Personal Injury Examiner
Claim processor job in Lakeland, FL
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Personal Injury Protection Claims Examiner - Lakeland, FL
Salary: $23.41-$29.41 per hour
What sets GEICO apart from our competition? One key factor is our ability to provide outstanding customer service during the insurance claims process. We are looking for Personal Injury Protection (PIP) Claims Examiners in our Lakeland, FL office to deliver our promise to be there and assist our customers throughout the often complicated medical aspects of auto insurance claims. 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. You will consult with involved parties, secure medical information and review insurance contracts, associated reports and billing documentation. We will rely on you to evaluate the validity of personal injury insurance claims and monitor case files over the course of treatment.
This job is a great fit for people who are continuous life learners, as PIP Claims Examiners are consistently challenged to learn more and increase their knowledge of our industry and company. Plus, GEICO encourages a promote-from-within culture, so there is plenty of room to grow your career and be rewarded for your hard work and determination.
Bring your passion for helping others and a desire to make impact and start a rewarding career with GEICO today!
Qualifications & Skills:
Bachelor's degree preferred
Prior insurance claims experience preferred, but not required
Personal injury, bodily injury or workers' compensation experience preferred
Solid analytical, customer service and multi-tasking skills
Strong attention to detail, time management and decision-making skills
#geico200
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
Auto-ApplySpecimen Processor
Claim processor job in Miramar, FL
Pride Health is hiring a Pride Health is hiring a Specimen Technician to support our client's medical facility in Miramar FL 33025. This is a 1 year+ assignment with the possibility of a contract-to-hire opportunity, and it's a great way to start working with a top-tier healthcare organization!
Job Title: Specimen Technician
Location: Miramar FL 33025
Pay Range: $18-$19.78 per hour
Schedule: Mon-Fri with Rotational Saturdays 11p-730a (40 hours per week)
Duration: 1 year+
Responsibilities:
Perform specimen processing tasks including A-station, presort, pickup, delivery, imaging, centrifugation, and aliquoting.
Enter data accurately and efficiently (6,000 keystrokes/hour).
Ensure accuracy, timeliness, and compliance with test regulations.
Maintain specimen organization and handle various specimen types correctly.
Adhere to safety protocols in a biohazard environment.
Meet productivity and quality standards in a production setting.
Communicate effectively with team members and other departments.
Keep work area clean and organized.
Demonstrate flexibility with shifts, weekends, holidays, and overtime.
Education/Qualifications:
High School Diploma or GED.
Prior laboratory experience preferred
Pride Global offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, , legal support, auto ,home insurance, pet insurance, and employee discounts with preferred vendors.
Inside Claims Examiner-P&C Homeowners Insurance
Claim processor job in Tampa, FL
Calling all innovators and people ready to take a proactive approach to claims handling in a digital world!!! Slide is a cutting-edge Tampa-based insurtech company (have you seen us in the news lately?!) and we are looking for tech-savvy Claims professionals!
Slide is an insurtech bringing together top talent, cutting-edge technology, world-class data science, and a human-centric approach.
We work and think differently, leveraging Big Data, AI, and machine learning to simplify and hyper-personalize every part of the insurance process. Why? Because modern consumers expect and deserve more from the insurance experience. And we have what it takes to deliver it.
Rebuilding every part of the insurance process to modernize the way it is written, explained, and managed is no small feat, but we are up for the challenge….are you?
Job Summary: The position is responsible for the investigation, evaluation, negotiation, and settlement of personal lines property claims including dispute resolution and/or recovery.
Duties and Responsibilities:
Proactively communicate and set accurate claims expectations with customers throughout the Claims process while providing high quality customer service.
Research, analyze, and interpret policy language and state law as it applies to submitted claims.
Examine and appropriately interpret policies, forms, and other records to determine coverage and extent of company's exposure or liability.
Appropriately apply knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations, and guidelines.
Draft, approve, and adjust estimates of damage and loss amounts.
Negotiate and settle claims in accordance with Slide's best practices, guidelines, and industry standards.
Assign, direct, and monitor vendors conducting mitigation and/or other services during the adjustment process.
Model ethical behavior and execute job responsibilities in accordance with Slide's core values, ethics, and information protection policies.
Document all relevant information in the electronic claims management system.
Contribute to the business production goals and objectives.
Establish timely and appropriate claim reserves in accordance with claim standards.
Appropriately represent the company by executing a high level of service and always maintaining professionalism.
Perform other duties, as assigned.
Education, Experience and Licensing Requirements:
Bachelor's degree in a field with skills transferable to insurance preferred; HS Diploma required.
Active Florida 6-20 Resident All Lines Adjuster License required.
3+ years of first-party property claims adjusting experience.
2+ years of experience working directly for a carrier
Working knowledge of Florida insurance laws and Florida good faith claims handling experience.
Technical savviness.
Xactimate proficiency a plus
Proficiency in Microsoft Windows environment.
Industry designations or certifications a plus.
Qualifications/Skills and Competencies:
Excellent interpersonal and critical thinking skills.
Data-driven, analytical approach necessary.
Working knowledge to interpret and apply laws, rules, regulations, policies and procedures, and department operational guidelines in daily functions.
Possesses strong customer service skills and can address customer escalations.
Strong analytical, organizational, negotiation and communication skills.
Ability to work independently, multi-task and adapt to frequent priority changes.
Ability to plan, prioritize workload, organize, and coordinate multiple tasks and projects.
Must possess excellent writing skills.
Desire to live Slide's Core Values.
What's in it for you?? A paycheck of course but really, much more!
The Slide Vibe - An opportunity to be a part of a fun and innovation-driven Culture fueled by Passion, Purpose and Technology!
Benefits - We have extensive and cost-effective benefits that cover you and your family from every angle... Physical Health, Emotional Health, Financial Health, Social Health, and Professional Health.
