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Claim specialist jobs in Boca Raton, FL - 83 jobs
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Claim Specialist
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Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations
Stout
Claim specialist job in Boca Raton, FL
At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team. About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include: Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations. Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies. Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic. Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning. Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives. Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support. Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations. Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery. Continue developing technical, analytical, and consulting skills while building credibility with clients. Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement. Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team. What You Bring Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred. Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles. Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance. Epic Resolute or other hospital billing system experience preferred; Epic certification a plus. Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required. Additional certifications such as CHC, CFE, or AHFI preferred. Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization. Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred. Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act. Willingness to travel up to 25%, based on client and project needs. How You'll Thrive Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions. Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships. Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time. Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment. Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility. Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions. Why Stout? At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life. We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve. We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals. Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives. Learn more about our benefits and commitment to your success. en/careers/benefits The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job. Stout is an Equal Employment Opportunity. All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law. Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.$35k-43k yearly est. 4d agoPatient Claims Specialist - Bilingual Only
Modernizing Medicine
Claim specialist job in Boca Raton, FL
ModMed is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine! Your Role: * Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections * Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates * Input and update patient account information and document calls into the Practice Management system * Special Projects: Other duties as required to support and enhance our customer/patient-facing activities Skills & Requirements: * High School Diploma or GED required * Availability to work 9:30-5:30pm PST or 11:30am to 8:30 pm EST * Minimum of 1-2 years of previous healthcare administration or related experience required * Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs) * Manage/ field 60+ inbound calls per day * Bilingual is a requirement (Spanish & English) * Proficient knowledge of business software applications such as Excel, Word, and PowerPoint * Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone * Ability and openness to learn new things * Ability to work effectively within a team in order to create a positive environment * Ability to remain calm in a demanding call center environment * Professional demeanor required * Ability to effectively manage time and competing priorities #LI-SM2$78k-98k yearly est. Auto-Apply 41d agoClaims Specialist (Substance Abuse Billing)
Codemax
Claim specialist job in Fort Lauderdale, FL
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$34k-61k yearly est. 3d agoClaims Specialist
Quadrant Health Group
Claim specialist job in Boca Raton, FL
Job Description Join our dynamic team at Quadrant Health Group! Quadrant Billing Solutions, a proud member of the Quadrant Health Group, is seeking a passionate and dedicated Claims Specialist to join our growing team. You will play a vital role focused on ensuring that healthcare services are delivered efficiently and effectively. Why Join Quadrant Health Group? Competitive salary commensurate with experience. Comprehensive benefits package, including medical, dental, and vision insurance. Paid time off, sick time and holidays. Opportunities for professional development and growth. A supportive and collaborative work environment. A chance to make a meaningful impact on the lives of our clients. Compensation: $18 - $24 per hour - Full-time What You'll Do: The ideal candidate is organized, persistent, and results-driven, with deep knowledge of out-of-network billing for Substance Use Disorder (SUD) and Mental Health (MH) services. You'll join a high-performing team focused on maximizing collections, reducing aging A/R, and ensuring every dollar is pursued. Major Tasks, Duties and Responsibilities: Proactively follow up on unpaid and underpaid claims for Detox, Residential, PHP, and IOP levels of care. Manage 500-700 claims per week, prioritizing efficiency and accuracy. Handle 4-5 hours of phone time per day with strong communication skills. Communicate with payers via phone, portals, and written correspondence to resolve billing issues. Identify trends in denials and underpayments and escalate systemic issues. Dispute and overturn wrongly denied claims. Update and track claims using CMD (CollaborateMD) and internal task systems. Follow QBS workflows using Google Drive, Docs, Sheets, and Kipu EMR. Maintain professional and timely communication with internal teams and facility partners. Bonus Experience (Not Required): Handling refund requests and appeals. Preparing and submitting level 1-3 appeals (e.g., medical necessity, low pay, timely filing). Gathering and submitting medical records for appeal support. Working with utilization review (UR) or clinical teams. Familiarity with ASAM and MCG medical necessity criteria. Exposure to payment posting, authorization reviews, or credentialing. What You'll Bring: Minimum 1 year of SUD/MH billing and claims follow-up experience (required). High School Diploma or equivalent, associate or bachelor's degree (preferred). Strong understanding of insurance verification, EOBs, and RCM workflows. Familiarity with major payers: BCBS, Cigna, Aetna, UHC, Optum, TriWest. Experience overturning insurance denials is a strong plus. Proficient in CMD (CollaborateMD) and Kipu EMR (strongly preferred). Excellent written and verbal communication skills. Highly organized, detail-oriented, and capable of managing multiple priorities. Why Join Quadrant Billing Solutions? Rapid career growth in a mission-driven, niche billing company. Collaborate with clinical and billing experts who understand behavioral health. Join a tight-knit, supportive team culture. Gain opportunities for leadership advancement as the company scales.$18-24 hourly 14d agoClaims Processor
The Law Offices of Kanner and Pintaluga
Claim specialist job in Boca Raton, 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.$29k-47k yearly est. Auto-Apply 7d agoClaims Examiner
Heritage Mga LLC
Claim specialist job in Sunrise, FL
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.$29k-47k yearly est. Auto-Apply 60d+ agoClaims Examiner III
Doctors Healthcare Plans, Inc.
