Claim processor jobs in Sanford, FL

DETAILS Claims Supervisor III - Property & Casualty Department: Property & Casualty Reports To: Claims Manager Property & Casualty FLSA Status: Exempt Job Grade: 16 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 Supervisor III to support our Property & Casualty department. Management that lives less than 36 miles from our local office AND have a direct report in the office, 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 lives in a state we operate in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA and WV). Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. Employees work a 37.5-hour work week. 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. The Claims Supervisor is responsible for supervising, directing, and coordinating the activities of a team handling complex liability claims within assigned authority limits and consistent with good faith handling practices. These claims are typically mid to high exposure. 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: Responsible for handling a unit of senior and complex examiners handling claims of a severe and complex nature involving bodily injury, property damage, occurrence or claims made and complex coverage. Exposures are typically valued at levels of 100K or higher Able to handle multiple coverage lines with specific concentration on high exposure Auto, GL, PL (E&O) involving varying program segments Plans, schedules, and supervises the work activities of the unit's personnel in reviewing, analyzing, investigating, negotiating, and settling claims in compliance with established standards and expectations Reviews claim loss reports, assesses complexity of submitted claims and assures claims are assigned to appropriate personnel (based on licensure, knowledge, skills, and abilities) to ensure optimal claims handling within team; serves as a technical resource for staff as necessary Reviews and approves, within assigned authority limits, claim expenses and settlements that exceed the claim adjusters granted authority; appropriately refers claim expenses and settlements that exceed personal authority limits for approval Oversight of complex and reportable litigation and coverage cases. Serves as the primary liaison between the examiners and clients on case conferences and referrals Must be able to interpret coverage, provide guidance on coverage matters and review reservation of rights and disclaimers for carrier approval Monitors and evaluates reserves for claims within the unit to ensure that they are adequate and that reserve adjustments are made, when necessary, consistent with established time frames Conducts regular reviews of pending and closed files to determine whether claims are handled appropriately; identifies areas for improvement and discusses individual training and development needs as necessary Prepares monthly reports on quality control, pending and closed file reviews and reserve activity to track and communicate unit performance relating to production, opportunity areas and significant achievements Maintains awareness of existing and proposed legislation, court decisions and emerging trends in claims litigation to monitor the company's compliance with the Unfair Claims Practices Act and to recommend process and/or procedure changes Participate in special projects such as analyzing reserves, leakage, methods for pending reduction and acquisition candidates Review and approve direct report monthly expense reports and related operating expenses for their assigned unit. Works closely with all levels of management to ensure compliance with budget targets for compensation, expense control and profitability. Assists in the selection of and monitors the performance of external vendors Works closely with the claims management team to identify needs of the unit and assist with hiring, training, motivating, and retaining staff, evaluating staff performance, encouraging staff development, recommending salary actions, and, as necessary, developing performance improvement plans and recommending individual terminations of employment Works with Management to achieve company initiatives and performance goals Works with clients to address issues regarding policies, and procedures to fulfill the service requirements of the account. Reviews and evaluates performance of staff in accordance with company performance guidelines Resolves employee/workflow problems Leads staff unit meetings Attends client and company meetings, as required, either in-person or remotely Conducts claim reviews with clients and other stakeholders Assures consistent and accurate claims coding throughout the unit ACCOUNTABILITIES Supervisory Responsibilities Supervising, scheduling, assigning, monitoring, and evaluating work of assigned staff are responsibilities for supervisor positions. Provide direct supervision to examiners, adjusters, claims assistants and all liability claims staff Review and approve direct report's monthly expense reports 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 Possesses 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 preferred Additional State Adjuster License(s), may be required within 180 days Maintain licenses and continuing education requirements in all states. 8+ years' experience in a claims lead or supervisor position required High exposure Auto, GL and Professional Liability claims experience Relies on extensive experience and judgment to plan and accomplish goals with a minimum 8-10 years' complex/major claims experience including proficiency in investigation and resolution of mid to severe to major casualty claims In-depth understanding of company operating structure Thorough knowledge of claims procedures, litigation management, client reporting requirements and Multi-line coverage exposures Proficiency in determining case value, negotiating settlements, and understanding CA jurisdictional statutes and regulatory requirements that drive exposure Comprehensive knowledge of claims handling systems Maintain confidentiality of information Thorough knowledge in coverage and claims investigation techniques. People management skills including interviewing skills, training, team building, and performance management. Proficiency at applying business and technical acumen by understanding how the business works and how technology supports business initiatives. Leverages technology for self and staff to improve efficiency. Handles stressful situations and deadline pressures well Thinks strategically and creatively about business (pricing, products, and outcomes) Partnering with team to ensure on time task completion; done through delegation and leading by example, executing tasks rather than just instructing to execute tasks Embrace the leadership role and can be counted on to help senior management drive towards the desired results and to exceed goals successfully. Command of company and department policies, practices and procedures including supervision, training, and performance evaluation. Able to track claims activity and properly document all actions Advanced verbal, interpersonal and written communication skills Skilled at presenting in small and large group settings unique to self-insured districts. Effectively influence people to achieve unit and organizational objectives Skilled at developing and maintaining effective relationships with others (co-workers, customers, vendors, management, and other key stakeholders) to achieve organizational goals Mathematical calculating skills Exercise independent judgment and analytic ability in solving complex and sensitive problems Computer processing skills, including the ability to leverage technology for self and staff to improve efficiency Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Able to plan, prioritize and organize claims workload for a unit Ability to work independently and in a group setting Strong attention to detail and the ability to research and resolve problems Advanced organizational skills to meet multiple deadlines and to plan and effectuate short- and long-range Company and department objectives. Must be flexible, adaptable, and positive. Exhibit passion and energy for ensuring that all employees are respected and treated in a manner consistent with Athens Values. 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 Availability for extended and long distance, overnight travel, when required 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