Claims Examiner I - Commercial Auto
Claim processor job in Lake Mary, FL
Details
Claims Examiner I - Commercial Auto
Department:
Property & Casualty
Reports To:
Claims Supervisor
FLSA Status:
Exempt in all state except California
Job Grade:
9
Career Ladder:
Next step in progression could include Claims Examiner II
ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for a full-time Claims Examiner I to support our Property & Casualty department. Employees who live less than 26 miles from the San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA and WV). Athens Program Insurance Services is the centerpiece of P&C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday through Friday at 37.5 hours per week. The Claims Examiner I is responsible for the timely investigation, evaluation and determination of settlement or denial of minor to moderate multi-line auto property and casualty claims. They will be handling claims from inception to closure. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
Knowledge in the following areas: 1) claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge, 2) functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated analytical, decision making and negotiation skills.
Investigate coverage, including evaluate insurance coverage problems and/or disputes
Investigate, evaluate and determine settlement value or denial of liability for all claims
Develop a measure of damage for each loss, establish and maintain appropriate reserves
Document and manage claims (i.e.: record statements, update diaries, write reports) from inception to closure
Ensure appropriateness of all payments
Negotiate settlement of claim within individual authority ($15,000 unless otherwise noted)
Maintain and update action plans for each claim
May assign and coordinate with vendors, legal counsel, appraisers or experts as necessary
Facilitate between claimants, clients, brokers and attorneys in resolution of liability claims
Exchange information with clients, claimants, insurance brokers, inspectors, producers and account managers
Provide customer service and support to insureds and claimants
Assist in training of new employees
Attend meetings and educational seminars for professional development
Maintain required licenses
ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
High School Diploma or equivalent (GED) required for all positions
AA/AS or BA/BS preferred but not required
Must possess a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL
Additional State Adjuster License(s) may be required within 180 days
Maintain licenses and continuing education requirements in all states
Minimum of three years auto-claims handling experience, at least one-year commercial auto required
Knowledge of property and casualty insurance policies
Knowledge of auto insurance laws, codes, procedures, and liability concepts
Proficiency in investigation and resolution of minor to medium level auto physical damage casualty claims
Strong negotiation skills and ability to achieve optimal settlement results for clients.
Well-developed verbal and written communication skills with strong attention to detail
Excellent organizational skills and ability to multi-task
Ability to type quickly, accurately and for prolonged periods
Proficient in Microsoft Office Suite
Ability to learn additional computer programs
Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner
Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor.
Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
Must be able to reliably commute to meetings and events as required by this position
APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************* This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here
Multi-Line Claim Specialist- Commercial Auto
Claim processor job in Maitland, FL
Commercial Auto - Multi Line Claim Specialist
Hours: Monday - Friday, 8:00 AM to 4:30 PM ET
Salary Range: $60,000-$85,000
NY License required
At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.
Reasons you should consider a career with CCMSI:
Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.
The Multi-Line Claim Specialist position is responsible for the investigation and adjustment of assigned general liability claims. This position may be used as an advanced training position for promotion consideration for supervisory/management positions. The position is also accountable for the quality of multi-line claim services as perceived by CCMSI clients and within our corporate claim standards.
Responsibilities
Investigate, evaluate and adjust multi-line claims in accordance with established claim handling standards and laws.
Establish reserves and/or provide reserve recommendations within established reserve authority levels.
Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated multi-line claims. Negotiate any disputed bills or invoices for resolution.
Authorize and make payments of multi-line claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
Assist in the selection, referral and supervision of designated multi-line claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
Review and maintain personal diary on claim system.
Assess and monitor subrogation claims for resolution.
Compute disability rates in accordance with state laws.
Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the multi-line claim adjustment process.
Provide notices of qualifying claims to excess/reinsurance carriers.
Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent oral and written communication skills.
Initiative to set and achieve performance goals.
Good analytic and negotiation skills.
Ability to cope with job pressures in a constantly changing environment.
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with minimum supervision.
Discretion and confidentiality required.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
10+ years multi-line claim experience is required.
Bachelor's Degree is preferred.
NY license required
Computer Skills
Proficient with Microsoft Office programs.
Certificates, Licenses, Registrations
Adjusters license may be required based upon jursidiction.
AIC, ARM or CPCU Designation preferred.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work requires the ability to sit or stand up to 7.5 or more hours at a time.
Work requires sufficient auditory and visual acuity to interact with others.
CORE VALUES & PRINCIPLES
Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits.
Visa Sponsorship:
CCMSI does not provide visa sponsorship for this position.
ADA Accommodations:
CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team.
Equal Opportunity Employer:
CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment.
#CCMSICareers #CCMSIMaitland #EmployeeOwned #ESOP #GreatPlaceToWorkCertified #ClaimsSpecialist #LiabilityClaims #HybridWork #FloridaJobs #InsuranceCareers #GeneralLiability #AutoClaims #MultiJurisdiction #FLAdjusters #CommercialAuto #NowHiring #InsuranceJobs #FLLiability #IND123 #LI-Hybrid
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Auto-ApplyClaims Examiner - Workers Comp (REMOTE - Southeast, VA, WV Exp Needed)
Claim processor job in Mobile, AL
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Claims Examiner - Workers Comp (REMOTE - Southeast, VA, WV Exp Needed)
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?
+ Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
+ Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations.
+ Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
+ Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights.
+ Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
+ Enjoy flexibility and autonomy in your daily work, your location, and your career path.
+ Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
**ARE YOU AN IDEAL CANDIDATE?** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
**PRIMARY PURPOSE** : To analyze complex or technically difficult workers' compensation 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.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
+ Negotiates settlement of claims within designated authority.
+ Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
+ Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
+ Prepares necessary state fillings within statutory limits.
+ Manages the litigation process; ensures timely and cost effective claims resolution.
+ Coordinates vendor referrals for additional investigation and/or litigation management.
+ Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
+ Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
+ Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
+ Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
+ Ensures claim files are properly documented and claims coding is correct.