Claim specialist job in Miami, FL
Job Description The Claims Examiner III ensures that claims are processed according to department standards and assists the Claims manager in maintaining the workflow and processes, in order to achieve set goals. Key Responsibilities: Review and release professional and institutional claims Process Member Reimbursement claims Coordinates with the Assistant Director the weekly/monthly workflow issues and set goals for the department Assists the Assistant Director on generating reports to track productivity and pending items Collaborate in the application of policies and procedures of the department Collaborate with the Assistant Director to ensure the team is meeting production and quality metrics Communicate effectible to the department staff the strategy to improve performance and meet stablished goals Maintain a positive environment that support staff well-being and foster an atmosphere that builds teamwork Ensure that the team utilizes the system capabilities to its maximum potential Performs other duties as necessary Qualifications: High School Diploma or GED 3+ years as Medical Claims Examiner Experience in contract interpretation Knowledge of CMS guidelines and regulations Ability to work Windows and other computer applications Ability to work well with others Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member. No Third Party Agencies or Submissions Will Be Accepted. Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein. Powered by JazzHR q5FAGx79Ms$29k-47k yearly est. 9d agoClaims Processing Representative
Centerwell
Claim specialist job in Miramar, FL
**Become a part of our caring community and help us put health first** The Claims Processing Representative reviews and adjudicates complex or specialty claims, submitted either via paper or electronically while performing basic administrative/clerical/operational/customer support/computational tasks. The Claims Processing Representative determines whether to return, deny, or pay claims following organizational policies and procedures. Accurately enters claims information into the company's database and maintain up-to-date records. Communicates effectively with policyholders, healthcare providers, and other stakeholders to gather necessary information and provide updates on claim status. Ensures all claims are processed in accordance with company policies, industry regulations, and legal requirements. Investigates and resolves discrepancies or issues related to claims, working collaboratively with other departments as needed. Provides exceptional service to clients, addressing inquiries and concerns promptly and courteously. **Use your skills to make an impact** **Required Qualifications** + Medical Claims experience and/or knowledge of medical claims processes + Knowledge of CPT, ICD-10, and HCPCS coding + Medical terminology + Ability to manage multiple or competing priorities, work in a fast-paced environment and adapt quickly to change + Aptitude for quickly learning and navigating new technology systems and applications + Ability to think analytically + Strong focus on accuracy and detail + Proficiency in all Microsoft Office Programs, including Word, PowerPoint, and Excel **Preferred Qualifications** + Billing experience + Coding Certification + Previous inbound call center or related customer service experience + Knowledge of HIPAA 837 and 835 electronic claims transactions + Knowledge of Medicare Risk Adjustment and/or Medicaid processes **Additional Information** + Onsite (Location: 3351 Executive Way Miramar, FL 33025) + Required shifts: 8:00a - 5:00p (ET) **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $39,000 - $49,400 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About Us** About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************$39k-49.4k yearly 2d agoLevel 1 Claims Adjuster
Amwins
Claim specialist job in Sunrise, FL
Job DescriptionAmwins Specialty Auto is seeking career-oriented candidates to join a claims team within our rapidly growing company. As a Level I Claims Adjuster, you will investigate straightforward 1st party and non-injury related liability claims in accordance with company procedures.In the fast-paced environment of auto claims this role requires strong oral, written, analytical, decision making and organizational skills and lends itself to considerable career growth potential. Along with competitive salary, Amwins Specialty Auto offers a full range of benefits including insurance, retirement, and educational reimbursement programs. Amwins Specialty Auto is part of Amwins Group, the largest specialty broker in the United States, with over $14 billion of premium. This is an in office position based out of our Sunrise, FL location! Responsibilities: Establish timely contact with all applicable parties to a claim (insureds, drivers, witnesses, etc), gathers facts of the loss and clearly explains the claims process Assess coverage, identifying and addressing potential coverage issues Determine liability and document the claim file with details of the claim investigation Communicate to applicable parties the rationale behind coverage or liability decisions Document information obtained regarding damages and resolve within assigned authority limits Manage the assignment of claims to material damage handling units for inspection or repairs Maintain file notes and correspondence while performing multiple tasks associated with a