Claim processor jobs in Miami, FL

Founded in 2003, Kanner & Pintaluga is a NLJ500 and Mid-Market Pro 50 law firm that has recovered over $1 billion for property damage and personal injury clients nationwide. With nearly 100 lawyers and more than 30 offices throughout the Central and Southeastern United States, our primary goal is to achieve the most favorable outcome for our clients, who have the absolute right to receive the maximum compensation for their damages. POSITION SUMMARY: The Claims Processor is responsible for handling insurance claims, obtaining and verifying information, corresponding with insurance agents and beneficiaries, and promptly sending Letters of Representation for the case to begin its process. ESSENTIAL JOB FUNCTIONS: Open claims with insurance companies. Handle incoming and outgoing calls as well as faxes. Perform general data entry tasks. Verify the information for accuracy. Perform other related duties as assigned. EXPERIENCE/REQUIREMENTS: Full-time, 8:00 am to 5:00 pm, M-F. High school/GED diploma required. Strong customer service skills and experience. Proficient with Microsoft Office programs (Word, Excel, and Outlook). Ability to manage a heavy workload in a fast-paced environment. Ability to communicate with clients and co-workers effectively and efficiently. Possess excellent organizational skills and the ability to multitask and prioritize workload. FIRM BENEFITS The Firm offers a competitive benefits package for our full-time employees and their families. Here is a summary of our benefits (the list is not all-inclusive): Competitive Wage Paid Time Off, Holiday, Bereavement, and Sick Time 401K Retirement Savings Plan with Firm match Group Medical/Dental/Vision Plans Employer-Covered Supplemental Benefits Voluntary Supplemental Benefits Annual Performance Reviews Equal Opportunity Statement Kanner & Pintaluga is an Equal Opportunity Employer. Kanner & Pintaluga retains the right to change, assign, or reassign duties and responsibilities to this position at any time - in its sole discretion. Employment is at will. E-Verify This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the I-9 Form.

IntegratedResources, Inc is a premier staffing firm recognized as one of the tri-statesmost well-respected professional specialty firms. IRI has built its reputationon excellent service and integrity since its inception in 1996. Our missioncenters on delivering only the best quality talent, the first time and everytime. We provide quality resources in four specialty areas: InformationTechnology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Description Job Title: Claims Analyst III Duration: 3 Months Location: Doral, Florida Qualifications Responsibilities: This department handles claim provider complaints. Review of claims that have already been processed by the system. The suppliers are complaining about issues with the previously processed claims. Will be identifying root causes, necessary correction of root causes and provide feedback to providers. Will be utilizing Microsoft Excel heavily. *A minimum of 1-2 years' experience in claims processing with professionals or hospitals* Top 3 skills: Computer skills - Microsoft Excel (intermediate to advanced skills, i.e.: pivot tables, v-look ups) Attention to detail Strong written communication skills Must Haves: Claims background Knowledge of billing guidelines Knowledge of contract interpretation Knowledge of billing/coding - CPT & ICD-10 Additional Information Kind Regards, Arnab Ghatak Technical Recruiter Integrated Resources, Inc. IT Life Sciences Allied Healthcare CRO Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I Gold Seal JCAHO Certified ™ for Health Care Staffing “INC 5000's FASTEST GROWING, PRIVATELY HELD COMPANIES” (8th Year in a Row)

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 ********************

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 is a requirement (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