+ Refers cases as appropriate to supervisor and management.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**QUALIFICATION**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
**Experience**
Five (5) years of claims management experience or equivalent combination of education and experience required.
**Licensing / Jurisdiction Knowledge:** Southeast and VA, WV Claims Exp Preferred
**TAKING CARE OF YOU**
+ Flexible work schedule.
+ Referral incentive program.
+ Career development and promotional growth opportunities.
+ A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Claims Analyst-Federal Construction
Claim processor job in Pensacola, FL
Job Title: Claims Analyst-Federal Construction ***Work Location: Panama City, FL (Tyndall AFB) *** Salary: Based on experience and will be discussed with manager in interview REQUIREMENT- Must be a US Citizen and must pass a federal background review and drug screen
Responsibilities/Duties:
Analyze contract terms, project schedules, and scope to identify potential claims or disputes.
Prepare, evaluate, and document construction claims including Requests for Equitable Adjustment (REAs), time extensions, and cost impacts.
Review subcontractor claims and coordinate analysis with project and legal teams.
Maintain organized documentation related to claims, including correspondence, daily reports, meeting minutes, schedules, and cost records.
Work closely with project managers, estimators, and schedulers to gather and validate data.
Support negotiations and settlement of claims with clients and subcontractors.
Provide recommendations for claim avoidance and risk mitigation.
Ensure all claims comply with applicable contract clauses and federal regulations (FAR, DFARS, etc.).
Assist in drafting position papers, presentations, and reports to support claim resolution or litigation support.
Education/Experience:
Bachelor's degree in Construction Management, Engineering, Business, or related field.
Minimum of 5 years of experience in construction claims analysis, preferably in federal or military construction projects.
Experience on U.S. Army Corps of Engineers (USACE) or NAVFAC projects.
Certification in construction claims or contract management (e.g., CCP, PMP, AACE certifications).
Working knowledge of construction law and dispute resolution processes.
Strong understanding of federal contracting regulations and procedures (FAR, DFARS).
Familiarity with scheduling techniques and tools (e.g., Primavera P6, Microsoft Project).
Experience analyzing cost impacts and time delays using industry-standard methodologies.
Excellent written and verbal communication skills.
Highly organized with strong attention to detail.
Ability to work independently and collaboratively with project teams.
Proficient in Microsoft Office Suite (Excel, Word, Outlook).
Benefits:
Competitive salary based on experience.
Comprehensive health, dental, and vision insurance.
Retirement savings plan with company match.
Paid time off and holidays.
Professional development and career advancement opportunities.
A supportive and collaborative work environment.
Equal Opportunity Employer (U.S.) all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity, or any other characteristic protected by law. Accura uses E-Verify in its hiring practices to achieve a lawful workplace. *******************
Patient Claims Specialist - Bilingual Only
Claim processor job in Tampa, FL
We are united in our mission to make a positive impact on healthcare. Join Us!
South Florida Business Journal, Best Places to Work 2024
Inc. 5000 Fastest-Growing Private Companies in America 2024
2024 Black Book Awards, ranked #1 EHR in 11 Specialties
2024 Spring Digital Health Awards, “Web-based Digital Health” category for EMA Health Records (Gold)
2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara)
Who we are:
We Are Modernizing Medicine (WAMM)! We're a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany.
ModMed is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine!
Your Role:
Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections
Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates
Input and update patient account information and document calls into the Practice Management system
Special Projects: Other duties as required to support and enhance our customer/patient-facing activities
Skills & Requirements:
High School Diploma or GED required
Availability to work 9:30-5:30pm PST or 11:30am to 8:30 pm EST
Minimum of 1-2 years of previous healthcare administration or related experience required
Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs)
Manage/ field 60+ inbound calls per day
Bilingual required (Spanish & English)
Proficient knowledge of business software applications such as Excel, Word, and PowerPoint
Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone
Ability and openness to learn new things
Ability to work effectively within a team in order to create a positive environment
Ability to remain calm in a demanding call center environment
Professional demeanor required
Ability to effectively manage time and competing priorities
#LI-SM2
ModMed Benefits Highlight:
At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits:
India
Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk,
Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees,
Allowances: Annual wellness allowance to support your well-being and productivity,
Earned, casual, and sick leaves to maintain a healthy work-life balance,
Bereavement leave for difficult times and extended medical leave options,
Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave,
Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind.
United States
Comprehensive medical, dental, and vision benefits
401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep.
Generous Paid Time Off and Paid Parental Leave programs,
Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs,
Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed,
Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning,
Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles,
Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters.
PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (*************************). Please check senders' email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.
Auto-ApplyInsurance Claims Specialist
Claim processor job in Tampa, FL
The Claims Specialist will be responsible for assisting with the management of the Fleet Vehicle Safety & Operations Policy for DPR (and DPR related entities) across the US, as well as first and third-party auto physical damage and low severity property damage claims as requested by, and under the supervision of, DPR's Insured Claims Manager.
Specific Duties include:
Claims & Incident Management:
* Initial processing of first and third-party auto and low severity property damage incidents involving DPR (and DPR related entities), including but not limited to:
* Input and/or review all incidents reported in DPR's RMIS system.
* Maintain incident records in Insurance Team's document management system.
* Ensure all necessary information is compiled to properly manage the claims, including working with the internal teams to identify culpable parties, potential risk transfer to the culpable trade partner, if applicable, collecting documents such as incident reports, root cause analyses, if any, and vehicle lease or rental agreements.
* Report, with all appropriate documents and information, all claims for DPR (and DPR related entities) to all potentially triggered insurance policies for various types of programs (traditional, CCIP, OCIP), including analyzing contractual risk transfer opportunities.
* Assess potential risk transfer opportunities and ensure additional insured tenders or deductible responsibility letters are sent, where applicable.
* Liaison with the carriers in evaluating whether claims reported directly to the carriers are appropriate.