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Auto/Bodily Injury **PRIMARY PURPOSE** : To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly. + Responsible for litigation process on litigated claims. + Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims. + Reports large claims to excess carrier(s). + Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. + Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. + Communicates claim action/processing with insured, client, and agent or broker when appropriate. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. **Experience** Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws. **Skills & Knowledge** + In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws + Knowledge of medical terminology for claim evaluation and Medicare compliance + Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs. + Strong oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Strong organizational skills + Strong interpersonal skills + Good negotiation skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical:** Computer keyboarding, travel as required **Auditory/Visual:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $75,000_ _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

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.

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.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. Demonstrated ability to develop collaborative business relationships with internal and external work partners. Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. Demonstrated investigative experience with an analytical mindset and critical thinking skills. Strong work ethic, with demonstrated time management and organizational skills. Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. Developing ability to negotiate low to moderately complex settlements. Adaptable to a changing environment. Knowledge of Microsoft Office Suite and ability to learn business-related software. Demonstrated ability to value diverse opinions and ideas Education & Experience: Bachelor's Degree or equivalent experience. Typically a minimum four years of relevant experience, preferably in claim handling. Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. Professional designations are a plus (e.g. CPCU) #LI-AR1 #Li-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois , Maryland, Massachusetts , New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

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.

The Claims Specialist will be responsible for assisting with the management of the Fleet Vehicle Safety & Operations Policy for DPR (and DPR related entities) across the US, as well as first and third-party auto physical damage and low severity property damage claims as requested by, and under the supervision of, DPR's Insured Claims Manager. Specific Duties include: Claims & Incident Management: * Initial processing of first and third-party auto and low severity property damage incidents involving DPR (and DPR related entities), including but not limited to: * Input and/or review all incidents reported in DPR's RMIS system. * Maintain incident records in Insurance Team's document management system. * Ensure all necessary information is compiled to properly manage the claims, including working with the internal teams to identify culpable parties, potential risk transfer to the culpable trade partner, if applicable, collecting documents such as incident reports, root cause analyses, if any, and vehicle lease or rental agreements. * Report, with all appropriate documents and information, all claims for DPR (and DPR related entities) to all potentially triggered insurance policies for various types of programs (traditional, CCIP, OCIP), including analyzing contractual risk transfer opportunities. * Assess potential risk transfer opportunities and ensure additional insured tenders or deductible responsibility letters are sent, where applicable. * Liaison with the carriers in evaluating whether claims reported directly to the carriers are appropriate. * Manage all auto and low severity property damage claims, as assigned, in the DPR RMIS system for DPR (and DPR related entities), including ensuring that all information is kept up to date. * Provide in-network aluminum certified repair shop information to drivers