We are seeking a highly motivated individual to join our Company as a Claims Analyst based in Miami. The candidate will have multiple claims responsibilities such as supporting the effective management, analysis, and resolution of claims, ensuring accurate processing and timely communication between clients, reinsurers, and external providers (adjusters, engineers, surveyors, attorneys, etc.) The role involves detailed data analysis, documentation review, and coordination across departments to maintain the integrity and efficiency of the claims process across multiple lines of business. The Role Claims Administration & Reporting * Receive, register, and review incoming claim notifications. * Prepare claim summaries, bordereaux, and loss advices for reinsurers and internal use. * Monitor the progress of claims, coordinate settlements, follow up on recoveries, and reconcile balances with Accounts and Settlements team. * Ensure accurate and timely entry of claims data into the claims management system. Analysis & Processing * Perform analytical reviews of claims data to identify trends and analyze portfolio-level loss for Management review and escalation. * Identify and flag potential coverage issues, ambiguities, or emerging challenges. * Analyze policy coverage of multiple lines including but not limited to Property, Marine, Casualty, and Financial Lines in various LatAm jurisdictions and the Caribbean. * Support the preparation of claims reports and presentations for internal and external stakeholders. Liaison * Communicate with clients, reinsurers, and external providers to resolve queries and obtain required documentation. * Assist in negotiating and securing claim settlements from reinsurers. * Maintain strong professional relationships with key parties to facilitate efficient claims resolution. Compliance & Quality Assurance * Ensure adherence to internal policies, market regulations, and reinsurance contract terms. * Maintain knowledge of coverage wordings, legal and compliance requirements, and industry claim practices. * Support internal audits and compliance checks by providing documentation and responding to inquiries. * Contribute to continuous improvement initiatives within the local and regional claims team to enhance efficiency and accuracy Qualifications The Requirements Essential: * Bachelor's degree in Risk Management, Finance, Business, Economics or a related discipline. * 5-year experience in an insurance or reinsurance environment, ideally within a broker or (re)insurer claims setting. * Knowledge of multiple lines (as detailed above). Experience in Financial Lines is a plus. * Strong understanding of insurance and reinsurance structures. * Excellent analytical, numerical, and problem-solving skills. * High attention to detail with strong organizational skills. * Proficiency in MS Office (Word, Excel) is required. * Bilingual, English and Spanish required. Desirable: * Engagement or progress toward a professional insurance qualification (e.g., CPCU, Are, AIC). Key Competencies * Analytical thinking and accuracy * Client advocacy and relationship management * Initiative and attention to detail * Time management and prioritization * Collaboration and teamwork * Adaptability in a fast-paced environment Company Benefits WTW provides a competitive benefit package which includes the following (eligibility requirements apply): * Health and Welfare Benefits: Medical (including prescription coverage), Dental, Vision, Health Savings Account, Commuter Account, Health Care and Dependent Care Flexible Spending Accounts, Group Accident, Group Critical Illness, Life Insurance, AD&D, Group Legal, Identify Theft Protection, Wellbeing Program and Work/Life Resources (including Employee Assistance Program) * Leave Benefits: Paid Holidays, Annual Paid Time Off (includes paid state/local paid leave where required), Short-Term Disability, Long-Term Disability, Other Leaves (e.g., Bereavement, FMLA, ADA, Jury Duty, Military Leave, and Parental and Adoption Leave), Paid Time Off * Retirement Benefits: Contributory Pension Plan and Savings Plan (401k). All Level 38 and more senior roles may also be eligible for non-qualified Deferred Compensation and Deferred Savings Plans. Pursuant to the San Francisco Fair Chance Ordinance and Los Angeles County Fair Chance Ordinance for Employers, we will consider for employment qualified applicants with arrest and conviction records. EOE, including disability/vets