* Manage all auto and low severity property damage claims, as assigned, in the DPR RMIS system for DPR (and DPR related entities), including ensuring that all information is kept up to date.
* Provide in-network aluminum certified repair shop information to drivers following an incident.
* Act as a liaison between our carriers, auto repair shops, Operations, Fleet and EHS teams related to claim progress, strategy, expenses and settlement.
* When required, notify the applicable State's Department of Motor Vehicles office of motor vehicle accidents by preparing and mailing the specific State form.
* Work with Insurance Controller on auto program claim reports
* Liaison with Operations, Fleet and EHS teams on new incident reporting processes, as needed.
Fleet Vehicle Safety & Operations Policy Management:
* Manage the Fleet Risk Index scores for authorized drivers, ensuring its accurate and up to date based on incidents and MVRs
* Assign training to authorized drivers based on MVA incidents, MVRs and citations, as well as managing completion of the training
* Ensure authorized driver list is kept current
* Liaison with internal HR, Fleet, EHS and Business Unit Leaders, where appropriate, on suspending vehicle usage permissions
* Responsible for working with internal teams on implementing appropriate updates to the Fleet Vehicle Safety & Operations Policy
Key Skills:
* Strategic thinking
* Ability to mentor and inspire others
* Integrity
* Team player
* Strong writing and communication skills
* Self-Starter
* Highly organized and responsive - ability to meet deadlines
* Detail Oriented
* Basic working knowledge in all of the following coverages/programs: auto insurance, commercial general liability, property insurance, and controlled insurance programs.
* Risk and dispute management - insured claims
Qualifications:
* A minimum of five years relevant insurance industry experience
* Previous experience in auto claims management highly desired
DPR Construction is a forward-thinking, self-performing general contractor specializing in technically complex and sustainable projects for the advanced technology, life sciences, healthcare, higher education and commercial markets. Founded in 1990, DPR is a great story of entrepreneurial success as a private, employee-owned company that has grown into a multi-billion-dollar family of companies with offices around the world.
Working at DPR, you'll have the chance to try new things, explore unique paths and shape your future. Here, we build opportunity together-by harnessing our talents, enabling curiosity and pursuing our collective ambition to make the best ideas happen. We are proud to be recognized as a great place to work by our talented teammates and leading news organizations like U.S. News and World Report, Forbes, Fast Company and Newsweek.
Explore our open opportunities at ********************
Auto-ApplyWorkers Compensation Claims Specialist, East
Claim processor job in Lake Mary, FL
You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s).
JOB DESCRIPTION:
Essential Duties & Responsibilities:
Performs a combination of duties in accordance with departmental guidelines:
Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information.
Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols.
Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims.
Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation.
Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.
May serve as a mentor/coach to less experienced claim professionals
May perform additional duties as assigned.
Reporting Relationship
Typically Manager or above
Skills, Knowledge & Abilities
Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed.
Demonstrated ability to develop collaborative business relationships with internal and external work partners.
Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions.
Demonstrated investigative experience with an analytical mindset and critical thinking skills.
Strong work ethic, with demonstrated time management and organizational skills.
Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
Developing ability to negotiate low to moderately complex settlements.
Adaptable to a changing environment.
Knowledge of Microsoft Office Suite and ability to learn business-related software.
Demonstrated ability to value diverse opinions and ideas
Education & Experience:
Bachelor's Degree or equivalent experience.
Typically a minimum four years of relevant experience, preferably in claim handling.
Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience.
Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
Professional designations are a plus (e.g. CPCU)
#LI-AR1
#LI-Hybrid
In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut,
Illinois
,
Maryland,
Massachusetts
,
New York and Washington,
the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
Auto-ApplyClaims Investigator - Experienced
Claim processor job in Pensacola, FL
Job Description
Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must.
Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments.
If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ******************
The Claims Investigator should demonstrate proficiency in the following areas:
AOE/COE, Auto, or Homeowners Investigations.
Writing accurate, detailed reports
Strong initiative, integrity, and work ethic
Securing written/recorded statements
Accident scene investigations
Possession of a valid driver's license
Ability to prioritize and organize multiple tasks
Computer literacy to include Microsoft Word and Microsoft Outlook (email)
Full-Time benefits Include:
Medical, dental and vision insurance
401K
Extensive performance bonus program
Dynamic and fast paced work environment
We are an equal opportunity employer.
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WpChNsxXV1
Claims Investigator - Part-Time
Claim processor job in Pensacola, FL
Overview
Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services. Allied Universal Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.
Job Description
Allied Universal is hiring a Claims Investigator. Claim Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation.
Florida applicants must either hold a C Private Investigators' License
OR
independently complete the 40-hour course necessary to successfully apply for a CC Private Investigator's license (apprenticeship) before applying.
Must possess a valid driver's license with at least one year of driving experience
RESPONSIBILITIES:
Investigate insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability
Gather information independently and in collaboration with clients and case managers through various methods such as data collection, interviews, research, and scene investigations
Follow guidance from the handling insurance adjuster to perform field tasks essential to the investigation
Develop and document information on any investigation in a professional and expert manner by writing clear, concise, and grammatically correct reports, memos, and letters
Run appropriate database indices if necessary and verify the accuracy of results found
QUALIFICATIONS (MUST HAVE):
Must possess one or more of the following:
Bachelor's degree in Criminal Justice
Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims
High school diploma with a minimum of six (6) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims
Ability to be properly licensed as a Private Investigator as required by the states in which you work
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course
Minimum of two (2) years of demonstrated experience conducting insurance claims investigations or adjusting complex claims
Working knowledge and understanding of anti-fraud laws, insurance regulations, and compliance rules and standards in their home state and within their designated region of the country
Special Investigative Unit (SIU) Compliance knowledge
Ability to type 40+ words per minute with minimum error
Flexibility to work varied and irregular hours and days including weekends and holidays
Proficient in utilizing laptop computers and cell phones
PREFERRED QUALIFICATIONS (NICE TO HAVE):
Military experience
Law enforcement
Insurance administration experience
One or more of the following professional industry certifications
Certified Fraud Investigator (CFE)
Certified Insurance Fraud Investigator (CIFI)
Fraud Claim Law Associate (FCLA)
Fraud Claim Law Specialist (FCLS)
Certified Protection Professional (CPP)
Associate in Claims (AIC)
Chartered Property Casualty Underwriter (CPCU)
BENEFITS:
Medical, dental, vision, basic life, AD&D, and disability insurance
Enrollment in our company's 401(k)plan, subject to eligibility requirements
Seven paid holidays annually, sick days available where required by law
Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law.
