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Claim processor jobs in Pensacola, FL

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  • Risk, Claims, and Carrier Qualification Specialist

    Patterson Companies 4.7company rating

    Claim processor job in Plant City, FL

    The Risk, Claims & Carrier Qualifications Specialist plays a critical role in protecting Patterson Companies from operational, financial, and reputational risk. This position is responsible for managing all Overages, Shortages, and Damages (OS&D), processing and resolving freight claims, qualifying and onboarding carriers, maintaining carrier insurance compliance, and overseeing organizational risk management procedures. This role ensures that Patterson Companies operate within industry regulations while building strong partnerships with carriers and safeguarding our customers' freight. Key Responsibilities Claims & OS&D Management Serve as the first point of contact for all OS&D and freight claims from shippers, carriers, and internal teams. Investigate, document, and process claims in compliance with company policies, federal regulations, and industry best practices. Communicate with carriers, customers, and internal stakeholders to resolve disputes promptly and fairly. Maintain detailed claim files, documentation, and reporting for trend analysis and process improvement. Carrier Vetting & Qualification Conduct thorough vetting of new carriers, including verifying MC/DOT authority, safety ratings, insurance coverage, and operational capabilities. Ensure carriers meet Patterson Companies' safety and compliance standards before onboarding. Monitor ongoing carrier compliance, including insurance renewals, safety performance, and regulatory changes. Manage the carrier onboarding process in collaboration with the operations team, utilizing TMS-integrated vetting tools (e.g., Highway). Insurance & Compliance Management Track and verify carrier insurance policies, ensuring timely renewals and appropriate coverage. Coordinate with carriers and insurance providers to update coverage documents in company systems. Monitor regulatory requirements and ensure company compliance with FMCSA, DOT, and other governing bodies. Organizational Risk Management Identify operational risks and recommend preventive strategies to mitigate exposure. Develop and update company policies related to risk, claims, and carrier compliance. Provide regular risk and claim trend reports to leadership to inform decision-making. Collaborate with sales, operations, and leadership to ensure contractual agreements protect company interests. Other duties as assigned Qualifications Required: Minimum 3 years of experience in transportation, logistics, risk management, or claims processing. Strong knowledge of carrier vetting, insurance requirements, OS&D processes, and freight claims procedures. Proficient in using TMS platforms and compliance monitoring tools. Excellent communication, negotiation, and problem-solving skills. Ability to manage multiple priorities and meet deadlines in a fast-paced environment. Preferred: Experience in a 3PL or freight brokerage environment. Operations experience is preferred. Familiarity with Highway, RMIS, SaferWatch, Carrier411, or equivalent compliance software. Knowledge of cargo insurance policies, Carmack Amendment, and freight claim regulations. To apply online, please visit: *********************************
    $41k-52k yearly est. 1d ago
  • Field Claims Representative

    Auto-Owners Insurance 4.3company rating

    Claim processor job in Enterprise, AL

    Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims Become familiar with insurance coverage by studying insurance policies, endorsements and forms Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary Ensure that claims payments are issued in a timely and accurate manner Handle investigations by phone, mail and on-site investigations Desired Skills & Experience Bachelor's degree or direct equivalent experience handling property and casualty claims A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims Field claims handling experience is preferred but not required Knowledge of Xactimate software is preferred but not required Above average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.
    $31k-39k yearly est. 2d ago
  • Inside Claims Examiner-P&C Homeowners Insurance

    Slide 2.8company rating

    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.
    $33k-44k yearly est. 60d+ ago
  • Claims Examiner II - Commercial Auto

