Director of Claims Processing and Payment Integrity Humana IncDirector of Claims Processing and Payment IntegrityMiramar, FL$138,900–$191,000 / yearDecisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, new business contracts, drives goals and objectives, and improves performance. The Director, Claims Processing and Payment Integrity contributes to overall provider satisfaction by paying claims accurately and timely, and cost reduction by increasing the accuracy of provider contract payments in our payer systems.
Complex Claims Manager - Construction Defect and Environmental CRC Insurance Services, LLCComplex Claims Manager - Construction Defect and EnvironmentalFLPlease review the following job description: A Complex Claims Manager - Construction Defect and Environmental is responsible for investigating, evaluating, and resolving insurance claims related to environmental damage, as well as claims involving General Liability (GL) and Excess Liability. This role involves analyzing coverage, assessing liability, negotiating settlements, and managing legal defense strategies, all while ensuring compliance with environmental regulations and minimizing the company''s financial exposure.
Director of Claims Processing and Payment Integrity CenterWellDirector of Claims Processing and Payment IntegrityMiramar, OhioDecisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, new business contracts, drives goals and objectives, and improves performance. The Director, Claims Processing and Payment Integrity contributes to overall provider satisfaction by paying claims accurately and timely, and cost reduction by increasing the accuracy of provider contract payments in our payer systems.
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.
NewClaims Specialist Pyramid Consulting, IncClaims SpecialistMiami, FLRemote$15–$18 / hourBy applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. High school diploma or equivalent required; Associate or bachelor’s degree in business, Finance, Healthcare Administration, or related field preferred.
Claims Examiner - Liability | PIP/NO FAULT | Jurisdiction: FL, NY, MI, MD | Licensing: FL and NY preferred - Remote Sedgwick Claims Management Services, Inc.Claims Examiner - Liability | PIP/NO FAULT | Jurisdiction: FL, NY, MI, MD | Licensing: FL and NY preferred - RemoteFLRemote$60,000–$75,000 / 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. PRIMARY PURPOSE OF THE ROLE To analyze PIP/ No Fault 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 Examiner Workers Comp - Southeast (FL, GA, NC, SC, AL, AR, KY) Sedgwick Claims Management Services, Inc.Claims Examiner Workers Comp - Southeast (FL, GA, NC, SC, AL, AR, KY)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. PRIMARY PURPOSE OF THE ROLE To analyze 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 Examiner, Auto | Commercial Bodily Injury | Litigation Required Sedgwick Claims Management Services, Inc.Claims Examiner, Auto | Commercial Bodily Injury | Litigation RequiredFLTo analyze complex auto bodily injury claims on behalf of our valued clients by evaluating coverage, investigating liability, and managing damages, while ensuring timely resolution within service expectations, industry best practices, and specific client requirements. Education & Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.
Claims Examiner - Workers Compensation | Jurisdiction: Southeast states | Licensing: FL or Home state required - Remote Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation | Jurisdiction: Southeast states | Licensing: FL or Home state required - RemoteFLRemote$70,000–$90,000 / 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. PRIMARY PURPOSE OF THE ROLE 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 Representative, Auto | Property Damage Sedgwick Claims Management Services, Inc.Claims Representative, Auto | Property DamageFL$50,000–$55,000 / yearProcesses auto and general liability property damage claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy. 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, Auto | Bodily Injury Sedgwick Claims Management Services, Inc.Claims Examiner, Auto | Bodily InjuryFLTo analyze complex auto bodily injury claims on behalf of our valued clients by evaluating coverage, investigating liability, and managing damages, while ensuring timely resolution within service expectations, industry best practices, and specific client requirements. Education & Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.
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 Examiner - Bodily Injury Sedgwick Claims Management Services, Inc.Claims Examiner - Bodily InjuryFL$80,000–$85,000 / yearTo analyze complex auto bodily injury claims on behalf of our valued clients by evaluating coverage, investigating liability, and managing damages, while ensuring timely resolution within service expectations, industry best practices, and specific client requirements. Education & Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.
Claims Examiner - Liability | General and Product Liability | Jurisdiction: All states | Licensing: Home state and NY Required (Remote) Sedgwick Claims Management Services, Inc.Claims Examiner - Liability | General and Product Liability | Jurisdiction: All states | Licensing: Home state and NY Required (Remote)FLRemote$60,000–$80,000 / yearPRIMARY PURPOSE OF THE ROLE: To analyze complex or technically difficult general and product liability and ligated claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Mental: 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.
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 Auditor Lead Elevance Health IncClaims Auditor LeadMiami, FLMinimum Requirements: Requires a HS diploma or GED and a minimum of 6 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
WFRP Claims Specialist Sompo International Holdings LimitedWFRP Claims SpecialistFL$70,000–$90,000 / yearThe employee is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; visual inspection involving small defects, small parts, and/or operation of machines (including inspection); using measurement devices; and/or assembly or fabrication parts at distances close to the eyes. As one of the leading writers of Federal Crop Insurance, AgriSompo North America combines industry experience, resources, capital and talent to deliver both traditional and innovative crop insurance and productivity tools to farmers, ranchers, insurers and agribusinesses in the United States.
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.
Claims Advocate - Risk Services Insurance Office of AmericaClaims Advocate - Risk ServicesHallandale Beach, FLRemote$70,000–$95,000 / yearFull timeAbout the Role: Responsible for IOA insurance Claims Management activities including: client advocacy, service and communication, problem claim resolution, data analysis and action, monitoring triggered activities, claims reviews and audits, workers compensation claim oversight, reserve analysis, unit stat and stewardship reporting, client education and consulting, sales support, litigation process management, new client onboarding, intake process support, data management and entry, and Producer communication. Fully remote for Florida based candidates | Experience: Looking for a Claims Advocate that has commercial experience in at least two lines of business (General Liability, Worker's Compensation, Professional Liability, Auto, etc).
Claims Representative Norwegian Cruise LineClaims RepresentativeMiami, FloridaOur brands deliver vacations of a lifetime with innovative product offerings, a high level of service and unique guest experiences aboard each vessel and we’re continually seeking applicants who are passionate about hospitality and committed to being their personal best. The combined brands currently operate 32 ships, employ over 35,000 shipboard crew from more than 110 different countries and visit approximately 700 different port destination each year.