Closing
Allied Universal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: ***********
If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: ***********/offices.
Requisition ID
2025-1488548
Claims Investigator - Part-Time
Claim processor job in Pensacola, FL
Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services. Allied Universal Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.
Job Description
Allied Universal is hiring a Claims Investigator. Claim Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation.
Florida applicants must either hold a C Private Investigators' License
OR
independently complete the 40-hour course necessary to successfully apply for a CC Private Investigator's license (apprenticeship) before applying.
Must possess a valid driver's license with at least one year of driving experience
RESPONSIBILITIES:
Investigate insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability
Gather information independently and in collaboration with clients and case managers through various methods such as data collection, interviews, research, and scene investigations
Follow guidance from the handling insurance adjuster to perform field tasks essential to the investigation
Develop and document information on any investigation in a professional and expert manner by writing clear, concise, and grammatically correct reports, memos, and letters
Run appropriate database indices if necessary and verify the accuracy of results found
QUALIFICATIONS (MUST HAVE):
Must possess one or more of the following:
Bachelor's degree in Criminal Justice
Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims
High school diploma with a minimum of six (6) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims
Ability to be properly licensed as a Private Investigator as required by the states in which you work
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course
Minimum of two (2) years of demonstrated experience conducting insurance claims investigations or adjusting complex claims
Working knowledge and understanding of anti-fraud laws, insurance regulations, and compliance rules and standards in their home state and within their designated region of the country
Special Investigative Unit (SIU) Compliance knowledge
Ability to type 40+ words per minute with minimum error
Flexibility to work varied and irregular hours and days including weekends and holidays
Proficient in utilizing laptop computers and cell phones
PREFERRED QUALIFICATIONS (NICE TO HAVE):
Military experience
Law enforcement
Insurance administration experience
One or more of the following professional industry certifications
Certified Fraud Investigator (CFE)
Certified Insurance Fraud Investigator (CIFI)
Fraud Claim Law Associate (FCLA)
Fraud Claim Law Specialist (FCLS)
Certified Protection Professional (CPP)
Associate in Claims (AIC)
Chartered Property Casualty Underwriter (CPCU)
BENEFITS:
Medical, dental, vision, basic life, AD&D, and disability insurance
Enrollment in our company's 401(k)plan, subject to eligibility requirements
Seven paid holidays annually, sick days available where required by law
Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law.
Closing
Allied Universal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: ***********
If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: ***********/offices.
Requisition ID 2025-1488548
Auto-ApplyTravel Orders and Claims Specialist
Claim processor job in Tampa, FL
Travel Orders and Claims Specialist Please note: This position is contingent upon the award of a contract. We will provide updates on the status of the contract and next steps during the hiring process.
Minimum Qualifications Summary
Certification & Education
Must possess a current US Passport with ability to travel and work overseas
Must be able to meet COMSEC briefing and Local Element management certification requirements available under the OPNAVINST 2201.4, DoD Instruction 8523.01 and Air Force Manual 17-1301
Must possess a SECRET Security Clearance
Experience Required
Possess full understanding and experience of federal and DoD policies, processes, procedures and systems - including Defense Travel System - used to enable worldwide travel
Five years' military experience
Job Objective Under a five-year contract, the Travel Orders and Claims Specialist will support the United States Marine Corps Forces, Central Command (MARCENT) and subordinate commands. The scope of the requirement includes professional services for MARCENT located aboard MacDill Air Force Base (AFB), Florida, which serves as a Component Command to U.S. Central Command (USCENTCOM). Specifically, the Travel Orders and Claims Specialist will support the Manpower Directorate (G-1) within the continental United States (CONUS) and outside the continental United States (OCONUS). The G-1 performs analysis of manpower requirements to support operations. Additionally, the G-1 advises and assists the Commander in matters relating to personnel operations, management, policy, administration, awards, correspondence, travel management, the Government Travel Charge Card (GTCC) Program, and administrative support to all Marines stationed at MacDill AFB as well as individual augments in the USCENTCOM Area of Responsibility (AOR). Responsibilities
Provide travel orders processing support services
Execute travel arrangement coordination with travelers and designated DoD Commercial Travel Offices
Inform travelers on travel requirements, allowances, limitations, and process travel claims, coordinate settlement actions with associated finance/disbursing entities, assist the Government Travel Charge Program Manager, and support the Director, Personnel Admin Center
Provide a capability to process (from inception to settlement), a minimum of 450 up to a maximum of 2,800 travel claims per month
Coordinate and arrange travel logistics, ensuring all transportation, lodging, and meals are scheduled efficiently and in compliance with military regulations
Book airline tickets, ground transportation, hotel accommodations, and any other necessary travel-related services for military personnel
Develop, manage, and distribute detailed travel itineraries, ensuring all schedules are clearly communicated and updated as needed
Adjust travel plans in the event of changes or emergencies, ensuring MARCENT personnel are promptly informed of modifications
Ensure all travel arrangements comply with military regulations, including the Joint Travel Regulations (JTR) and Department of Defense (DoD) policies
Maintain and process all necessary travel documentation, including travel authorizations, vouchers, receipts, and expense reports
Assist in monitoring travel budgets and ensure that all travel expenses remain within allocated limits
Submit travel-related financial reports and keep accurate records of expenses.