We are seeking a highly motivated individual to join our Company as a Claims Analyst based in Miami. The candidate will have multiple claims responsibilities such as supporting the effective management, analysis, and resolution of claims, ensuring accurate processing and timely communication between clients, reinsurers, and external providers (adjusters, engineers, surveyors, attorneys, etc.) The role involves detailed data analysis, documentation review, and coordination across departments to maintain the integrity and efficiency of the claims process across multiple lines of business. The Role Claims Administration & Reporting Receive, register, and review incoming claim notifications. Prepare claim summaries, bordereaux, and loss advices for reinsurers and internal use. Monitor the progress of claims, coordinate settlements, follow up on recoveries, and reconcile balances with Accounts and Settlements team. Ensure accurate and timely entry of claims data into the claims management system. Analysis & Processing Perform analytical reviews of claims data to identify trends and analyze portfolio-level loss for Management review and escalation. Identify and flag potential coverage issues, ambiguities, or emerging challenges. Analyze policy coverage of multiple lines including but not limited to Property, Marine, Casualty, and Financial Lines in various LatAm jurisdictions and the Caribbean. Support the preparation of claims reports and presentations for internal and external stakeholders. Liaison Communicate with clients, reinsurers, and external providers to resolve queries and obtain required documentation. Assist in negotiating and securing claim settlements from reinsurers. Maintain strong professional relationships with key parties to facilitate efficient claims resolution. Compliance & Quality Assurance Ensure adherence to internal policies, market regulations, and reinsurance contract terms. Maintain knowledge of coverage wordings, legal and compliance requirements, and industry claim practices. Support internal audits and compliance checks by providing documentation and responding to inquiries. Contribute to continuous improvement initiatives within the local and regional claims team to enhance efficiency and accuracy The Requirements Essential: Bachelor's degree in Risk Management, Finance, Business, Economics or a related discipline. 5-year experience in an insurance or reinsurance environment, ideally within a broker or (re)insurer claims setting. Knowledge of multiple lines (as detailed above). Experience in Financial Lines is a plus. Strong understanding of insurance and reinsurance structures. Excellent analytical, numerical, and problem-solving skills. High attention to detail with strong organizational skills. Proficiency in MS Office (Word, Excel) is required. Bilingual, English and Spanish required. Desirable: Engagement or progress toward a professional insurance qualification (e.g., CPCU, Are, AIC). Key Competencies Analytical thinking and accuracy Client advocacy and relationship management Initiative and attention to detail Time management and prioritization Collaboration and teamwork Adaptability in a fast-paced environment Company Benefits WTW provides a competitive benefit package which includes the following (eligibility requirements apply): Health and Welfare Benefits: Medical (including prescription coverage), Dental, Vision, Health Savings Account, Commuter Account, Health Care and Dependent Care Flexible Spending Accounts, Group Accident, Group Critical Illness, Life Insurance, AD&D, Group Legal, Identify Theft Protection, Wellbeing Program and Work/Life Resources (including Employee Assistance Program) Leave Benefits: Paid Holidays, Annual Paid Time Off (includes paid state/local paid leave where required), Short-Term Disability, Long-Term Disability, Other Leaves (e.g., Bereavement, FMLA, ADA, Jury Duty, Military Leave, and Parental and Adoption Leave), Paid Time Off Retirement Benefits: Contributory Pension Plan and Savings Plan (401k). All Level 38 and more senior roles may also be eligible for non-qualified Deferred Compensation and Deferred Savings Plans. Pursuant to the San Francisco Fair Chance Ordinance and Los Angeles County Fair Chance Ordinance for Employers, we will consider for employment qualified applicants with arrest and conviction records. EOE, including disability/vets

Job Description Job Type: Contract Workplace Type: Hybrid (50% remote, 50% fieldwork) Compensation: $25/hr plus $.50/mi Phoenix Loss Control (PLC) is a US-based business services provider in the cable, telecom, and utilities sector. PLC's core service is outside plant damage investigation, recovery, and prevention. Across the US and parts of Canada, we help our clients recover the costs of third-party damage to their infrastructure, such as underground fiber optic or gas lines. PLC currently employs over 140 people, servicing some of the largest cable and telecoms operators (e.g., Comcast, Spectrum, AT&T, and Google). PLC is currently aggressively expanding its business and looking for talented and energetic people to bring onboard to help drive growth. POSITION SUMMARY Outside Plant Damage (OPD) costs our clients over 30 million annually. Field investigators are needed to collect, access, and report these damages. This is a part-time, on-call contract job to help support our clients with damage recovery. For our field investigators, each day and every investigation is different. We need inquisitive, self-driven individuals who are comfortable rolling up their sleeves and working in a constantly changing, dynamic environment. Duties Conduct on-site field investigations Write detailed but concise investigation reports using diverse sources of information, types of evidence, witness statements, and costing estimates Develop and maintain comprehensive knowledge of local and state statutes, laws, and regulations for underground and aerial cables and utility service lines Remain prepared and willing to respond to damage calls within a timely manner Complete damage investigations within 7 days and then work with and support our claims managers to complete the investigation and begin the recovery process Respond to damages same day if received during business hours (if not, first response following day) Accurately record all time, mileage, and other associated specific items Requirements Interpersonal skills to gather information and conduct field interviews with involved parties including contractors and technicians, witnesses, law enforcement, and possible damagers Smartphone to gather photos, videos, and other information while conducting investigations Computer, with high-speed internet access, to upload and download reports, research cases, and to interact with our claims system and other databases and portals Exceptional attention to detail and strong written and verbal communication skills Proven ability to operate independently and prioritize while adhering to timelines Strong and objective analytical skills Valid driver's license, current insurance, and reliable vehicle with ability to respond to damages at any time Safety vest, work boots, and hard-hat Preferred Qualifications and Skills Current or previous telecommunication or utility experience Knowledge of underground utility locating procedures and systems Investigation, inspection, or claims/field adjusting Criminal justice, legal, or military training or work experience Engineering, infrastructure construction, or maintenance background Remote location determined at discretion of investigations manager This is a contract position. There are no benefits offered with this position.

