Claim specialist jobs in Hialeah, FL - 87 jobs

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

ESSENTIAL DUTIES & RESPONSIBILITIES To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation; including, but not limited to: Serve as a liaison between the plan, claims, providers, and various departments to effectively identify and resolve claims issues. Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication. Review, research, solve and process assigned work. This would include navigating multiple computer systems and platforms (e.g. Verify pricing, prior authorizations, applicable benefits) Audit check run and send claims for corrections. Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes, and procedures (e.g. Claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates tool) Independently complete on a daily basis all documentation and communicate the status of claims as needed adhering to all reporting requirements. Communicate through correspondence with members and providers regarding claim payment or required information, using clear, simple language to ensure understanding. Meet and maintain the performance goals established for the position in the areas of quality, production, and attendance. Performs other duties as assigned. QUALIFICATIONS & EDUCATION High school diploma / GED (or higher) OR 5+ years of equivalent working experience. Knowledge of Medical Terminology, coding, and diagnosis coding is helpful. Excellent verbal and written communication skills. Commitment to excellence and high standards. Strong organizational, problem-solving, and analytical skills. Able to manage priorities and workflow. Demonstrates a high level of professionalism in dealing with confidential and sensitive issues. Ability to work effectively, independently and in a team environment. Ability to deal effectively with a variety of individuals. Fluency in Spanish and English required. Proficiency in computer software (i.e. Microsoft Word, Excel, Power-Point, and Outlook) and the ability to learn new and complex computer system applications (including comfort using short-cut keys/demands). WORKING CONDITIONS The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Interacts with health plan members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances. This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. The work schedule is approximate, and hours/days may change based on company needs.

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.

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.

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. 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.

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.

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.

Overview: Loyalty MGA is looking for experienced Bilingual Auto Insurance Adjusters to join our team onsite. Whether your expertise is in Bodily Injury, Personal Injury Protection, Property Damage, Payment Adjustment, Appraisal, or Special Investigation Units, we want to hear from you. This role is ideal for professionals seeking to advance their careers in a dynamic and supportive environment. Responsibilities: Investigate and assess auto insurance claims across various segments, including Bodily Injury, Personal Injury Protection, Property Damage, Payment Adjustment, Appraisal, and Special Investigation Units. Determine coverage, valuation, and exposure for claims. Resolve claims efficiently and fairly. Collect and analyze statements from involved parties. Maintain accurate claim reserves. Provide exceptional customer service to both internal and external stakeholders. Requirements: High School Diploma or G.E.D. 6 months of claims handling or intake experience. Bilingual in English and Spanish is required. Active insurance adjuster's license preferred; must obtain and maintain as needed. Strong customer service and communication skills. Basic proficiency in Microsoft Office. This role is onsite, providing an opportunity to work closely with our team and clients. Apply now to advance your career with Loyalty MGA! Qualifications Hold a valid all lines 6-20 license Negotiate settlements with claimants or their representatives, ensuring fair and equitable agreements. Adhere to ethical standards and guidelines while handling claims and interacting with stakeholders. High school diploma or equivalent; bachelor's degree in business, or related field preferred. Strong problem-solving skills with a focus on delivering timely and effective resolutions to customer issues. Strong organizational and time management skills to handle multiple tasks efficiently. Professional, energetic, and ability to thrive in a fast-paced environment and adapt to changing priorities. Excellent verbal and written communication skills. Ability to articulate solutions clearly and concisely.

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.

Effectively and accurately applies policy conditions of coverage, processing guidelines and cost containment knowledge into the adjudication of global health claims and comprehensive cases. ESSENTIAL JOB DUTIES AND RESPONSIBILITIES: Processes all types of global health insurance claims Conduct claims analysis reviewing in detail claim documentation, medical reports and supporting documentation to decide compensability Examine with accuracy policy and member information, plan conditions of coverage and processing guidelines against claim documentation to determine benefit application Conduct post claim underwriting reviews to identify possible pre-existing condition Utilize anti-fraud policies to mitigate fraud possibility for submitted claims Review benefit letter / medical authorizations for cost and benefit application Evaluate claim compensability based on procedures performed, treatment intensity and diagnosis Validate benefit accumulators, patient responsibility, duplicate claim prevention and provider discount Assign ICD-10 codes along with valid procedure codes when necessary Apply Usual, Customary and Reasonable pricing guidelines to determine acceptable claim cost Maintain acceptable productivity and turnaround times for all assignments Maintain high work accuracy and quality scores Support team with versatile assignments related to department needs Qualifications DESIRED MINIMUM QUALIFICATIONS: Proficiency in Microsoft product suite (i.e. Microsoft Office, Word, Excel, etc.) Strong analytical, problem solving and negotiating skills Ability to adapt quickly in fast paced environment Detail oriented with exceptional organizational and communication skills Complete Fluency in English, Spanish (Portuguese a plus) Proven ability to work independently and meet determined deadlines Ability to navigate and enter data utilizing multiple systems and screens Education and Experience: Associates Degree or commensurate work experience Billing/Coding Certification preferred Minimum of 3 years experience in Health Insurance Industry

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.

IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity Matters: With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster. You're welcome to sign up on our jobs roster if you meet our guidelines. How We Can Help You Succeed: At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals. Seize the Opportunity Today! Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (********************************************************* and Facebook at: (************************************************** for additional resources and updates. APPLY HERE #AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.

Salary: Commensurate based on experience and qualifications This is an excellent opportunity for recent college graduates looking to build long-term careers in a fast-paced industry. Apply today. Would it surprise you to find an employer that... …pays 100% of employees' medical insurance premiums …offers Paid Time Off starting on Day One. …contributes to a Health Savings Account (HSA) to help cover deductibles …offers a 401(k) savings match …has doubled in size in the past 3 years …and...is a car insurance company! We invite top candidates to learn more. About Responsive Founded in 2007 and headquartered in Plantation, Florida, Responsive is a leading provider of personal auto insurance in Florida. We collaborate with thousands of agents from the most respected insurance agencies to deliver world-class service and claims experiences-all while continuing to rapidly grow and expand into new territories. Our mission to make auto insurance simple, affordable, and hassle-free; something we deliver on through innovation, feedback, analysis, and a commitment to excellence. Why Join Responsive? Responsive is more than just our name; it's how we do business. It's an idea that extends to our culture too-one that values collaboration along with plenty of fun. We support our employees with a competitive and comprehensive benefits package that pays 100% of employee premiums for medical, dental, and vision coverage, contributes to your Health Savings Account to offset health plan deductibles, matches a percentage of your 401(k) contributions, and offers worry-free paid time off. We also provide top-notch training through our proprietary Claims University program, an accessible executive team, and plenty of opportunities for growth. What You'll Do As an Associate Claims Adjuster, you'll develop the skills needed to effectively manage the claims process through hands-on training and mentorship. Specifically, you'll: Learn the fundamentals of claims adjusting Assist experienced adjusters with processing medical bills Communicate with medical providers, claimants, attorneys, and other parties in both English and Spanish Support the adjustment and administration of claims Maintain accurate and timely claim documentation Other duties as assigned Requirements Qualifications College degree (required) Bilingual in English and Spanish (required) Strong organizational and analytical skills Ability to manage multiple tasks and meet deadlines Professional communication skills (written and verbal) Florida 6-20 Adjuster License preferred, but not required Responsive provides equal employment opportunities (EEO) to all employees and applicants, fostering a diverse and inclusive workplace.

Job DescriptionCLAIMS ADJUSTER (remote) ARC Group seeks two Bodily Injury Claims Adjuster to work in a remote contract role for our direct client based in Fort Lauderdale, FL. This is a 90 day contract to start and could possibly extend. The Claims Adjuster must have experience with bodily injury, liability, and preferably with liability, property damage, and commercial auto. But bodily injury is required. The Claims Adjuster will investigate, evaluate, and negotiate bodily injury claims. The Claims Adjuster will ensure compliance with legal standards and company policies while also coordinating with counsel on the defense of claims. There is a preference for someone on the east coast or central time zones. Our client is a leading insurance underwriter, and this is a great opportunity for a Claims Adjustor to work with a well-established firm (45+ years) that values their employees and life-work balance. Claims Adjuster 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 AdjustEr Qualifications: 3+ years of previous bodily injury insurance experience, investigations or other related fields with liability, and property damage, and commercial auto (preferred) MUST HAVE recent / current work with Bodily Injury/BI claims along with property damage. 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? For immediate consideration, please send your resume directly to Jon Meredith at ******************* or call him at ************. You can also apply directly and view all our open positions 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.

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

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.

Job Description ESSENTIAL DUTIES & RESPONSIBILITIES To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation; including, but not limited to: Serve as a liaison between the plan, claims, providers, and various departments to effectively identify and resolve claims issues. Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication. Review, research, solve and process assigned work. This would include navigating multiple computer systems and platforms (e.g. Verify pricing, prior authorizations, applicable benefits) Audit check run and send claims for corrections. Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes, and procedures (e.g. Claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates tool) Independently complete on a daily basis all documentation and communicate the status of claims as needed adhering to all reporting requirements. Communicate through correspondence with members and providers regarding claim payment or required information, using clear, simple language to ensure understanding. Meet and maintain the performance goals established for the position in the areas of quality, production, and attendance. Performs other duties as assigned. QUALIFICATIONS & EDUCATION High school diploma / GED (or higher) OR 5+ years of equivalent working experience. Knowledge of Medical Terminology, coding, and diagnosis coding is helpful. Excellent verbal and written communication skills. Commitment to excellence and high standards. Strong organizational, problem-solving, and analytical skills. Able to manage priorities and workflow. Demonstrates a high level of professionalism in dealing with confidential and sensitive issues. Ability to work effectively, independently and in a team environment. Ability to deal effectively with a variety of individuals. Fluency in Spanish and English required. Proficiency in computer software (i.e. Microsoft Word, Excel, Power-Point, and Outlook) and the ability to learn new and complex computer system applications (including comfort using short-cut keys/demands). WORKING CONDITIONS The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Interacts with health plan members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances. This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. The work schedule is approximate, and hours/days may change based on company needs.

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.

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