    Athens Administrators 4.0company rating

    Claim processor job in Florida

    DETAILS Claims Examiner II Department: Property & Casualty Reports To: Claims Supervisor P&C FLSA Status: Exempt in all states but CA Job Grade: 11 Career Ladder Next step in progression could include Senior Claims Examiner 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 II to support our Property & Casualty department. Employees who live less than 26 miles from the Concord, CA, Orange, CA, 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. As an Inside Property and Casualty Claims Examiner II, this candidate will be responsible for the review, analysis, and process of moderate to severe commercial auto claims with an opportunity to handle Commercial Property, Inland Marine, and General Liability claims. These claims are typically moderate exposure and may entail litigation and coverage issues. The goal of the position is to ensure the delivery of quality service to customers while protecting their interests. 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: Advanced 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 advanced analytical, decision making and negotiation skills. Investigate, evaluate, and determine settlement value or denial of liability for moderate to severe level commercial auto claims Within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to management Manage the litigation process through the retention of counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment Document and manage claims (i.e.: record statements, update diaries, write reports) from inception to closure. Ensure appropriateness of all payments Coordinate and work with a vendor service such as appraiser, independent adjusting firms, contractors, social media and private investigation and various other field service vendors Facilitate between claimants, clients, brokers, and attorneys in resolution of liability claims Exchange information with clients, claimants, insurance brokers, inspectors, producers, and account managers Attend meetings and educational seminars for professional development Maintain required licenses Conduct quarterly claim reviews with the client 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 5 years of commercial auto handling experience Knowledge of tort law, civil procedure, and contract law Knowledge of auto insurance laws, codes, procedures, and liability concepts Knowledge of property and casualty insurance policies Proficiency in investigation and resolution of minor to medium level auto physical damage claims. Limited minor BI claims may be optional Negotiation skills Relies on extensive experience and judgment to plan and accomplish goals in a fast-paced environment 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
    $41k-61k yearly est. 60d+ ago
  • Multi-Line Claim Specialist- Commercial Auto

    Cannon Cochran Management 4.0company rating

    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 We can recommend jobs specifically for you! Click here to get started.
    $60k-85k yearly Auto-Apply 4d ago
  • Claims Analyst-Federal Construction

    Accura Engineering & Consulting Services 3.7company rating

    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. *******************
    $54k-77k yearly est. 8d ago
  • Patient Claims Specialist - Bilingual Only

    Modmed 4.5company rating

    Claim processor job in Boca Raton, 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.
    $78k-98k yearly est. Auto-Apply 5d ago
  • Construction Claims Specialist

    Johnson Controls Holding Company, Inc. 4.4company rating

    Claim processor job in Lake Mary, FL

    Remote Role - Live Anywhere in the United StatesBuild your best future with the Johnson Controls team As a global leader in smart, healthy and sustainable buildings, our mission is to reimagine the performance of buildings to serve people, places and the planet. Join a winning team that enables you to build your best future! Our teams are uniquely positioned to support a multitude of industries across the globe. You will have the opportunity to develop yourself through meaningful work projects and learning opportunities. We strive to provide our employees with an experience, focused on supporting their physical, financial, and emotional wellbeing. Become a member of the Johnson Controls family and thrive in an empowering company culture where your voice and ideas will be heard - your next great opportunity is just a few clicks away! What we offer Competitive salary Paid vacation/holidays/sick time Comprehensive benefits package Encouraging and collaborative team environment Dedication to safety through our Zero Harm policy JCI Employee discount programs (The Loop by Perk Spot) Check us Out: A Day in the Life of the Building of the Future ******************* ZMNrDJviY What you will do The Operations Claims Specialist is part of our Building Solutions business at Johnson Controls. Under general direction, works in concert with the Claims Consultants to ensure consistent delivery of services and assure customer expectations are being met as well as internal financial commitments. Responsible for Claim Status Reporting trend analysis along with recommendations on analysis of construction documents (i.e. certified payroll analysis, continuous improvement of process documentation, schedule collection and verification). Proactively track time horizons and claim deadlines to keep the Claims Consultants focused on client triage, recommending and implementing solutions where appropriate How you will do it Provides support for Claims Consultants and ensures completion of all phases of the Claim Identifies issues and recommends solutions to the appropriate processes. Participates in monthly Claims Status, Local Market Backlog Reviews, and Staff Meetings. Serve as Publisher and Editor of the team's affirmative and defensive claims. Initiates research and follow up on fact gathering, document retention and e-discovery. Provides feedback to Manager of Construction Claims and Claims Consultants as appropriate. Owns, maintains and ensures the integrity of the team's project data for purposes of forecasting, scheduling and staffing. Serves as the team's data historian. Prioritizes work activities based upon financial impact to desired business goals What we look for Required Bachelor's Degree in Construction Management, Business Administration, Finance, or equivalent directly related work experience plus two to three years' experience in the construction industry/contracting business performing similar contract and project management functions. Read copy or proof to detect and correct errors in spelling, punctuation, and syntax. Ability to effectively represent JCI and communicate with clients at varying levels. Demonstrated proficiency to simultaneously handle a large and diverse number of projects and issues with tact, cooperation, and persistence. Ability to prioritize work activities based upon financial impact to desired business goals. Innovative and conceptual thinker. High level of productivity and efficiency. HIRING SALARY RANGE: $85,000- 107,000(Salary to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, location and alignment with market data.) This position includes a competitive benefits package. For details, please visit the About Us tab on the Johnson Controls Careers site at ***************************************** #LI-MM1 #LI-Remote Johnson Controls International plc. is an equal employment opportunity and affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, protected veteran status, genetic information, sexual orientation, gender identity, status as a qualified individual with a disability or any other characteristic protected by law. To view more information about your equal opportunity and non-discrimination rights as a candidate, visit EEO is the Law. If you are an individual with a disability and you require an accommodation during the application process, please visit here.
    $85k-107k yearly Auto-Apply 6d ago
  • Lien & Claims Specialist