Job Description << PHARMACY TECHNICIAN/MEDICAL PROCESSOR NEEDED FOR MEDICAL PRACTICE >> We are searching for TOP TALENT! NuLife Institute is Miami's premier medical facility for Functional, Integrative Medicine and Age Management. It is the only facility of its kind to provide personalized non-surgical age reversing treatment plans custom-tailored to your body, using your very own Internal Blueprint™. We are searching for a driven and customer service oriented Medical Processor/Pharmacy Technician to process medication treatment programs to help drive our patient retention and practice operations success. This person plays a critical role in ensuring that patients receive the correct medications safely and efficiently, making their skills and attention to detail indispensable to any team. This role will may become a hybrid role in the future with working from locations and home once candidate is able to work autonomous. Daily Responsibilities and Required Skills Daily Responsibilities: Reviewing incoming Patient Program Orders: Reviewing and crossing checking doctor's orders line up with medication to be sold and dispensed. Reviewing and taking payment. Medication Preparation and Dispensing: Accurately measure, count, and label medications as prescribed in compliance with state and federal regulations. Prescription Processing: Receive and verify prescriptions from patients within patient programs and/or our healthcare provider notes. Input prescription information into the pharmacy system. Pharmacy Interaction: Review Invoices Direct connection with pharmacies for orders, pricing and ongoing issues. Inventory Management: Maintain stock levels and organize inventory. Check for expired medications and dispose of them appropriately. Compliance and Record-Keeping: Ensure all prescriptions meet regulatory standards. Ensure compliance with State and Federal regulations and company policies and procedures that ensure the safety, security and privacy of the staff and its customers. Individual provides support and guidance to staff in processing medical programs efficiently and effectively. Requirements Required Skills: Math Skills: Proficiency in basic arithmetic for measuring, weighing, and calculating dosages. Ability to interpret and calculate proportions for compounding medications. Attention to Detail: Double-checking prescriptions to prevent errors. Ensuring labels, dosages, and patient information are accurate. Organization: Keeping the workspace tidy and medications properly sorted. Managing multiple tasks efficiently in a fast-paced environment. Communication: Effectively interacting with staff and healthcare providers. Promoting excellent customer service to ensure patient satisfaction from team members, including troubleshooting challenges, and if necessary, developing processes to circumvent possible recurrences. Explaining instructions clearly and professionally. Technical Proficiency: Ability to adapt to new online systems. Problem-Solving: Resolving issues or prescription discrepancies quickly. Addressing customer inquiries and concerns empathetically. Compliance Awareness: Understanding of federal and state regulations regarding controlled substances and prescription medications. Adherence to HIPAA and patient privacy laws. QUALIFICATIONS/REQUIREMENTS General Computer knowledge and Experience (Word, Excel) Prior Experience with Electronic Medical Records (EMR) or CRM System (ie. Salesforce) Strong organizational skills are imperative Ability to be self-directed and a self-starter Highly strategic, creative and process oriented thinker Proven ability to resolve conflicts and discrepancies Excellent customer service and communication skills. Experience working with prescriptions, healthcare, or customer-facing roles (preferred) Proficient in understanding and mastering workflow and system processes Knowledge of HIPAA OSHA, and other federal, state, and local regulations Knowledge of maintaining medical supply inventory for medical office Ability to communicate professionally with Medical Team, Administrative Team, distributors/supplies, Pharmacy Representatives, patients and guests Benefits Retirement Plan 401(k) [Matching] Health Insurance Medical Dental Vision (PTO) Paid Time Off