fast-paced environment Manage reserve adequacy throughout the life of the claim Alert claims supervisor in the event of potential fraud, recovery, or severity escalation in the claim Ensure timely and cost-effective claim resolution Qualifications: 1-3 years of P&C adjusting experience Must be fluent in English, fluent in Spanish is preferred Associates degree or above preferred Must obtain Florida adjuster license prior to start date Ability to multi-task in a fast-paced environment Strong communication skills and ability to clearly document and communicate the basis for decisions made Excellent written skills that demonstrate clear, professional and succinct communications for file documentation, internal communications and external correspondence Strong organizational and time-management skills Courteous and professional telephone communications Ability to work in a team environment and maintain calm demeanor even during heated circumstances Benefits: Amwins Specialty Auto seeks to attract career-oriented individuals, and as such provides competitive pay and considerable opportunity for merit-based advancement. Our comprehensive benefits package includes the following: Medical, dental & vision coverage 401K with Company match Paid time-off Pay-for-Performance Flexible spending accounts Tuition reimbursement Work/Life resources Employee and Dependent life insurance Disability insurance Accidental death and dismemberment insurance No direct inquiries, please.$44k-52k yearly est. 3d agoField Claims Adjuster
EAC Claims Solutions
Claim specialist job in Fort Lauderdale, FL
At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.$43k-53k yearly est. Auto-Apply 40d agoClaims Examiner
Independent Living Systems
Claim specialist job in Miami, FL
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.$29k-39k yearly est. Auto-Apply 39d agoMedical Coding Appeals Analyst
Elevance Health
Claim specialist job in Miami, FL
Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. This position is not eligible for employment based sponsorship. Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. PRIMARY DUTIES: * Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code. * Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. * Translates medical policies into reimbursement rules. * Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits. * Coordinates research and responds to system inquiries and appeals. * Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. * Perform pre-adjudication claims reviews to ensure proper coding was used. * Prepares correspondence to providers regarding coding and fee schedule updates. * Trains customer service staff on system issues. * Works with providers contracting staff when new/modified reimbursement contracts are needed. Minimum Requirements: Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required. Preferred Skills, Capabilities and Experience: * CEMC, RHIT, CCS, CCS-P certifications preferred. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed/Certified - Other Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.$38k-62k yearly est. 3d agoPublic Adjuster
Icbd Holding LLC
Claim specialist job in West Palm Beach, FL
Public Adjuster Are you a licensed public adjuster looking to stand out in an established but growing company? Get more opportunity to work the big claims at a premier Florida public adjusting firm-Sentry Public Adjusting. We are looking for a hard-working closer who wants be part of a fast growing, professional, ethical and ambitious Public Adjusting Company. About Sentry Public Adjusting Sentry Public Adjusting is a full-service public adjusting firm covering the State of Florida. Our team includes licensed adjusters, certified claim estimators, administrative claim support specialists and mortgage liaisons-everything necessary for an adjuster to be successful. We offer a competitive base salary plus commission commensurate with experience. Our benefits package includes medical, dental, vision, short/long-term disability, life insurance, and 401(k). Our aggressive structure provides an incentive to work hard, help many people in challenging times, and will allow the right candidate to far exceed annual base pay. Your Position The licensed Public Adjuster follows up on qualified leads and develops a working relationship with local property managers and businesses who may experience future losses. The public adjuster networks contacts and follows up on client references to help bring in new clients. What You Will be Doing · Working efficiently with and managing adjuster apprentices · Onboarding, signing up, and maintaining communication with clients · Overseeing claims process from beginning to end . Maintaining internal systems such as Salesforce and ClaimWizard · Negotiating, corresponding, and dealing with insurance carriers · Following up to ensure claims are being properly handled by deadlines . Attendance at Home Shows on occasional weekends will be required. · Traveling -regularly travel to appointments within our operational area. Your Qualifications · Florida Public Adjuster license 3-20 PCA or licensed in a reciprocal state · Experience in real estate, construction, or insurance fields is helpful but not necessary · Strong writing and communication skills including attention to detail · Proficiency with Microsoft Office · Highly organized with the ability to juggle multiple deadlines in a fast-paced environment · Ability to read and