    Doodie Calls

    Claim processor job in Saint Petersburg, FL

    About us: Doodie Calls, LLC. provides sanitation services for residential, construction sites, special events and disaster relief. We believe that each staff member plays a vital role in our success, and we foster an environment of mutual respect. Our goal is to see our employees thrive and grow, as their success is our success. Whether in the field or in the office, our dispatch team, district managers, and office managers are consistently available to provide support and guidance. We believe in the power of collaboration and mutual support. Job Summary: We're seeking a detail-oriented Lien & Claims Specialist to join our team in St. Petersburg, FL. This position plays a vital role in protecting our company's financial interests by managing the lien process from start to finish, filing small claims, and ensuring all customer documentation is complete and compliant. Job Classification: Full-time non-exempt under the Fair Labor Standards Act. Location: St. Petersburg, FL Pay Range: $70,000 to $90,000, depending on experience Responsibilities: Prepare, file, and manage liens on properties through completion of the lien process. Review and execute lien releases accurately and promptly Prepare and file small claims actions when necessary Manage and track certificates of insurance (COIs) for customers Complete and maintain vendor packets and other required customer documentation Collaborate with internal teams and external partners to ensure all deadlines and compliance requirements are met Organize and maintain legal files and documents Qualifications/Requirements: Experience with the lien process from start to finish is required Knowledge of filing small claims and related procedures Background or experience in construction law or a related field is highly preferred JD or experienced paralegal preferred Strong attention to detail and excellent organizational skills Ability to manage multiple deadlines in a fast-paced environment Ability to read and understand contracts and other legal documents Strong knowledge of legal terminology and procedures Excellent research and writing skills Proficiency in Microsoft Office and legal research databases Ability to work independently and as part of a team Benefits: 401(k) & 401(k) matching Health Insurance Dental Insurance Life insurance Paid time off Vision insurance Employee Assistance Program Supplemental Plans Referral Bonus Eligibility Posting Notes: We are a veteran-friendly employer and proudly welcome applications from those who have served in the U.S. Armed Forces. We are not accepting unsolicited resumes from external recruiters or staffing agencies. We are an equal employment opportunity employer . The Company's policy is not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, veteran or uniformed service-member status, genetic information, or any other basis protected by applicable federal, state, or local laws.
    $70k-90k yearly 60d+ ago
  • Medical Coding Appeals Analyst

    Elevance Health

    Claim processor job in Tampa, FL

    Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law This position is not eligible for employment based sponsorship. Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. PRIMARY DUTIES: * Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code. * Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. * Translates medical policies into reimbursement rules. * Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits. * Coordinates research and responds to system inquiries and appeals. * Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. * Perform pre-adjudication claims reviews to ensure proper coding was used. * Prepares correspondence to providers regarding coding and fee schedule updates. * Trains customer service staff on system issues. * Works with providers contracting staff when new/modified reimbursement contracts are needed. Minimum Requirements: Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required. Preferred Skills, Capabilities and Experience: * CEMC, RHIT, CCS, CCS-P certifications preferred. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed/Certified - Other Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $38k-62k yearly est. 60d+ ago
  • Claims Specialist