following an incident. * Act as a liaison between our carriers, auto repair shops, Operations, Fleet and EHS teams related to claim progress, strategy, expenses and settlement. * When required, notify the applicable State's Department of Motor Vehicles office of motor vehicle accidents by preparing and mailing the specific State form. * Work with Insurance Controller on auto program claim reports * Liaison with Operations, Fleet and EHS teams on new incident reporting processes, as needed. Fleet Vehicle Safety & Operations Policy Management: * Manage the Fleet Risk Index scores for authorized drivers, ensuring its accurate and up to date based on incidents and MVRs * Assign training to authorized drivers based on MVA incidents, MVRs and citations, as well as managing completion of the training * Ensure authorized driver list is kept current * Liaison with internal HR, Fleet, EHS and Business Unit Leaders, where appropriate, on suspending vehicle usage permissions * Responsible for working with internal teams on implementing appropriate updates to the Fleet Vehicle Safety & Operations Policy Key Skills: * Strategic thinking * Ability to mentor and inspire others * Integrity * Team player * Strong writing and communication skills * Self-Starter * Highly organized and responsive - ability to meet deadlines * Detail Oriented * Basic working knowledge in all of the following coverages/programs: auto insurance, commercial general liability, property insurance, and controlled insurance programs. * Risk and dispute management - insured claims Qualifications: * A minimum of five years relevant insurance industry experience * Previous experience in auto claims management highly desired DPR Construction is a forward-thinking, self-performing general contractor specializing in technically complex and sustainable projects for the advanced technology, life sciences, healthcare, higher education and commercial markets. Founded in 1990, DPR is a great story of entrepreneurial success as a private, employee-owned company that has grown into a multi-billion-dollar family of companies with offices around the world. Working at DPR, you'll have the chance to try new things, explore unique paths and shape your future. Here, we build opportunity together-by harnessing our talents, enabling curiosity and pursuing our collective ambition to make the best ideas happen. We are proud to be recognized as a great place to work by our talented teammates and leading news organizations like U.S. News and World Report, Forbes, Fast Company and Newsweek. Explore our open opportunities at ********************

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.

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

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.

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

Job Description Customer Claims Representative- Orlando Join the Service Pros Auto Glass team inside our partnered dealerships! You'll engage customers, spot glass-replacement opportunities, and coordinate quick, professional service - all while building strong relationships and developing a personal team. This role is perfect for a teachable person who loves being part of a supportive, winning team. What You'll Do: Engage customers in the service drive and identify windshield replacement needs. Educate and guide customers through their options and next steps. Build strong relationships with service advisors, managers, and technicians. Encourage dealership referrals and hit daily/weekly sales goals. Schedule and coordinate on-site glass services. Keep accurate records of leads, interactions, and completed jobs. Represent the company with a professional, positive attitude. What Makes You a Great Fit: Experience in customer service or sales is a plus, but not required. Strong communication and people skills. A self-motivated, proactive approach - you enjoy taking the lead. Team-oriented mindset with a friendly, professional appearance. Valid driver's license and reliable transportation. What We Offer: A fun, energetic, team-first culture Ability to earn $1000 - $2500 per week You are paid on a weekly basis Promotion from within and clear growth paths Ongoing training and development Team events, company outings, and a culture that celebrates wins

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.