interpret contracts Working Conditions Candidates must meet the company's hiring criteria to include a pre-employment background investigation and drug test. We are an Equal Opportunity Employer and a drug-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. Must be able to separate personal issues with work issues to ensure healthy relationships with clients. This is not a work from home position, and you shall be expected to adhere to normal office hours when not on appointments. As per the nature of the work appointments are governed by the requirements of our customer base, so a willingness to work outside of normal office hours and at weekends will at times be expected. Staffing Agencies Unsolicited resumes from search firms will not be honored as valid. Consequently, we politely ask agencies not to solicit our business managers directly as well. Thank you in advance. Job Type: Full-time$40k-55k yearly est. Auto-Apply 60d+ agoClaims Adjuster (Bodily Injury)
Arc Group
Claim specialist job in Oakland Park, FL
Job Description CLAIMS ADJUSTOR (remote - East Coast) ARC Group seeks a Bodily Injury Claims Adjuster to work in a remote hybrid role for our direct client based in FL. The Claims Adjustor will investigate, evaluate, and negotiate bodily injury claims, ensuring compliance with legal standards and company policies while also coordinating with counsel on the defense of claims. There is a preference for someone in FL but Claims Adjusters from surrounding gulf and eastern seaboard states will be considered. The Claims Adjustor must have experience with bodily injury, liability, and preferably with liability, property damage, and commercial auto. But bodily injury is required. Our client is a leading insurance underwriter, and this is a great opportunity for a Claims Adjustor to join a well-established firm (45+ years) that is on a multi-year growth plan. You would join a company that offers competitive salary and comprehensive benefits package including PTO, Paid Holidays, health, vision, detail, Life & Voluntary/ADD, STD & LTD, 401K contributions and business casual dress Claims Adjustor Responsibilities: Correspond and interview with agents, witnesses, or claimants to compile information Take accurate and detailed statements from all involved parties Calculate and approve payment of claims within a certain monetary limit Negotiate and settle property losses with little oversight Coordinate with legal counsel in handling cases correctly Negotiation and Settlement: Negotiate settlements with claimants, attorneys, and other involved parties in a fair and cost-effective manner. Collaborate with internal teams, such as underwriters and claims specialists, to facilitate efficient claims resolution. Documentation and Reporting: Prepare detailed and accurate documentation of claim investigations, legal actions, and settlement agreements. Provide regular reports to management on claim status, legal developments, and financial implications. Compliance and Best Practices: Ensure compliance with state and federal regulations, as well as company policies and procedures. Stay informed about changes in legislation and industry trends affecting commercial auto insurance. Claims Adjustor Qualifications: 3+ years of previous bodily injury insurance experience, investigations or other related fields with liability, and property damage, and commercial auto (preferred) Experience in conflict resolution Strong negotiation skills Excellent written and verbal communication skills Deadline and detail-oriented Would you like to know more about our new opportunity? You can apply online while viewing all open jobs at ******************* ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. We are proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse workforce. We are a no-fee agency for candidates.$43k-53k yearly est. 30d agoPublic Adjuster
The Misch Group
Claim specialist job in Miami, FL
Department Insurance & Financial Services Employment Type Full Time Location Florida Workplace type Hybrid Compensation $90,000 - $170,000 / year Key Responsibilities Skills, Knowledge and Expertise Benefits About The Misch Group Stone Hendricks Group is a direct-hire search firm that brings together years of experience and a diverse range of talent to connect businesses with exceptional job candidates. With a focus on timely and effective recruitment, we understand the power of a well-formed employee base in helping businesses achieve their goals. We offer our services to businesses of all sizes, providing qualified candidates for blue- and grey-collar roles, as well as white-collar and executive positions. The success of our direct-hire search process is driven by our advanced training, proprietary technology, and extensive network across industries. At Stone Hendricks Group, we value integrity and prioritize connectedness, commitment, and candor in our interactions with both employers and job seekers. Our clients consider us trusted advisors, relying on the highly personalized service we provide and our ability to find candidates that are an ideal fit for their unique needs. Choose Stone Hendricks Group for unsurpassed direct-hire search services that match successful organizations with talented job candidates.$40k-55k yearly est. 60d agoVerification Specialist
Get Me Healthcare
Claim specialist job in Deerfield Beach, FL