    Mindlance 4.6company rating

    Claim processor job in Lake Mary, FL

    My name is Pondsy Anthony , and I am Recruiting Specialist with Mindlance Inc . I have reviewed your resume and at a first glance find it to be a good fit for a Position that we are exclusively recruiting for. We are working very closely with our Client based in FL to fill this requirement urgently. This is a 4+ months of contract position with a possible extension depending on performance. You can get back to me at ************ to discuss in detail. Job Description Job Title: Claim Specialist Client Location : 255 Technology Park, Lake Mary, FL 32746 Contract Duration : 4+ months (High possibility of Extension) ***Info about Schedules: - Candidates being selected need to be open for the contractor shift of either 9a-6p or 10a-7p or 11-8. - If contractors are hired on, they have to be available for shifts like 11a-8p and 12p-9p. Please let candidates know this! Looking for :- Candidates must have reimbursement experience that is within the past 6 months Prior authorization - submission, review, support, completion, verification Appeal - submission, review, support, completion, verification, coordination Reimbursement - investigation, verification JOB SUMMARY: 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 of Express Scripts. 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. SCOPE OF JOB Reimbursement verification of enrollments MINIMUM QUALIFICATIONS TO ENTER THE JOB: 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. 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 Qualifications • Prior authorization - submission, review, support, completion, verification • Appeal - submission, review, support, completion, verification, coordination • Reimbursement - investigation, verification Additional Information All your information will be kept confidential according to EEO guidelines.
    $37k-51k yearly est. 20h ago
  • Claims Investigator - Part-Time

    Security Director In San Diego, California

    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
    $29k-41k yearly est. Auto-Apply 10d ago
  • Claims Investigator - Experienced

    Command Investigations

    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. Powered by JazzHR WpChNsxXV1
    $29k-41k yearly est. 19d ago
  • Claims Investigator - Part-Time

    Allied Universal Compliance and Investigations

    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
    $29k-41k yearly est. 10d ago
  • Claims Specialist - General Liability (BI/PD)

