Claim processor jobs in Pompano Beach, FL

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

THIS ROLE IS FOR: 1571 Sawgrass Parkway, Sunrise FL The Role is 100% ON SITE Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition. Responsibilities: Provides voice to voice contact within 24 hours of first report. Conducts timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel. Investigates each claim through prompt contact with appropriate parties such as policyholders, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements. Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates the results of their efforts and findings. Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals. Utilizes evaluation documentation tools in accordance with department guidelines. Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution. Maintains and document claim file activities in accordance with established procedures. Attends depositions and mediations and all other legal proceedings, as needed. Protects organization's value by keeping information confidential. Maintains compliance with Claim Department's Best Practices. Provides quality customer service and ensures file quality Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs. Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner. Participates in special projects as assigned. Some overnight travel maybe required. Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures. Qualifications: Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree. 620 Licensure required. One to three years of experience processing claims; property and casualty segment preferred. Experience with Xactware products preferred. Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions. Proficiency with Microsoft Office products required; internet research tools preferred. Demonstrated customer service focus / superior customer service skills. Excellent communication skills and ability to interact on a professional level with internal and external personnel Results driven with strong problem solving and analytical skills. Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively. Detail-oriented and exceptionally organized Collaborative partner; ability to contribute to a positive work environment. General Information: All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc. The preceding has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Heritage Insurance Holdings, Inc. is an Equal Opportunity Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.

Job Description We are seeking a Claims Examiner to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. About the Role: The Claims Examiner plays a critical role in the health care and social assistance industry by thoroughly reviewing and evaluating insurance claims to ensure accuracy, compliance, and appropriateness of payments. This position involves analyzing medical documentation, policy details, and billing information to determine the validity of claims and identify any discrepancies or potential fraud. The Examiner collaborates with healthcare providers, insurance agents, and internal teams to resolve claim issues and facilitate timely reimbursement. By maintaining up-to-date knowledge of healthcare regulations and insurance policies, the Examiner helps protect the organization from financial loss and supports the delivery of fair and efficient claims processing. Ultimately, this role contributes to the integrity and sustainability of the healthcare insurance system by ensuring claims are processed accurately and ethically. Minimum Qualifications: High school diploma or GED Minimum of 2 years experience in claims examination, medical billing, or healthcare insurance processing. Strong understanding of medical terminology, insurance policies, and healthcare billing codes (e.g., ICD-10, CPT). Proficiency with claims management software and Microsoft Office suite. Preferred Qualifications: Associate's degree or Bachelor's degree in health administration, healthcare management, or a related discipline. Certification such as Certified Professional Coder (CPC) or Certified Claims Professional (CCP). Experience working within the health care and social assistance industry or with government healthcare programs. Familiarity with regulatory frameworks such as HIPAA and the Affordable Care Act. Responsibilities: Review and analyze health insurance claims for completeness, accuracy, and compliance with policy terms and regulatory requirements. Verify medical codes, treatment documentation, and billing information to ensure services are properly covered and billed. Investigate and resolve claim discrepancies by communicating with providers, members, and internal departments. Identify and escalate potential fraudulent claims or billing errors to compliance or legal teams. Maintain detailed records of claim evaluations and stay current with healthcare laws and industry standards to support audits and improve processing workflows.

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

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.

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

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. 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.

Job Description Join our dynamic team at Quadrant Health Group! Quadrant Billing Solutions, a proud member of the Quadrant Health Group, is seeking a passionate and dedicated Claims Specialist to join our growing team. You will play a vital role focused on ensuring that healthcare services are delivered efficiently and effectively. Why Join Quadrant Health Group? Competitive salary commensurate with experience. Comprehensive benefits package, including medical, dental, and vision insurance. Paid time off, sick time and holidays. Opportunities for professional development and growth. A supportive and collaborative work environment. A chance to make a meaningful impact on the lives of our clients. Compensation: $18 - $24 per hour - Full-time What You'll Do: The ideal candidate is organized, persistent, and results-driven, with deep knowledge of out-of-network billing for Substance Use Disorder (SUD) and Mental Health (MH) services. You'll join a high-performing team focused on maximizing collections, reducing aging A/R, and ensuring every dollar is pursued. Major Tasks, Duties and Responsibilities: Proactively follow up on unpaid and underpaid claims for Detox, Residential, PHP, and IOP levels of care. Manage 500-700 claims per week, prioritizing efficiency and accuracy. Handle 4-5 hours of phone time per day with strong communication skills. Communicate with payers via phone, portals, and written correspondence to resolve billing issues. Identify trends in denials and underpayments and escalate systemic issues. Dispute and overturn wrongly denied claims. Update and track claims using CMD (CollaborateMD) and internal task systems. Follow QBS workflows using Google Drive, Docs, Sheets, and Kipu EMR. Maintain professional and timely communication with internal teams and facility partners. Bonus Experience (Not Required): Handling refund requests and appeals. Preparing and submitting level 1-3 appeals (e.g., medical necessity, low pay, timely filing). Gathering and submitting medical records for appeal support. Working with utilization review (UR) or clinical teams. Familiarity with ASAM and MCG medical necessity criteria. Exposure to payment posting, authorization reviews, or credentialing. What You'll Bring: Minimum 1 year of SUD/MH billing and claims follow-up experience (required). High School Diploma or equivalent, associate or bachelor's degree (preferred). Strong understanding of insurance verification, EOBs, and RCM workflows. Familiarity with major payers: BCBS, Cigna, Aetna, UHC, Optum, TriWest. Experience overturning insurance denials is a strong plus. Proficient in CMD (CollaborateMD) and Kipu EMR (strongly preferred). Excellent written and verbal communication skills. Highly organized, detail-oriented, and capable of managing multiple priorities. Why Join Quadrant Billing Solutions? Rapid career growth in a mission-driven, niche billing company. Collaborate with clinical and billing experts who understand behavioral health. Join a tight-knit, supportive team culture. Gain opportunities for leadership advancement as the company scales.