Serve as the primary point of contact for travel-related inquiries
Liaise with transportation companies, lodging facilities, and other service providers to ensure smooth and cost-effective travel
Provide support and assistance during travel disruptions, such as cancellations, delays, or unexpected changes, to ensure travel needs are met promptly
Assist with rebooking travel and arranging alternative accommodations if necessary
Provide guidance to personnel on travel policies, entitlements, and procedures
Conduct travel training sessions or distribute materials to ensure MARECENT personnel understand the proper travel protocols
Maintain organized records of all travel-related documents, including tickets, itineraries, receipts, and travel authorizations
Generate and submit travel-related reports and summaries as required by supervisors or higher command
Address any travel-related concerns or complaints, providing prompt and professional solutions
Offer superior customer service by assisting with travel inquiries, changes, or issues during the travel process
Continuously evaluate and improve travel processes to enhance efficiency and minimize costs
Recommend changes to improve the overall effectiveness of the MARCENT travel program
Education & Certification
Must possess a current US Passport with ability to travel and work overseas
Must be able to meet COMSEC briefing and Local Element management certification requirements available under the OPNAVINST 2201.4, DoD Instruction 8523.01 and Air Force Manual 17-1301
Security Clearance
Must possess a SECRET Security Clearance
Work Location
MARCENT, MacDill Air Force Base, Tampa, Florida
Travel: Contractor personnel must support the projected travel in support of government requirements to MARCENT AOR and supporting locations, which includes but not limited to the following countries: Bahrain, United Arab Emirates (UAE), Saudi Arabia, Jordan, Egypt, France, Germany, United Kingdom, Oman, Qatar, Kuwait, Iraq, Israel, Afghanistan, Syria, Lebanon, Yemen, Pakistan, Turkmenistan, Uzbekistan, Kyrgyz Republic, Tajikistan, Kazakhstan, Djibouti, Cyprus, Turkey, Italy, and Greece. The ideal candidate will be available for travel on less than 24 hours-notice to support personnel recovery and training for forward deployed forces. The ideal candidate will possess the ability to execute OCONUS travel throughout the Central Command (CENTCOM) AOR.
About Lukos Lukos has been delivering professional services to the Federal Government for 15 years. We help a variety of federal agencies in areas such as national security, homeland security, international development, training, analytics, healthcare, and other professional services. Since our founding, we have grown to support all military services and multiple federal civilian agencies. About Our Name: Lukos is ancient Greek for “wolf”. The characteristics of the wolf match our approach to national security. The wolf is known for cunning, aggression, patience, and teamwork. An individual wolf is smart, strong, and resilient, but the true strength of wolves is their ability to work together as a wolfpack. Kipling said it best in The Law of the Jungle. "For the strength of the pack is the wolf, and the strength of the wolf is the pack." At Lukos we take care of our pack by offering full time employees competitive benefits to include: medical, dental, vision, 401(k), life insurance, short and long term disability coverage, paid time off and Federal holidays.
Lukos is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, disability, or national origin.
Claims Specialist
Claim processor job in Florida
Who We Are
With a comprehensive lineup of Vehicle Protection plans, Sonsio offers industry-leading programs that cover Tire Road Hazard Protection, Appearance, Parts & Labor Warranties, Mechanical Advisory, and other critical consumer services. These benefits provide vehicle owners with affordable and valuable coverages to keep their vehicles on the road safely, and also maximize the resale value by keeping the appearance of their vehicles like-new.
Sonsio Vehicle Protection is committed to innovation and excellent customer service. Since our inception in 1984, Sonsio has been a leader in the automotive industry-serving more than 74,000 dealerships, F&I service providers, manufacturers, insurance companies, parts suppliers, retail chains, and many independent retailers across all 50 states, Canada, and Puerto Rico.
We understand the challenges and complexities that our partners face when it comes to offering vehicle protection plans. There is no one-size-fits-all. Every business we help is different and has their own set of challenges. That's why, when you partner with Sonsio, we work with you to provide a custom solution designed to improve customer acquisition and retention and increase profitability.
And when it comes to managing claims, you don't have the time or resources to worry about the headaches. Sonsio provides end-to-end support and decades of expertise to give customers the highest quality services with a world-class customer experience.
Base Pay Range:
$18-$19/HR
As a Claims Adjuster, Tire Operations, L1, your essential job functions will include the following:
Claims Adjuster, Tire Operations, L1 Responsibilities
To have thorough knowledge of all service agreement (terms and conditions), claims guidelines and updating\settlement claim procedures. Standard: Quality Assurance scores above 90% with at least half having a 100% score.
In a timely manner and accurately process each claim you are in. This is to be done by following through each step of a claim. Standard: From audits to have no more than 2% in errors.
Handle all claim inquiries from customers and repair facilities. Notes must have as much detail as possible including, who you talked with, complete description of the failure, location of the failed component, and any other information that would be needed in a claim. Standard: Level 1 claims adjuster standard for calls is minimum of 55 calls each day. All claims adjusters should be on the phone 80% of the time and calls should be answered within the first 45 seconds. Average length of calls at 5 1\2 minutes. Claims comment worksheet is followed for all notes.
Establish good working relationships with customers and repair facilities. Standard: No complaints from contract holders or shops.
Process all photos received on claims where damage verification is needed. Standard: Verify and document all information gathered in a timely manner.
Handle calls from specific tire programs in the claim department, this will include Dealer Tire and other level 1 calls once fully trained. Standards: Have complete understanding of all programs and be able to process claims under each program.
Attendance is a must on all scheduled days of work. Standard: Keep from calling in at a minimum-being a call center it is essential to be staffed appropriately.
Be punctual when showing up to work and coming off of breaks and lunches. Standard: Be ready to take phone calls at the start of scheduled shifts.