    Everstory Partners

    Claim processor job in Altamonte Springs, FL

    Full-time Description Please Note: This is an in-person role based at our Altamonte Springs, FL office and handles moderate-to-complex bodily injury and property damage claims. Prior experience with BI/PD investigations, detailed analysis, evaluations, and settlements is required. Why Everstory At Everstory Partners, our mission is to create supportive spaces where individuals and families can find solace, meaning, and hope in the midst of loss. At the heart of our mission is a deep understanding of the profound and complex nature of grief. Every person's journey through loss is unique, and we are committed to providing compassionate and personalized support. We also believe that grief is not a problem to be solved or a burden to manage alone, but rather a natural and beautiful part of the human experience. Backed by our national strength and our local partners' role is to be a steady presence, a source of comfort and guidance, and a partner in celebrating the life and legacy of the person who has passed. The Impact You Will Make The Claims Specialist at Everstory will handle insurance claims for the Company, including general liability, auto and property damage claims, and assist with worker's compensation claims. The role reports to the Senior Litigation Counsel and works closely with the Legal Operations Manager. Essential Duties and Responsibilities: Investigate reported incidents to determine exposure and provide recommended action plans to manage incident or report the claim to Company's insurance carrier. Responsible for communicating with brokers and adjusters, facilitating contact with employees involved in a claim, gathering, and securing all needed information to effectively evaluate, investigate and resolve a claim. Making recommendations to members of the Everstory legal department with respect to reserves and excess authority. Responsible for evaluating claims, reviewing reserves, identifying and acting upon claims resolution opportunities within an assigned level of authority. Ensuring claims are properly documented and audited regularly. Work closely with internal counsel on General Liability claims by serving as the primary liaison between Everstory and the insurance carrier. The Claims Specialist will report incidents to the insurance carrier as directed by internal counsel and serve as the day-to-day point of contact with adjusters. Independently investigate and document claims by gathering statements, photos, and other evidence; coordinate with site operations to obtain necessary documentation; and provide detailed updates to internal counsel and Risk Management. Prepare and deliver written status reports on open General Liability claims; meet one-on-one with internal counsel to review strategy and progress; and participate in quarterly claim reviews with the insurance carrier and regular meetings with the broker. Analyze data from current incidents and claim trends to identify patterns, recommend corrective actions, and develop strategies to reduce losses and mitigate future risk exposure. Monitoring and reporting on trends in claims. The ideal candidate must have the ability and confidence to present on data, trends and recommendations to Everstory leadership team. Reviewing and evaluating claims-related expenses for reasonableness and necessity, and tracking/organizing broker and carrier invoices. Assisting with new vendor approvals by reviewing Certificates of Insurance (COI) for compliance with Everstory's coverage requirements. Providing administrative support to Legal Operations Manager on Workers' Compensation claims. Annually, working with departments to gather and secure all needed information to renew Everstory's insurance program, serving as the primary point of contact for Everstory's insurance broker. Adhering to Everstory's incident and claims reporting processes and procedures. Providing feedback and support to other departments. Requirements Bachelor's degree in a related field, such as business, finance, law, or health. 5 to 10 years of multi-line/multi-state insurance claims adjusting experience. 5+ years of experience in claims management, either with a corporate risk management department or with an insurance company. Must possess a valid Driver's License. Knowledge of property damage issues. Knowledge of relevant laws, regulations, and standards. Excellent research and communication skills. Able to handle complex claims. All-Lines License, preferred, but not required. Experience with multi-state, worker's compensation issues, including monopolistic states, preferred, but not required. Core Competencies: Compassion - Genuinely cares about people; is concerned about their work and non-work problems; is available and ready to help; is sympathetic to the plight of others not as fortunate; demonstrates real empathy with the joys and pains of others. Customer Focus - Is dedicated to meeting the expectations and requirements of internal and external customers; gets first-hand customer information and uses it for improvements in products and services; acts with customers in mind; establishes and maintains effective relationships with customers and gains their trust and respect. Ethics and Values - Adheres to appropriate (for the setting) and effective set of core values and beliefs during both good and bad times; acts in line with those values; rewards the right values and disapproves of others; practices what he/she preaches. Role Competencies: Organizing - Can marshal resources (people, funding, material, support) to get things done. Can orchestrate multiple activities at once to accomplish a goal. Uses resources effectively and efficiently. Arranges information and files in a useful manner. Functional/Technical Skills - has the functional and technical knowledge and skills to do the job at a high level of accomplishment. Problem Solving: uses rigorous logic and methods to solve difficult problems with effective solutions. Probes all fruitful sources for answer. Can see hidden problems. Excellent at honest analysis. Looks beyond the obvious and doesn't stop at the first answers. Presentation Skills - effective in a variety of formal presentation settings, one-on-one, small and large groups, with peers, direct reports, and bosses. Is effective both inside and outside the organization, on both data based and controversial topics. Commands attention and can manage group process during the presentation. Can change tactics midstream when something isn't working. Work Environment: On-Site M-F at our Altamonte Springs, FL Support Center. Our Investment in You Everstory Partners is proud to provide our employees with a quality work environment and opportunity for both personal and professional growth. As part of our ongoing commitment, we offer a competitive benefits package for our Full-Time Employees including: Medical, Dental, Vision, Life, AD&D and STD Insurance Tuition Reimbursement Career Advancement and Training Funeral and Cemetery Benefits Employee Referral Bonus 401k with Company Match Everstory Partners is an Equal Opportunity Employer and is committed to employing a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, national origin, age, sex, religion, disability, sexual orientation, marital status, military or veteran status, gender identity or expression, or any other basis protected by local, state, or federal law. The pay range for this role is based on a wide range of factors that are considered in making compensation decisions regardless of race, gender, age, religion, or any other protected characteristic. They include skill set, experience and training, licensure and certification, and other business and organizational needs. This range estimate has been adjusted for the applicable geographic differential associated with the location at which the position may be filled. Compensation decisions are dependent on the circumstances of each hire. Salary Description $80,000 - $85,000 per year
    $80k-85k yearly 49d ago
  • Claim Specialist

