Attorney (Municipal Entities)FLRemoteThe Company will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e))(the "VCCLEA"), which restricts financial institutions and insurers such as TMHCC from employing individuals with certain types of criminal convictions. The Tokio Marine HCC - Public Risk Group is seeking a self-motivated Claims Attorney to join our growing Claims Department and handle litigated and non-litigated claims primarily arising under Auto and General Liability, as well as potentially some Law Enforcement, Public Officials, and Employment Practices liability policies in various jurisdictions.
Claims Processor Flex Benefits NFP CorpClaims Processor Flex BenefitsFL$43,000–$50,000 / yearPosition Summary:The Claims Processor is responsible for accurate and timely processing of claims which includes claims for Flexible Spending Accounts (FSA), Health Reimbursement Arrangements (HRA), Retiree plans, Lifestyle Accounts, Parking and more. American Benefits Group (ABG) is one of the nation's leading employee benefit solution providers for Consumer Directed Health accounts, COBRA and Direct Billing services.
NewNational Complex Claims Leader Marsh & McLennan Companies IncNational Complex Claims LeaderFort Lauderdale, FL$93,700–$174,800 / yearReporting to the SVP, National Claims Director, you will serve as a senior resource and technical authority on complex and high-exposure claims, bringing deep expertise, strategic judgment, and a national perspective to drive resolution on complex, high-stakes commercial P&C claim situations across the organization. In this capacity, you will build and maintain strong relationships with national and regional leadership, industry vertical leaders, and Marsh Risk, ensuring MMA clients receive best-in-class advocacy at every level.
Director Of Field Claims - Federal Workers' Compensation American International GroupDirector Of Field Claims - Federal Workers' CompensationMiami, FLEnsures appropriate claim file reserving, claim payments, legal/allocated expenses and recoveries are effectively applied and consistent with company guidelines via review and management of Open and Closed file reviews as well as other review processes. 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.
Warranty Claims Investigator Amrize LtdWarranty Claims InvestigatorFLRemoteRemote workforce position with regular travel in the field performing in-depth investigations to complete analysis of roofing systems exhibiting issues, requiring extensive knowledge of all construction practices as they relate to Elevate/GenFlex roofing systems. Quick and thorough completion of all paperwork including photographs related to each claim to properly document Amrize Building Envelope position for presentation and future reference including possible litigation.
Senior Data Engineer - EDI Claims Processing NationsBenefits, LLCSenior Data Engineer - EDI Claims ProcessingPlantation, FLThis role is responsible for designing, developing, and maintaining enterprise-scale healthcare data integration solutions focused on HIPAA X12 EDI transactions, Medicaid encounters, and CMS compliance. Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction.
Senior Data Engineer – EDI Claims Processing NationsBenefits, LLCSenior Data Engineer – EDI Claims ProcessingPlantation, FLThis role is responsible for designing, developing, and maintaining enterprise-scale healthcare data integration solutions focused on HIPAA X12 EDI transactions, Medicaid encounters, and CMS compliance. Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction.
Claims Analyst III Integrated Resources, IncClaims Analyst IIIDoral, FloridaContractorWill be utilizing Microsoft Excel heavily.*A minimum of 1-2 years' experience in claims processing with professionals or hospitals *Top 3 skills:Computer skills - Microsoft Excel (intermediate to advanced skills, i.e. pivot tables, v-look ups)Attention to detailStrong written communication skillsMust Haves:Claims backgroundKnowledge of billing guidelinesKnowledge of contract interpretationKnowledge of billing/coding - CPT & ICD-10Kind Regards,Arnab GhatakTechnical RecruiterIntegrated Resources, Inc. IT Life Sciences Allied Healthcare CROCertified MBE | GSA - Schedule 66 I GSA - Schedule 621IGold Seal JCAHO Certified for Health Care Staffing"INC 5 0 0 0 's FASTEST GROWING, PRIVATELY HELD COMPANIES" (8th Year in a Row)
Pharmacy Claims Auditor CPhT Conduent IncPharmacy Claims Auditor CPhTMiami, FLIn this role, you can expect the following working conditions: Hybrid work: Will be working from home 25% of the month and will be working in the field doing audits at different pharmacy locations 75% of the month. Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them.
NewClaims 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.