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 2025-1488499

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 2025-1488499

General Description: Investigates, evaluates, negotiates, and resolves assigned property claims having low to moderate complexity and value, working within delegated reserve and settlement authority. Works closely with the Unit Manager, occasionally handling claims with additional complexities related to unique coverage and/or exposure issues. Essential Duties and Responsibilities: Investigates, evaluates, negotiates, and resolves assigned property claims of low to moderate complexity. Determines the facts of the loss, coverage compensability, and the degree of exposure by unit of coverage. Reviews, analyzes, and applies policy conditions, provisions, exclusions and endorsements pertinent to a variety of losses. Establishes timely and accurate property claim and expense reserves. Communicates clearly and professionally with the customer, or their representative, by telephone and/or written correspondence regarding all aspects of the claims process. Determines settlement amounts based on independent judgment, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits, and deductibles. Negotiates and conveys property claim settlements within authority limits to insureds. Controls damage exposures through proper usage of cost containment tools. Maintains an effective diary system to ensure timely resolution and documents property claim file activities in accordance with established procedures and state regulations. Provides excellent customer service to meet the needs of the insured, agent, and all other internal and external customers. Handles files in compliance with state regulations, where applicable. Writes denial letters, Reservation of Rights, and other complex correspondence to insureds. Identifies property claims that may have value added by an outside field inspection. Determines cases that may have fraud potential and refers claims to Special Investigations Unit. Identifies potential for subrogation and refers appropriate claims to the Subrogation Unit. Partners with counsel to develop litigation plan and adhere to applicable guidelines. Performs other duties as required. Supplementary Information: This job description has been prepared to indicate the general nature and level of the work that the employees perform within their classification. This description is not to be interpreted as an inventory of all the duties, tasks, responsibilities and qualifications required for the employees assigned to this job. Education and / or Experience: Bachelor's Degree preferred but not required. Minimum of three (3) years of progressive experience in the adjusting of residential and commercial claims or a combination of education and experience. Strong verbal and written communications skills. Must be able to work in a collaborative atmosphere. Must be proficient with Microsoft Office, including Word, Excel, PowerPoint. Customer service orientation; empathy. Demonstrates ownership attitude and customer centric response to all assigned tasks. Solid analytical and decision making skills. Spanish speaking is a plus. Licenses and / or Certifications: Adjuster's license(s) (where applicable) required or successfully acquired within 60 days of hiring. AIC a plus. Professional designation specific to claims a plus.

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.

Business Claim Specialist Visa GC/Citizen Division Pharmaceutical Pay $16.00/hr. Contract 5 Month Timings Mon - Fri between 9.00AM - 6.00PM The primary function/purpose of this job. Verify member submitted claims forms, member's eligibility and pharmacy information is complete and accurate, updating system information as needed. Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency. Moderate knowledge of drugs and drug terminology used daily. Process claims according to client specific guidelines while identifying claims requiring exception handling. Navigate daily through several platforms to research and accurately finalize claim submissions. Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues. Adhere to strict HIPAA regulations especially when communicating to others outside the client. Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met. Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing. Analyze claims for potential fraud by member or pharmacy. May be required to work on special projects for claims team. ESSENTIAL FUNCTIONS: The 6-10 major responsibility areas of the job. Weight: (%) (Total = 100%) 1. Manage member and client expectations related to claim reimbursements. Input claim requests into adjudication platform maintaining compliance to performance guarantees, HIPAA guidelines and service standards, which include production and accuracy standards. Processing according to client guidelines making exceptions upon member appeal and client approval. Recognize and escalate appropriate system crises/problems and fraudulent claims to management. 40 % 2. Identify claims requiring additional research, navigate through appropriate system platforms to perform research and resolve issue or forward as appropriate 15 % 3. Research to define values for missing information not submitted with claim but required for processing. Identify drug form, type and strength to manually determine correct NDC number value which will allow claim to process. Continue researching values if system editing does not accept original assigned value. Utilize anchor platform, internet resources and/or contacting retail pharmacist as resources for missing values. 15 % 4. Initiate correspondence to members, pharmacies or other internal departments for missing information, claim denials or other claim issues. 15 % 5. Evaluate claim submission, ensure all required information is present and determine what action should be taken. Confirm patient eligibility and verify patient information matches system. Update member's address to match claim form if necessary. 5 % 6. Identify exception handling and process per client requirements. Monitor system to ensure client specific documentation related to claims processing and benefits is current and system editing is operating appropriately. 5 % 7. Variety of other miscellaneous duties as assigned 5 % SCOPE OF JOB Provide quantitative data reflecting the scope and impact of the job - such as budget managed, sales/revenues, profit, clients served, adjusted scripts, etc. Maintain an average of 30 Commercial claims per hour (cph) or 35 Work Comp claims per hour (cph). Qualifications Formal Education and/or Training: High school diploma or equivalent required, some college or technical training preferred Years of Experience: Two years' experience in P.B.M. environment is helpful but not required. Computer or Other Skills: Strong data entry, 10-key skills, general PC skills and MS Office experience Knowledge and Abilities: • Strong data entry and 10-key skills • Retail pharmacy, customer service experience helpful but not required • PC and MS Office literate • Strong attention to detail • Excellent retention and judgment ability • Proficient written and oral communication skills • Ability to work in fast-paced, production environment • Reliable, self-motivated with excellent attendance • Team player who has the ability to stay on task with little supervision Additional Information Thanks & Regards, Ranadheer Murari | Recruitment Executive | Mindlance, Inc. | W : ************ ***************************

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