    Essex Mortgage 4.2company rating

    Claim processor job in Ocala, FL

    Job Details Experienced Ocala, FL (In-Office) - Ocala, FL Full TimeJob Description is fully on-site located at our Ocala, FL office. Work Schedule: Monday through Friday 8:30am - 5:00pm The Claims Specialist in Mortgage Servicing is responsible for preparing, filing, and managing claims on FHA, USDA, VA, and Conventional loans to maximize reimbursement and ensure compliance with loan guidelines. This role requires expertise in various claim types, including FHA Part A, Part B, and supplemental claims, along with loss mitigation claims such as modifications and partial claims. The Specialist will monitor critical deadlines, gather necessary documentation, and may also handle vendor coordination for REO claims and process invoices for recoverable default expenses. Core Competencies: Maintains highest level of professional behavior at all times even in stressful situations. Avoids behaviors, comments, and conversations that harm morale, productivity, customer satisfaction and teamwork. Meets confidentiality requirements related to company, customer and financial information. Communicates in writing, verbally and via email in a clear and positive way. Meets policy requirements governing communication content. Meets high-productivity requirements and constantly evaluates and prioritizes work throughout the day to meet frequent deadlines. Takes ownership of work and completes tasks projects accurately. Reviews and proofreads work thoroughly. Works well in a fast-paced team environment and communicates regularly with other team members to ensure deadlines are met. Remains up to date on best practices relevant to the position and uses work hours productively. Essential Duties: Claims Management with Leadership: Prepare and file claims on FHA, USDA, VA, and Conventional loans, demonstrating leadership by ensuring each claim meets loan-specific requirements and supports high standards in servicing. Documentation Assembly with Transparency: Collect and organize all necessary documentation for claim packages (foreclosure deeds, extensions, invoices, over-allowable approvals), maintaining transparency throughout the documentation process to ensure compliance and clarity. Expert Claims Knowledge for High Performance: Apply specialized knowledge to manage and optimize various claim types, including: Foreclosure Claims: FHA Part A and Part B, CWCOT, PFS; VA TOC, 1874; USDA; FNMA and FHLMC Initial/Final Claims; and Mortgage Insurance (MI) Claims. Loss Mitigation Claims: FHA Modifications, Partial Claims, and Special Forbearance; VA Modifications, Partial Claims, and Refunding; FNMA Modifications, Reinstatements, PIFs, and Deferments; FHLMC Modifications, Reinstatements, PIFs, and Deferments. Supplemental Claims: Manage various supplemental claims as required. Proactive Deadline Monitoring: Ensure timely submissions by monitoring critical timelines for claim filings, embodying a high-performance mindset and taking the initiative to meet all deadlines. Invoice Processing with Accountability: Review and process invoices related to default items, verifying their recoverability and compliance, reinforcing transparency and accuracy in all financial transactions. Vendor Coordination for Raving Fans: Collaborate with REO claim vendors to manage REO-related claims efficiently, fostering strong vendor relationships and enhancing service quality to create "raving fans." Data Management for Operational Excellence: Pull, review, and post claims data from loss mitigation files, ensuring data integrity and accuracy to support high-performance operations. Administrative Support and Adaptability: Complete administrative tasks and other assigned duties to contribute to the team's goals, maintaining flexibility and high performance in a dynamic servicing environment. Education and Experience Education: High School Diploma or equivalent required. Associate's or Bachelor's degree in Business, Finance, or a related field preferred. Experience: Minimum of 2 years in mortgage servicing, with a focus on claims management, foreclosure, or loss mitigation. Direct experience with FHA, VA, USDA, and Conventional loan claims is strongly preferred. Familiarity with claim processes for Part A, Part B, CWCOT, PFS, and supplemental claims is a plus. Demonstrated knowledge of invoice processing and vendor coordination in mortgage servicing, with an emphasis on recoverable default expenses. Computer and Equipment Skills Intermediate in Microsoft Office programs (Word, Excel, PowerPoint) Word processing (speed and accuracy) MSP or FICS' Mortgage Servicer a plus Email Internet software Use typical office equipment (computers, fax, phones, copiers, scanners, projectors, etc.) Physical Requirement: Vision (with or without correction) sufficient to read a computer screen and to operate office equipment Clear speaking voice on the telephone, in person, and recorded Hearing within normal ranges in noise environments typical of office Able to sit for long periods of time at computer or other work-station and in meetings Able to use computers and operate equipment Able to lift 10 pounds occasionally unassisted Work Authorization: Must be able to verify identity and employment eligibility to work in the U.S. without a visa sponsorship. EEO Statement: As part of our dedication to the diversity of our workforce, Essex Mortgage is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, national origin or ancestry, sex, gender, gender identity, gender expression, sexual orientation, age, physical or mental disability, medical condition, marital/domestic partner status, military and veteran status, genetic information or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances.
    $34k-57k yearly est. 60d+ ago
  • US Retail Markets Claims Specialist Development Program-(January, June 2026)