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

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

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

Overview Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services. Allied Universal Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference. Job Description Allied Universal is hiring a Claims Investigator. Claim Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation. Florida applicants must either hold a C Private Investigators' License OR Independently complete the 40-hour course necessary to successfully apply for a CC Private Investigator's license (apprenticeship) before applying. Must possess a valid driver's license with at least one year of driving experience RESPONSIBILITIES: Investigate insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability Gather information independently and in collaboration with clients and case managers through various methods such as data collection, interviews, research, and scene investigations Follow guidance from the handling insurance adjuster to perform field tasks essential to the investigation Develop and document information on any investigation in a professional and expert manner by writing clear, concise, and grammatically correct reports, memos, and letters Run appropriate database indices if necessary and verify the accuracy of results found QUALIFICATIONS (MUST HAVE): Must possess one or more of the following: Bachelor's degree in Criminal Justice Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims High school diploma with a minimum of six (6) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims Ability to be properly licensed as a Private Investigator as required by the states in which you work Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course Minimum of two (2) years of demonstrated experience conducting insurance claims investigations or adjusting complex claims Working knowledge and understanding of anti-fraud laws, insurance regulations, and compliance rules and standards in their home state and within their designated region of the country Special Investigative Unit (SIU) Compliance knowledge Ability to type 40+ words per minute with minimum error Flexibility to work varied and irregular hours and days including weekends and holidays Proficient in utilizing laptop computers and cell phones PREFERRED QUALIFICATIONS (NICE TO HAVE): Military experience Law enforcement Insurance administration experience One or more of the following professional industry certifications Certified Fraud Investigator (CFE) Certified Insurance Fraud Investigator (CIFI) Fraud Claim Law Associate (FCLA) Fraud Claim Law Specialist (FCLS) Certified Protection Professional (CPP) Associate in Claims (AIC) Chartered Property Casualty Underwriter (CPCU) BENEFITS: Medical, dental, vision, basic life, AD&D, and disability insurance Enrollment in our company's 401(k)plan, subject to eligibility requirements Seven paid holidays annually, sick days available where required by law Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law. Closing Allied Universal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: *********** If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: ***********/offices. Requisition ID 2025-1488482

Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services. Allied Universal Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference. Job Description Allied Universal is hiring a Claims Investigator. Claim Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation. Florida applicants must either hold a C Private Investigators' License OR Independently complete the 40-hour course necessary to successfully apply for a CC Private Investigator's license (apprenticeship) before applying. Must possess a valid driver's license with at least one year of driving experience RESPONSIBILITIES: Investigate insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability Gather information independently and in collaboration with clients and case managers through various methods such as data collection, interviews, research, and scene investigations Follow guidance from the handling insurance adjuster to perform field tasks essential to the investigation Develop and document information on any investigation in a professional and expert manner by writing clear, concise, and grammatically correct reports, memos, and letters Run appropriate database indices if necessary and verify the accuracy of results found QUALIFICATIONS (MUST HAVE): Must possess one or more of the following: Bachelor's degree in Criminal Justice Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims High school diploma with a minimum of six (6) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims Ability to be properly licensed as a Private Investigator as required by the states in which you work Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course Minimum of two (2) years of demonstrated experience conducting insurance claims investigations or adjusting complex claims Working knowledge and understanding of anti-fraud laws, insurance regulations, and compliance rules and standards in their home state and within their designated region of the country Special Investigative Unit (SIU) Compliance knowledge Ability to type 40+ words per minute with minimum error Flexibility to work varied and irregular hours and days including weekends and holidays Proficient in utilizing laptop computers and cell phones PREFERRED QUALIFICATIONS (NICE TO HAVE): Military experience Law enforcement Insurance administration experience One or more of the following professional industry certifications Certified Fraud Investigator (CFE) Certified Insurance Fraud Investigator (CIFI) Fraud Claim Law Associate (FCLA) Fraud Claim Law Specialist (FCLS) Certified Protection Professional (CPP) Associate in Claims (AIC) Chartered Property Casualty Underwriter (CPCU) BENEFITS: Medical, dental, vision, basic life, AD&D, and disability insurance Enrollment in our company's 401(k)plan, subject to eligibility requirements Seven paid holidays annually, sick days available where required by law Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law. Closing Allied Universal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: *********** If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: ***********/offices. Requisition ID 2025-1488482