Job Description Get Me Healthcare is searching for a full-time Verification Specialist to join our team in Deerfield, FL. In this role, you'll ensure every health insurance policy is accurate, compliant, and ready to make a difference in someone's life. If you're detail-oriented, a great communicator, and thrive in a fast-paced environment, we want you on our team. Apply today and let's make things happen together! GREAT PAY As our Verification Specialist, you'll earn $17-$23 per hour, based on experience. EXCELLENT BENEFITS Health Dental Vision Life insurance PTO Catered meals in office YOUR NEW ROLE AS OUR VERIFICATION SPECIALIST This is a full-time, in-office position with a Monday through Friday work schedule. Extended hours and occasional weekend availability may be available during peak enrollment periods. As our Verification Specialist, you'll be the last set of eyes before a health insurance application is submitted. You'll review applications for accuracy, listen to live and recorded calls to ensure compliance, and work directly with agents to fix any issues in real time. Your work will ensure every policy is clean, compliant, and ready to go. REQUIREMENTS Exceptional attention to detail Strong communication skills for real-time collaboration Highly organized with the ability to multitask Team-oriented and coachable Comfortable in a fast-paced, high-accountability environment Experience in compliance, insurance processing, customer service, or admin roles is preferred, but not required. If this sounds like you, apply today to join our team! ABOUT US It all started in Boca. Our flagship Florida office is where GetMeHealthcare's winning culture was born-and it still sets the pace. This team drives results, levels up fast, and turns high potential into real performance. From sales to ops, you'll get elite training, nonstop support, and a team that's locked in on success. We grind hard, win big, and celebrate like we mean it. The office? Built for speed and collaboration. The vibe? All gas, no brakes. Bonus: on-site gym, personal trainer, and a crew that pushes each other to be great-in and out of the office. If you're hungry, competitive, and chasing something bigger, Boca is where it begins. Ready to put your skills to work in a role that truly matters? Apply now! Our initial application process is quick, easy, and mobile-friendly. Job Posted by ApplicantPro$17-23 hourly 13d agoPatient Claims Specialist - Bilingual Only
Modmed
Claim specialist job in Boca Raton, FL
We are united in our mission to make a positive impact on healthcare. Join Us! South Florida Business Journal, Best Places to Work 2024 Inc. 5000 Fastest-Growing Private Companies in America 2024 2024 Black Book Awards, ranked #1 EHR in 11 Specialties 2024 Spring Digital Health Awards, “Web-based Digital Health” category for EMA Health Records (Gold) 2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara) Who we are: We Are Modernizing Medicine (WAMM)! We're a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany. ModMed is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine! Your Role: Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates Input and update patient account information and document calls into the Practice Management system Special Projects: Other duties as required to support and enhance our customer/patient-facing activities Skills & Requirements: High School Diploma or GED required Availability to work 9:30-5:30pm PST or 11:30am to 8:30 pm EST Minimum of 1-2 years of previous healthcare administration or related experience required Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs) Manage/ field 60+ inbound calls per day Bilingual required (Spanish & English) Proficient knowledge of business software applications such as Excel, Word, and PowerPoint Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone Ability and openness to learn new things Ability to work effectively within a team in order to create a positive environment Ability to remain calm in a demanding call center environment Professional demeanor required Ability to effectively manage time and competing priorities #LI-SM2 ModMed Benefits Highlight: At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits: India Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk, Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees, Allowances: Annual wellness allowance to support your well-being and productivity, Earned, casual, and sick leaves to maintain a healthy work-life balance, Bereavement leave for difficult times and extended medical leave options, Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave, Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind. United States Comprehensive medical, dental, and vision benefits 401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep. Generous Paid Time Off and Paid Parental Leave programs, Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs, Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed, Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning, Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles, Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters. PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (*************************). Please check senders' email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.$78k-98k yearly est. Auto-Apply 40d agoClaims Examiner III
Doctors Healthcare Plans
Claim specialist job in Coral Gables, FL