    Law Clerk In Cincinnati, Ohio

    Claim processor job in Lake Mary, FL

    Description Advance your career at Liberty Mutual - A Fortune 100 Company! Manages, investigates and resolves claims assigned and assists in providing service to policyholders. Responsibilities: Manages, investigates, and resolves claims. Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels. Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation. Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action. Responds to various written and telephone inquiries including status reports. Ensures adequacy of reserves. Accountable for security of financial processing of claims, as well as security information contained in claims files. Makes effective use of loss management techniques. Negotiates settlements with attorneys, claimants, and/or co-defendants. Arranges for expert inspections involving third party or potential fraud actions as needed. Updates files and provides comprehensive reports as required Qualifications Qualifications: Strong written and oral communications skills required. Good interpersonal, analytical, investigative, and negotiation skills required. Customer service experience preferred. Basic knowledge of legal liability, general insurance policy coverage and State Tort Law. Bachelor's degree is required. Ability to obtain proper licensing as required. We can recommend jobs specifically for you! Click here to get started.
    $33k-58k yearly est. Auto-Apply 6d ago
  • Construction Defect Technical Claims Specialist

    Frank Winston Crum Insurance

    Claim processor job in Clearwater, FL

    FrankCrum is a Top Workplace! Frank Winston Crum Insurance (FWCI) issues Workers' Compensation and General Liability policies by offering flexible coverage and payment options to meet the varied needs of businesses. Over the years, FWCI has grown from a single-state insurance carrier to one that is licensed in 45 states and continues to expand. In addition to regional and product line growth, FWCI has enhanced its value-added services. What has not changed though is the firm's commitment - echoed throughout the family of companies - "always to do the right things for the right reasons!" Click here to learn more about FrankCrum! The Role You'll Play to Create Success We are eager to announce a Construction Defect Technical Claims Specialist position filled with many exciting opportunities! This job contributes to the mission of FrankCrum by adjusting the most complex construction defect claims in the company's inventory and assisting in establishing the best and most cost-effective strategy for handling this claim type. Investigates, evaluates and brings to timely resolution an inventory of the most complex construction defect claims in the company's inventory of which most are litigated and may involve large projects in accordance with established claim handling standards and applicable state regulations and laws. Understands construction defect coverage issues and handles complex coverage issues related to sub-contractors, additional insured tenders by General Contractors and developers, Florida Chapter 558 process and issuing reservation of rights letters and denial of coverage letters Understands and interprets construction contracts and applies risk transfer when appropriate. Negotiates time on risk and the duty to defend and indemnify with liable insurers when appropriate. Manages litigation proactively and works well with defense counsel and insureds to reach optimal outcomes. Demonstrates a strong knowledge and utilization of resolution techniques such as high low agreements, proposals for settlement, offers of judgement to obtain optimal outcomes. Demonstrates an understanding of how to evaluate and respond timely to time limit demands, consumer complaints and Department of Insurance Complaints including Civil Remedy Notices often filed in construction defect claims. Demonstrates a strong knowledge of residential and commercial building construction, repair processes, and knows how to review and analyze the accuracy of damage reports prepared by contractors, engineers, and appraisers in order to assess property damage and construction defects damages. Demonstrates strong negotiations skills in alternative dispute resolution forums such as mediations and assists in finding early resolutions in order to obtain optimal outcomes when appropriate. Demonstrates an understanding of reserving requirements and philosophies and is able to maintain appropriate reserves on all assigned claim files. Prepares reports detailing claim status, payments and reserves. Engages in timely and effective communication with the appropriate parties and documents the claim file throughout the claim adjustment process which includes maintaining timely diaries on each claim. Effectively assists, trains and mentor's lessor skilled team members in conjunction with management. Assists managers with identifying trends and opportunities for improvement in processes and procedures and claim resolution to improve overall outcomes. Collaborates with other departments such underwriting on projects or as needed or performs other duties as assigned. The