Update claims throughout the day when call volume is low. Standard: Update a minimum of 7 claims per day while waiting for a call.
Seeks additional work when assigned work is completed.
Other Duties as Assigned
This position is targeted to be closed on:
Why Sonsio: An amazing opportunity to join a growing organization, built on the efforts of hard working, innovative, and team-oriented people. The compensation offered for this position will depend on qualifications, experience, and geographic location. The total compensation package may also include commission, bonus or profit sharing. We offer a competitive & comprehensive benefit package including: paid time off, medical, dental, vision, and 401k match (50% on the dollar up to 7% of employee contribution). For more information on our benefit offerings, please visit our Dealer Tire Family of Companies Benefits Highlights Booklet.
EOE Statement: Sonsio is an Equal Employment Opportunity (EEO) employer and does not discriminate on the basis of race, color, national origin, religion, gender, age, veteran status, political affiliation, sexual orientation, marital status or disability (in compliance with the Americans with Disabilities Act*), or any other legally protected status, with respect to employment opportunities.
*ADA Disclosure: Any candidate who feels that they may need an accommodation to complete this application, or any portions of same, based on the impact of a disability should contact Sonsio's Human Resources Department to discuss your specific needs. Please feel free to contact us at ************** x6550.
Auto-ApplyClaim Specialist
Claim processor job in Lake Mary, FL
Business Claim Specialist Visa GC/Citizen Division Pharmaceutical Pay $16.00/hr. Contract 5 Month Timings Mon - Fri between 9.00AM - 6.00PM The primary function/purpose of this job. Verify member submitted claims forms, member's eligibility and pharmacy information is complete and accurate, updating system information as needed. Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency. Moderate knowledge of drugs and drug terminology used daily. Process claims according to client specific guidelines while identifying claims requiring exception handling. Navigate daily through several platforms to research and accurately finalize claim submissions. Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues. Adhere to strict HIPAA regulations especially when communicating to others outside the client. Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met. Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing. Analyze claims for potential fraud by member or pharmacy. May be required to work on special projects for claims team.
ESSENTIAL FUNCTIONS:
The 6-10 major responsibility areas of the job. Weight: (%)
(Total = 100%)
1. Manage member and client expectations related to claim reimbursements. Input claim requests into adjudication platform maintaining compliance to performance guarantees, HIPAA guidelines and service standards, which include production and accuracy standards. Processing according to client guidelines making exceptions upon member appeal and client approval. Recognize and escalate appropriate system crises/problems and fraudulent claims to management. 40 %
2. Identify claims requiring additional research, navigate through appropriate system platforms to perform research and resolve issue or forward as appropriate 15 %
3. Research to define values for missing information not submitted with claim but required for processing. Identify drug form, type and strength to manually determine correct NDC number value which will allow claim to process. Continue researching values if system editing does not accept original assigned value. Utilize anchor platform, internet resources and/or contacting retail pharmacist as resources for missing values. 15 %
4. Initiate correspondence to members, pharmacies or other internal departments for missing information, claim denials or other claim issues. 15 %
5. Evaluate claim submission, ensure all required information is present and determine what action should be taken. Confirm patient eligibility and verify patient information matches system. Update member's address to match claim form if necessary. 5 %
6. Identify exception handling and process per client requirements. Monitor system to ensure client specific documentation related to claims processing and benefits is current and system editing is operating appropriately. 5 %
7. Variety of other miscellaneous duties as assigned 5 %
SCOPE OF JOB
Provide quantitative data reflecting the scope and impact of the job - such as budget managed, sales/revenues, profit, clients served, adjusted scripts, etc.
Maintain an average of 30 Commercial claims per hour (cph) or 35 Work Comp claims per hour (cph).
Qualifications
Formal Education and/or Training:
High school diploma or equivalent required, some college or technical training preferred
Years of Experience:
Two years' experience in P.B.M. environment is helpful but not required.
Computer or Other Skills:
Strong data entry, 10-key skills, general PC skills and MS Office experience
Knowledge and Abilities:
• Strong data entry and 10-key skills
• Retail pharmacy, customer service experience helpful but not required
• PC and MS Office literate
• Strong attention to detail
• Excellent retention and judgment ability
• Proficient written and oral communication skills
• Ability to work in fast-paced, production environment
• Reliable, self-motivated with excellent attendance
• Team player who has the ability to stay on task with little supervision
Additional Information
Thanks & Regards,
Ranadheer Murari
|
Recruitment Executive
|
Mindlance, Inc.
|
W
:
************
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Easy ApplyClaims Specialist
Claim processor job in Boca Raton, FL
Job Description
Join our dynamic team at Quadrant Health Group! Quadrant Billing Solutions, a proud member of the Quadrant Health Group, is seeking a passionate and dedicated Claims Specialist to join our growing team. You will play a vital role focused on ensuring that healthcare services are delivered efficiently and effectively.
Why Join Quadrant Health Group?
Competitive salary commensurate with experience.
Comprehensive benefits package, including medical, dental, and vision insurance.
Paid time off, sick time and holidays.
Opportunities for professional development and growth.
A supportive and collaborative work environment.
A chance to make a meaningful impact on the lives of our clients.
Compensation: $18 - $24 per hour - Full-time
What You'll Do:
The ideal candidate is organized, persistent, and results-driven, with deep knowledge of out-of-network billing for Substance Use Disorder (SUD) and Mental Health (MH) services. You'll join a high-performing team focused on maximizing collections, reducing aging A/R, and ensuring every dollar is pursued.
Major Tasks, Duties and Responsibilities:
Proactively follow up on unpaid and underpaid claims for Detox, Residential, PHP, and IOP levels of care.
Manage 500-700 claims per week, prioritizing efficiency and accuracy.
Handle 4-5 hours of phone time per day with strong communication skills.
Communicate with payers via phone, portals, and written correspondence to resolve billing issues.