The Claims Examiner III ensures that claims are processed according to department standards and assists the Claims manager in maintaining the workflow and processes, in order to achieve set goals. Key Responsibilities: Review and release professional and institutional claims Process Member Reimbursement claims Coordinates with the Assistant Director the weekly/monthly workflow issues and set goals for the department Assists the Assistant Director on generating reports to track productivity and pending items Collaborate in the application of policies and procedures of the department Collaborate with the Assistant Director to ensure the team is meeting production and quality metrics Communicate effectible to the department staff the strategy to improve performance and meet stablished goals Maintain a positive environment that support staff well-being and foster an atmosphere that builds teamwork Ensure that the team utilizes the system capabilities to its maximum potential Performs other duties as necessary Qualifications: High School Diploma or GED 3+ years as Medical Claims Examiner Experience in contract interpretation Knowledge of CMS guidelines and regulations Ability to work Windows and other computer applications Ability to work well with others Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member. No Third Party Agencies or Submissions Will Be Accepted. Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.$29k-47k yearly est. Auto-Apply 8d agoClaims Examiner
Independent Living Systems
Claim specialist job in Miami, FL
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.$29k-39k yearly est. 11d agoIn-house Public Adjuster
Icbd Holding LLC
Claim specialist job in West Palm Beach, FL
Public Adjuster Are you a licensed public adjuster looking to stand out in an established but growing company? Get more opportunity to work the big claims at a premier Florida public adjusting firm-Sentry Public Adjusting. We are looking for a hard-working closer who wants be part of a fast growing, professional, ethical and ambitious Public Adjusting Company. About Sentry Public Adjusting Sentry Public Adjusting is a full-service public adjusting firm covering the State of Florida. Our team includes licensed adjusters, certified claim estimators, administrative claim support specialists and mortgage liaisons-everything necessary for an adjuster to be successful. We offer a competitive base salary plus commission commensurate with experience. Our benefits package includes medical, dental, vision, short/long-term disability, life insurance, and 401(k). Our aggressive structure provides an incentive to work hard, help many people in challenging times, and will allow the right candidate to far exceed annual base pay. Your Position The licensed Public Adjuster follows up on qualified leads and develops a working relationship with local property managers and businesses who may experience future losses. The public adjuster networks contacts and follows up on client references to help bring in new clients. What You Will be Doing · Working efficiently with and managing adjuster apprentices · Onboarding, signing up, and maintaining communication with clients · Overseeing claims process from beginning to end . Maintaining internal systems such as Salesforce and ClaimWizard · Negotiating, corresponding, and dealing with insurance carriers · Following up to ensure claims are being properly handled by deadlines . Attendance at Home Shows on occasional weekends will be required. · Traveling -regularly travel to appointments within our operational area. Your Qualifications · Florida Public Adjuster license 3-20 PCA or licensed in a reciprocal state · Experience in real estate, construction, or insurance fields is helpful but not necessary · Strong writing and communication skills including attention to detail · Proficiency with Microsoft Office · Highly organized with the ability to juggle multiple deadlines in a fast-paced environment · Ability to read and interpret contracts Working Conditions Candidates must meet the company's hiring criteria to include a pre-employment background investigation and drug test. We are an Equal Opportunity Employer and a drug-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. Must be able to separate personal issues with work issues to ensure healthy relationships with clients. This is not a work from home position, and you shall be expected to adhere to normal office hours when not on appointments. As per the nature of the work appointments are governed by the requirements of our customer base, so a willingness to work outside of normal office hours and at weekends will at times be expected. Staffing Agencies Unsolicited resumes from search firms will not be honored as valid. Consequently, we politely ask agencies not to solicit our business managers directly as well. Thank you in advance. Job Type: Full-time$40k-55k yearly est. Auto-Apply 60d+ ago
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Learn more about claim specialist jobs
How much does a claim specialist earn in Boca Raton, FL?
The average claim specialist in Boca Raton, FL earns between $26,000 and $79,000 annually. This compares to the national average claim specialist range of $27,000 to $67,000.
Average claim specialist salary in Boca Raton, FL
$46,000
What are the biggest employers of Claim Specialists in Boca Raton, FL?
The biggest employers of Claim Specialists in Boca Raton, FL are:
- ModMed
- JM Family Enterprises
- Quadrant Health Group
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