Attributes We Seek Keys to success in this position include knowledge of construction defect claims handling and of applicable insurance policies claims systems and claims handling regulations, procedures, and laws in 48 states. Bachelor's degree in a related field or equivalent experience needed, Juris Doctorate a plus. Ten (10) years of construction defect claims adjusting experience with exposure to a minimum of $100,000. Must hold Proper adjuster licenses in Florida and other states with the ability to obtain additional licenses as needed. Our Competitive Benefits Along with this great opportunity, FrankCrum also provides exceptional benefits from top carriers including: Health Insurance is zero dollar paycheck cost for employee's coverage and only two-hundred-forty-five dollars a month for family! Dental and Vision Insurance Short Term Disability and Term Life Insurance at no cost to the employee Long Term Disability and Voluntary Term Life Insurance Supplemental insurance plans such as Accidental, Critical Illness, Hospital Indemnity, Legal Services and Pet Insurance 401(k) Retirement Plan where FrankCrum matches 100% of the first 4% the employee contributes, and the employee is immediately vested in the employer match Employee Assistance Program at no cost to the employee Flexible Spending Accounts for Medical and Dependent Care Reimbursement Health Savings Account funded by FrankCrum Paid time off and holiday pay Education reimbursement PTO cash out Tickets at Work Access to the Corporate America Family Credit Union Employee and client referral bonus programs Paid volunteer time What's Special About FrankCrum FrankCrum, a family-owned business-to-business entity since 1981 made of several companies: FrankCrum Corporate (a professional employer organization), FrankCrum Staffing, Frank Winston Crum Insurance Company, and the FrankCrum Insurance Agency - all based in Clearwater, Florida. This "family of employer solutions" employs approximately 500 people who serve over 4,000 clients throughout the United States. FrankCrum employees are trained to deliver high value through exceptional customer service and treat clients and coworkers like family. By living by our Brand Pillars (Integrity, Affinity, and Prosperity) employees are recognized at quarterly events for exceptional customer service and milestones in tenure. The FrankCrum headquarters spans 14 acres and includes a cafe, subsidized for employees. Menus include made-to-order breakfast, hot lunch options and even dinners that can be ordered to-go, all at very affordable prices. The cafe also plays host to monthly birthday and anniversary celebrations, eating and costume contests, and yearly holiday parties. Through the input of its own employees, The Tampa Bay Times has recognized FrankCrum as a Top Place to Work for more than 10 years in a row! FrankCrum also supports several community efforts through Trinity Cafe, the Homeless Empowerment Program, and Clearwater Free Clinic! If you want to play this role to positively impact our clients' day-to-day business, then apply now! This job posting will remain open continuously and qualified applicants will be considered as applications are received. Pay Data As required by applicable state and/or local regulations the following pay data provides a reasonable estimate of the compensation range for this position at the time of posting. FrankCrum may ultimately pay more or less than the posted pay range due to many economic and individualized considerations. The pay offered to the selected candidate will be based on factors including, but not limited to qualifications, knowledge, licensure, skills, abilities, work experience, education, budget, training, employment trends, internal wage considerations, market dynamics, certifications, geographical location, assessments, and other business and organizational needs. The annualized pay range at the time of initial posting for this position is $105,000-$125,000. These figures represent the annualized pay for both hourly and salaried types of positions and does not indicate employment is on a yearly basis nor remove the employee's employment at-will status. FrankCrum is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and pregnancy-related conditions), gender identity or expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, genetic information, or any other characteristic protected by applicable federal, state or local laws and ordinances. Privacy Policy CA Residents
    $34k-60k yearly est. Auto-Apply 60d+ ago
  • Claims Specialist

    Partnered Staffing

    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
    $15-16 hourly 20h ago
  • Claims Specialist

    Healthcare Support Staffing

    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
    $15-16 hourly 20h ago

Learn more about claim processor jobs

How much does a claim processor earn in Pensacola, FL?

The average claim processor in Pensacola, FL earns between $24,000 and $56,000 annually. This compares to the national average claim processor range of $26,000 to $62,000.

Average claim processor salary in Pensacola, FL

$37,000
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