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

Job Description Job Summary/Objective: The Medical Records Specialist is responsible for managing the medical records of the facility, including preparing, storing, and retrieving patient health records. The Medical Records Specialist reviews medical records for compliance with approved policies, is responsible for their completeness, proper release and maintenance. Works independently or as part of a medical records department. Essential Job Functions Medical Records Specialists organize and maintain health information both in paper files and in electronic systems. They check data for accuracy, assign codes for insurance reimbursement, record information and keep file folders and electronic databases up to date. Prepares new patient charts, gathering documents and information from paper sources and/or electronic health record. Ensures medical records are assembled in standard order and are accurate and complete. Creates digital images of paperwork to be stored in the electronic medical record. Files lab reports, correspondence, physician dictation/notes, progress notes, radiology reports and other approved document, in charts, ensuring they are completed in an accurate and timely manner. Ensures that charts for follow-up patients, who are to have testing performed prior to their next visit, are up-to-date with the reports of the test results, and that x-rays are also available. In addition to their clerical duties, Medical Records Specialists often consult with health care professionals to make sure information is accurate. They must also follow best practices for security and patient confidentiality. Ensures files are stored in the designated area according to storage procedures. Responsible for safeguarding patient records and ensuring compliance with HIPAA standards. Ensures fulfillment of all mailed-in and faxed requests for medical records from insurance companies, managed care plans, hospitals, attorneys, patients and other physicians-when appropriate releases are provided Answers phone inquiries regarding medical records and performs other clerical functions within the team as designated by supervisor. THE COMPANY Objectives and Service Standards The Company prides itself in delivering exceptional service while always exceeding customer expectations. This begins with its employees taking assertive action and building customer relationships and brand loyalty. Employees have the ability to maintain effective and productive working relationships with fellow employees, supervisors, and clients. They demonstrate the appropriate level of written and verbal communication skills necessary to perform the job, and possess the ability to handle confidential information and think logically and practically prior to making decisions. Employees demonstrate the value and thoroughness of the work produced, as well as the accuracy, attention to detail and effectiveness of the work completed. The ability to work under pressure and learn from previous mistakes, while accurately checking processes and tasks, as well as handling issues in a timely manner are characteristic of the company's employees. As are the ability to prioritize work and the timely implementation of workable solutions to problems. Employees demonstrate thoroughness in following through on tasks and instructions in a reliable, trustworthy, and timely manner. They reveal an overall consistent attendance and adherence to work schedules, office hours, and office demands, and abide to all company policies and procedures. Supervisory Responsibility This position has no supervisory responsibilities.

Job Description Job Type: Contract Workplace Type: Hybrid (50% remote, 50% fieldwork) Compensation: $22/hr plus $.50/mi Phoenix Loss Control (PLC) is a US-based business services provider in the cable, telecom, and utilities sector. PLC's core service is outside plant damage investigation, recovery, and prevention. Across the US and parts of Canada, we help our clients recover the costs of third-party damage to their infrastructure, such as underground fiber optic or gas lines. PLC currently employs over 140 people, servicing some of the largest cable and telecoms operators (e.g., Comcast, Spectrum, AT&T, and Google). PLC is currently aggressively expanding its business and looking for talented and energetic people to bring onboard to help drive growth. POSITION SUMMARY Outside Plant Damage (OPD) costs our clients over 30 million annually. Field investigators are needed to collect, access, and report these damages. This is a part-time, on-call contract job to help support our clients with damage recovery. For our field investigators, each day and every investigation is different. We need inquisitive, self-driven individuals who are comfortable rolling up their sleeves and working in a constantly changing, dynamic environment. Duties Conduct on-site field investigations Write detailed but concise investigation reports using diverse sources of information, types of evidence, witness statements, and costing estimates Develop and maintain comprehensive knowledge of local and state statutes, laws, and regulations for underground and aerial cables and utility service lines Remain prepared and willing to respond to damage calls within a timely manner Complete damage investigations within 7 days and then work with and support our claims managers to complete the investigation and begin the recovery process Respond to damages same day if received during business hours (if not, first response following day) Accurately record all time, mileage, and other associated specific items Requirements Interpersonal skills to gather information and conduct field interviews with involved parties including contractors and technicians, witnesses, law enforcement, and possible damagers Smartphone to gather photos, videos, and other information while conducting investigations Computer, with high-speed internet access, to upload and download reports, research cases, and to interact with our claims system and other databases and portals Exceptional attention to detail and strong written and verbal communication skills Proven ability to operate independently and prioritize while adhering to timelines Strong and objective analytical skills Valid driver's license, current insurance, and reliable vehicle with ability to respond to damages at any time Safety vest, work boots, and hard-hat Preferred Qualifications and Skills Current or previous telecommunication or utility experience Knowledge of underground utility locating procedures and systems Investigation, inspection, or claims/field adjusting Criminal justice, legal, or military training or work experience Engineering, infrastructure construction, or maintenance background Remote location determined at discretion of investigations manager This is a contract position. There are no benefits offered with this position.

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 a plus (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

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

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