We are seeking a Claims Auditor to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. About the Role: The Claims Auditor plays a critical role in ensuring the accuracy, compliance, and integrity of health care claims within the organization. This position involves conducting thorough audits of submitted claims to verify adherence to regulatory standards, contractual obligations, and internal policies. The auditor will identify discrepancies, potential fraud, and areas for process improvement, thereby safeguarding the organization's financial health and reputation. By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors. Ultimately, this role supports the delivery of efficient and ethical health care services by maintaining transparent and accountable claims operations. Minimum Qualifications: Bachelor's degree in Accounting, Finance, Health Administration, or a related field. At least 2 years of experience in claims auditing, health care compliance, or a similar role within the health care industry. Strong knowledge of health care claims processes, insurance billing, and regulatory requirements such as HIPAA and CMS guidelines. Proficiency in audit software and Microsoft Office Suite, particularly Excel for data analysis. Relevant experience may substitute for the educational requirement on a year-for-year basis. Preferred Qualifications: Master's degree in Accounting, Finance, Health Administration, or a related field. Certification such as Certified Internal Auditor (CIA), Certified Professional Coder (CPC), or Certified Healthcare Auditor (CHA). Experience with electronic health records (EHR) systems and claims management software. Familiarity with fraud detection techniques and health care fraud prevention programs. Advanced training or coursework in health care law, compliance, or risk management. Demonstrated ability to lead audit projects or mentor junior auditors. Responsibilities: Conduct detailed audits of healthcare claims to ensure accuracy, compliance with regulations, and adherence to organizational policies. Analyze claim data and documentation to identify errors, inconsistencies, or potential fraud. Prepare comprehensive audit reports with findings, recommendations, and corrective actions for management and stakeholders. Collaborate with claims teams and healthcare providers to resolve discrepancies and drive process improvements. Stay updated on healthcare regulations and industry best practices, while supporting internal and external audits with relevant documentation and insights.

Reports to: Claims Supervisor Employment Status: Full-Time FLSA Status: Non-Exempt Job Summary: We are searching for a diligent Claims Follow-Up Specialist to ensure a timely and accurate collection of medical claims. The specialist will work closely with insurance companies to rectify payment denials, settle disputes, and receive due reimbursements. The ideal candidate will possess strong communication skills, a deep understanding of medical billing and coding, and the determination to resolve outstanding claims. Duties/Responsibilities: · Reviews and works on unpaid claims, identifying and rectifying billing issues. · Communicates with insurance companies regarding any discrepancy in payments if necessary. · Conducts research and appeals denied claims timely. · Reviews Explanation of Benefits (EOBs) to determine denials or partial payment reasons. · Provides detailed notes on actions taken and next steps for unpaid claims. · Collaborates with the billing team to ensure accurate claim submission. · Maintains a comprehensive understanding of the insurance follow-up process, payer guidelines, and compliance requirements. · Resubmits claims with necessary corrections or supporting documentation when needed. · Tracks and documents trends related to denials and work towards a resolution with the billing team. · Assists patients with inquiries related to their insurance claims, providing clear and accurate information. · All other duties as assigned. Required Skills/Abilities: · Proficiency in healthcare billing software. · Strong analytical, organizational, and multitasking skills. · Excellent verbal and written communication abilities. · Ability to navigate payer websites and use online resources to resolve outstanding claims. Education and Experience: · High school diploma or equivalent required. · Experience in medical billing collections or a similar role in a Behavioral Health industry specializing in Substance abuse and Mental Health is strongly preferred. · Knowledge of medical terminology, CPT and ICD-10 coding is a plus. · Knowledge of HIPAA and other healthcare industry regulations. Benefits · Health Insurance · Vision Insurance · Dental Insurance · 401(k) plan with matching contributions View all jobs at this company View all jobs at this company

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.