Identify trends in denials and underpayments and escalate systemic issues.
Dispute and overturn wrongly denied claims.
Update and track claims using CMD (CollaborateMD) and internal task systems.
Follow QBS workflows using Google Drive, Docs, Sheets, and Kipu EMR.
Maintain professional and timely communication with internal teams and facility partners.
Bonus Experience (Not Required):
Handling refund requests and appeals.
Preparing and submitting level 1-3 appeals (e.g., medical necessity, low pay, timely filing).
Gathering and submitting medical records for appeal support.
Working with utilization review (UR) or clinical teams.
Familiarity with ASAM and MCG medical necessity criteria.
Exposure to payment posting, authorization reviews, or credentialing.
What You'll Bring:
Minimum 1 year of SUD/MH billing and claims follow-up experience (required).
High School Diploma or equivalent, associate or bachelor's degree (preferred).
Strong understanding of insurance verification, EOBs, and RCM workflows.
Familiarity with major payers: BCBS, Cigna, Aetna, UHC, Optum, TriWest.
Experience overturning insurance denials is a strong plus.
Proficient in CMD (CollaborateMD) and Kipu EMR (strongly preferred).
Excellent written and verbal communication skills.
Highly organized, detail-oriented, and capable of managing multiple priorities.
Why Join Quadrant Billing Solutions?
Rapid career growth in a mission-driven, niche billing company.
Collaborate with clinical and billing experts who understand behavioral health.
Join a tight-knit, supportive team culture.
Gain opportunities for leadership advancement as the company scales.
Inside Claims Rep-Pace, FL
Claim processor job in Pace, FL
This job is with Florida Farm Bureau which is the Florida state office for Southern Farm Bureau Casualty Insurance Company, and we currently have an opening for an Inside Claims Representative to work in Pace, FL. This position is responsible for resolving damage and injury claims caused by or incurred by insureds. Starting salary of $54,800. We offer many benefits including health, dental, vision, PTO, Extended Illness Leave, Pension and matching 401K.
ESSENTIAL DUTIES AND RESPONSIBILITES: Include the following. Other duties may be assigned.
Investigate, validate, evaluate, negotiate, and settle all claims as assigned.
Maintain claim files and follow departmental reporting procedures.
Submit reserve recommendations on assigned claims.
Communicate with customers and other Claims personnel regarding procedures, problems, and coverages.
Enroll in training and continuing education courses when and where required.
Negotiate fair settlements with individual claimants or attorneys.
Report risk reviews to Underwriting Department.
Regular and predictable attendance is required.
EDUCATION and/or EXPERIENCE:
Bachelor's degree from four-year college or university
Obtain Adjuster's license in 6 months
SKILLS/ABILITY
Strong Verbal communication & listening skills
Effective negotiation skills
Effective conflict management skills
Ability to simultaneously handle multiple priorities
Possesses strong product knowledge
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally required to sit at a desk or table with some walking, standing, bending, stooping or carrying of light objects. The employee frequently is required to perform continuous operations of personal computer for four hours or more and use their hands to finger, handle, or feel objects, tools, or controls; and talk or hear. Specific vision abilities required by this job include close vision.
Claims Specialist
Claim processor job in Lake Mary, FL
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Description
Kelly Services is currently seeking several Claims Specialist for our client's Lake Mary, FL location.
In addition to working with the world's most recognized and trusted name in staffing, Kelly employees can expect:
Competitive pay
Paid holidays
Year-end bonus program
Recognition and incentive programs
Access to continuing education via the Kelly Learning Center
Pay $15 - $16 per hour
Schedule: Monday through Friday - 9:00am - 6:00pm
Duration: 4 months possible extension (Possible temp - perm)
Anticipated start date: 10/31/2016 to 03/31/2017
SUMMARY
Responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved.
MAJOR JOB DUTIES AND RESPONSIBILITIES
Verify member submitted claims forms, member's eligibility and pharmacy information is complete and accurate, updating system information as needed.
Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency.
Moderate knowledge of drugs and drug terminology used daily.
Process claims according to client specific guidelines while identifying claims requiring exception handling.
Navigate daily through several platforms to research and accurately finalize claim submissions.
Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues.
Adhere to strict HIPAA regulations especially when communicating to others outside
Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met.
Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing.
Analyze claims for potential fraud by member or pharmacy.
May be required to work on special projects for claims team.
EDUCATION/EXPERIENCE
High School Diploma or GED Required
1-3 years of Call Center and Reimbursement experience required
Knowledge of completed benefits verifications, submitted test claims, completed or reviewed prior authorizations required
Strong data entry and 10-key skills
Proficient in MS Word and Excel
Additional Information
Why Kelly?
As a Kelly Services candidate you will have access to numerous perks, including:
Exposure to a variety of career opportunities as a result of our expansive network of client companies
Career guides, information and tools to help you successfully position yourself throughout every stage of your career
Access to more than 3,000 online training courses through our Kelly Learning Center
Group-rate insurance options available immediately upon hire*
Weekly pay and service bonus plans
Claims Specialist
Claim processor job in Clearwater, FL
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Job Description
Assesses insurance reimbursement for individual supplies to ensure maximum reimbursement
Verifies that all appropriate supporting documentation are obtained prior to shipment and/or prior to billing
Audits configuration of supplies based on supporting documentation, formulary requirements and manufacturer compatibility
Qualifications
High school diploma or GED equivalent
Minimum of two years of medical billing/collections/claims experience necessary.
Must be knowledgeable of reimbursement processes and procedures.
Ability to work with other employees and provide assistance as needed
Proficient in basic PC skills (MS Office)
Additional Information
Shift:
8-5
Monday-Friday
Advantages of this Opportunity:
Competitive salary $15-$16, based on experience
Growth potential
Excellent benefits offered: Medical, Dental, Vision, 401k and PTOFun
Positive work environment