Job Description Claims Coordinator Delray Beach or Palm Beach Gardens, FL (Hybrid) $21-$26 per hour + full benefits About the Opportunity A long-established Florida insurance agency with more than 100 years in business is looking for a Claims Coordinator to join its growing team. In this role, you will support clients through every stage of the claims process, ensuring claims are handled efficiently, accurately, and with care. You will work closely with the Claims Administrator, producers, and account managers to advocate on behalf of clients and provide clear, timely communication between insureds and carriers. What You'll Do · Facilitate first notice of loss and coordinate claim setup with carriers. · Maintain claim activities and documentation in EPIC. · Respond to all client and carrier inquiries within 24 hours. · Monitor open claims to ensure timely status updates and resolutions. · Advocate for clients on claim-related issues such as coverage questions, denials, or legal notices. · Communicate with the Claims Administrator, producers, and account managers to address and resolve issues. · Notify producers and account managers of significant losses or high-value claims. · Provide detailed loss runs and reports upon request. · Maintain and update a network of trusted vendors such as restoration companies and glass repair providers. · Report any coverage concerns or omissions to the appropriate team members. · Support the claims department with additional projects as needed. What You Bring · High School Diploma or GED required. · 3 to 5 years of claims or commercial/personal lines experience. · Strong organizational and communication skills. · EPIC experience preferred. · A proactive, client-focused approach with attention to detail. What You'll Get · Hourly pay between $21 and $26, depending on experience. · 100% employer-paid Medical, Dental, and Vision insurance for employees. · 401(k) with profit sharing. · Long-term stability with an agency that has been serving clients for over a century. · Supportive, team-based culture focused on client service and professional growth. If you are organized, responsive, and passionate about helping clients navigate the claims process, this role offers an excellent opportunity to grow within a respected Florida agency.

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 2025-1488482

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 2025-1488482

Job Details Corporate Office - Boca Raton, FLDescription As Accounting Clerk I, you will review claims submitted for payment processing. Assuring the accuracy of the amount requested for payment. You will also review each claim for prior payments and ensure they are correctly accounted for. Verification of the payees listed on the payment request must match with the policy documents (dec page) and signed contracts and documents which are found in the claim. You will play a key role in the verification of all payments prior to them being processed, as well as ensuring that the payees on all payments are verified. Essential Functions: Processing claims payment requests and verification of the payment coding. Review of SOL and EST against the payment request to ensure accuracy of the amount to be processed. Verify all information in the letter going out to the insured for accuracy. Review the dec page and contracts in the claim to make sure all payees are to the payment request. Make sure that vendors/Attorneys/PA's added as payees, are selected from the global list. Review potential payment variances and identify any discrepancies. Contacting claims of discrepancies, explaining these discrepancies so they can be resolved. Documenting discrepancies in the claim. Assist in resolving complex billing issues with the SA's, to timely process payment requests. Ensuring adherence to accounting processes and internal controls. Answering inquiries regarding checks (cleared or outstanding) and banking issues. Qualifications Required Education and Experience: High school diploma, some college preferred. 1-2 years of experience in accounting and/or Accounts payable or a combination of education and experience. Essential Skills: Excellent analytical, financial, and critical thinking skills. Elevated level of attention to details and accuracy. Ability to adapt to shifting priorities, effectively manage and prioritize multiple projects/tasks to meet deadlines. Understanding of accounting principles like debits and credits. Ability to perform calculations accurately. Proficient with Microsoft Office products, with Excel skills. Clear and concise communication with colleagues and outside vendors. Ability to work independently as well as within a team with a strong sense of teamwork.

Why You Should Work For Us: 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 START DATE 1/25 Daily Responsibilities: Receive and respond to all telephone or written correspondence inquiries from providers within established time frames and policies. Will be taking calls from providers about payment/reimbursement for services. First line of communication to assist providers with claims issues & will be potentially assisting with pushing claims back into consideration/adjustment. Hours for this Position: Monday through Friday Must be flexible for any of the following shifts: 8am-5pm. 9am-6pm, 10am-7pm, 11am-8pm Salary: $14-$16 an hour Advantages of this Opportunity: • Competitive salary, negotiable based on relevant experience • Benefits offered, Medical, Dental, and Vision • Fun and positive work environment Qualifications Requirements: 2+ years of claims experience is required At least 1 year customer service experience in a call center environment, High School Diploma or GED Additional Information Are you an experienced Customer Service Rep looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career as a Customer Service Rep by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! If you are interested, PLEASE reply to this job posting and CONTACT Catalina Danko at 407-478-0332 ext 141

Job Details Job Family STAFF - Support Staff Grade H9 Salary $18.71 Base Rate Department Testing Reports To Director of Testing Closing Date Open Until Filled FLSA Status Non-Exempt First Review Date July 07, 2025 The Part-Time Examiner is responsible for the coordination, administration, scoring, and interpretation of a large variety of placement, admission and certification examinations. What you will be doing * Administers and troubleshoots computer based and paper based exams * Interprets and implements testing policies and procedures * Prepares logistical paperwork for the administration of tests * Keeps accurate confidential records and ensures the integrity and security of all exams * Scores and reports test results to students and faculty * Assists student with issues related to testing * Disseminates information about tests and services provided by the department * Enters and retrieves test records * Processes scores received from other institutions as per established procedures * Gathers and reports daily testing and department data * Documents incident/irregularity reports in a concise and accurate manner * Assists with student feedback and office related job tasks * Maintains the security and integrity of test materials * Operates scanner and converts confidential documents into electronic format * Performs other duties as assigned What you need to succeed * Bachelor's degree from a regionally accredited institution and one (1) year of relevant testing or student/customer service experience or; Associate's degree from a regionally accredited institution and three (3) years of relevant testing or student/customer service experience * Knowledge and understanding of College organization, goals, and objectives, and policies and procedures * Proficiency in Microsoft Office software and specific computer programs related to area of responsibility * Possess excellent communication skills (verbal and written) * Strong customer service and problem solving skills * Ability to make sound and timely decisions * Possess superior analytical skills * Ability to work a flexible schedule to include evening and weekend assignments * Ability to work well in a multi-ethnic and multi-cultural environment with students, faculty and staff Preferences * Testing and/or Assessment experience preferred Additional Requirements The final candidate is to successfully complete a background screening and reference check process. EQUAL ACCESS/EQUAL OPPORTUNITY Miami Dade College is an equal access/equal opportunity institution which does not discriminate on the basis of sex, race, color, marital status, age, religion, national origin, disability, veteran's status, ethnicity, pregnancy, sexual orientation or genetic information. To obtain more information about the College's equal access and equal opportunity policies, procedures and practices, please contact the College's Civil Rights Compliance Officer: Cindy Lau Evans, Director, Equal Opportunity Programs/ ADA Coordinator/ Title IX Coordinator, at ************** (Voice) or 711 (Relay Service). 11011 SW 104 St., Room 1102-01; Miami, FL 33176. *********************

Job Description Founded in 2003, Kanner & Pintaluga is a NLJ500 and Mid-Market Pro 50 law firm that has recovered over $1 billion for property damage and personal injury clients nationwide. With nearly 100 lawyers and more than 30 offices throughout the Central and Southeastern United States, our primary goal is to achieve the most favorable outcome for our clients, who have the absolute right to receive the maximum compensation for their damages. POSITION SUMMARY: The Claims Processor is responsible for handling insurance claims, obtaining and verifying information, corresponding with insurance agents and beneficiaries, and promptly sending Letters of Representation for the case to begin its process. ESSENTIAL JOB FUNCTIONS: Open claims with insurance companies. Handle incoming and outgoing calls as well as faxes. Perform general data entry tasks. Verify the information for accuracy. Perform other related duties as assigned. EXPERIENCE/REQUIREMENTS: Full-time, 8:00 am to 5:00 pm, M-F. High school/GED diploma required. Strong customer service skills and experience. Proficient with Microsoft Office programs (Word, Excel, and Outlook). Ability to manage a heavy workload in a fast-paced environment. Ability to communicate with clients and co-workers effectively and efficiently. Possess excellent organizational skills and the ability to multitask and prioritize workload. FIRM BENEFITS The Firm offers a competitive benefits package for our full-time employees and their families. Here is a summary of our benefits (the list is not all-inclusive): Competitive Wage Paid Time Off, Holiday, Bereavement, and Sick Time 401K Retirement Savings Plan with Firm match Group Medical/Dental/Vision Plans Employer-Covered Supplemental Benefits Voluntary Supplemental Benefits Annual Performance Reviews Equal Opportunity Statement Kanner & Pintaluga is an Equal Opportunity Employer. Kanner & Pintaluga retains the right to change, assign, or reassign duties and responsibilities to this position at any time - in its sole discretion. Employment is at will. E-Verify This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the I-9 Form.

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.