Claims adjuster jobs in Fort Lauderdale, FL - 150 jobs

* Bachelor's Degree in Business Administration, Risk Management, or closely related field. * A minimum of one (1) to three (3) years progressively responsible experience in investigation, review, and evaluation of insurance liability issues. * All Lines 520 Insurance Adjuster License required within six (6) months of employment. * Must possess and maintain throughout employment, a valid Florida driver license without any restrictions affecting job performance. Driver license must show current address. * All candidates must submit with the application, a Certified Department of Motor Vehicles "entire" driving history. * Florida driving histories can be obtained at any courthouse in Broward County. Three (3) year, seven (7) year, and online Florida driving history records will not be accepted. If you have possessed a driver's license in any other state in the past 10 years you will need to submit an "entire" driving history from that state. For non-Florida driving histories, please contact that state's division of motor vehicles * The search date for all driving histories must be within one month of the date the application for employment is received by the Bureau of Human Resources. * To view information on obtaining the required Certified Department of Motor Vehicles "entire" driving history, please click on the following link: Driving History (in-person) OR Driving History (online) * An equivalent combination of education, training, and experience may be considered. Such training/experience must be clearly demonstrated on the application for consideration. Under administrative direction, the purpose of the position is to perform review, evaluation, analysis, investigation, and adjustment work for claims and liability issues within the Risk Management Division of the Broward Sheriff's Office. Position examines claims and liability issues with intent to prevent and minimize losses to the agency in both short and long term perspectives. Position ensures compliance with established regulatory standards in the conduct of all work. Performs related work as directed.The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification. It is not necessarily descriptive of any one position in the class. The omission of an essential function does not preclude management from assigning duties not listed herein if such functions are a logical assignment to the position. Reviews new liability claims as assigned; determines extent of the investigation required to assess negligence. Reviews and investigates claims, records and documentation for the purpose of evaluating agency liability. Conducts interviews with claimants or representatives for the purpose of securing and requesting facts to determine agency liability. Analyzes and evaluates acquired data to determine if liability exists; prepares correspondence for forwarding to claimant in cases of denial of claim. Implements negotiation strategies and tactical methods to define and develop positions, defenses, and knowledge for assessing relative strengths and/or weaknesses of claims and claimants. Prepares transmittal letters and forwards all claims in suit to defense attorneys, as assigned by administrative supervisor; authorizes and monitors litigation expenditures. Determines extent of financial liability through calculation and proportional adjustment. Prepares and submits case file summaries, to include requests for settlement authority, evaluated negligence/liability, negotiation strategies, and other case specifics. Attends and participates in claims mediation, trials, and case and claims settlement negotiations; discusses cases with defense attorneys; monitors activities of defense attorneys. Maintains complete, accurate, and detailed documentation concerning all claims investigation and adjustment activities. Performs related duties as directed. Tasks involve the ability to exert light physical effort in sedentary to light work, but which may involve some lifting, carrying, pushing and/or pulling of objects and materials of light weight (5-10 pounds). Tasks may involve extended periods of time at a keyboard or workstation. When responding to a scene, some tasks are performed with potential for intermittent exposure to disagreeable elements including, but not limited to, heat, humidity, inclement weather, loud noise, pathogens, violent behavior, and animals. When responding to a scene, tasks may include working around moving parts, vehicles, equipment, carts, and materials handling, where extremely heightened awareness to surroundings and environment is essential in the preservation of life and property. Tasks may be performed in outdoor environments. Tasks may include regular exposure to traffic conditions, where heightened awareness to surroundings and observance of established safety precautions is essential in avoidance of injury or accidents. Broward Sheriff's Office is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, Broward Sheriff's Office will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer.

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.

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.

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.

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.

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.

at Seaboard Marine Long-term employment with opportunities for growth. Discover more about our organization, culture, and employee benefits by visiting this page. Explore life at Seaboard Marine: ************************************************* We offer excellent benefits including: 401(K) Retirement Saving Plan w/ Employer Match Low-Cost Health, Dental & Vision insurance (Starting DAY ONE) Tuition & Certification Reimbursement Paid Time Off - (15 Days; prorated before 1st year) Parental Leave Paid holidays POSITION SUMMARY: In this function, an individual performs within operational procedures that have been developed and has the authority and the ability to interpret and apply laws and regulations to case scenarios and maintain working relationships with customers, attorneys, insurance companies and local authorities. Assignments are generally broad in scope with frequent opportunity for exercising independent judgment in making claims management decisions subject to final review and approval by Claims Supervisor and Claims Manager. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. GEOGRAPHIC REGION:Please note applicants out of the geographic region for position applied will not be considered. QUALIFICATIONS: Required Minimum one (1) year of recent experience as a claim's adjuster working with handling cargo, property, casualty, contents or auto claims. Must possess a general understanding of the usage of a diary-based system to move claims along towards completion. Knowledge of insurance and claims legal vocabulary in order to understand the nature of cargo claims. Knowledge of techniques of investigation, adjustment, negotiation and settlement. Must have intermediate computer skills in programs such as MS Word, Excel & Outlook, etc. Must have advanced communication skills (reading, writing & speaking) both in English and Spanish in order to communicate at different levels throughout the organization, exterior organizations, out port offices, attorneys, etc. Possess strong analytical skills. Possess organizational and time management skills with ability to prioritize and be detail oriented. Ability to conduct effective negotiations with claimants, attorneys and insurance carriers. Ability to express ideas clearly and concisely, verbally and in writing. Ability to analyze define problems, collect data, establish facts, and exercise sound judgment in drawing valid conclusions. Ability to prepare a variety of reports and meet consistent deadlines. Ability to work independently with limited supervision, multitask and possess strong initiative. Ability to establish and maintain effective working relationships with customers, vendors and fellow employees. Ability to think logically, establish and follow procedures, instructions and make sound decisions. Ability to exercise independent judgment within established systems and procedures. Ability to work a flexible schedule, extended hours, holidays, and/or weekends as needed. Possess high energy level, comfortable performing multifaceted projects in conjunction with normal activities. Must have or be able to obtain a TWIC card within 30 days of employment. Preferred Experience handling marine cargo claims Knowledge of Carriage of Goods by Sea Act (COGSA). Bachelor's degree in Business Administration or related field. DUTIES AND RESPONSIBILITIES: Primary Plan, organizes and reviews the investigation, negotiation and preparation of settlement recommendations of a variety of insurance claims; reviews accident reports, losses and litigation claims, reefer claims; and provides intra-company personnel with technical advice and assistance. Manages highly complex investigation of claims, including coverage issues liability, compensability and damages Manages all types investigative activity or litigation or litigation on major claims, including the posting of appropriate reserves in a timely manner Monitoring claims to ensure file handling is compliant with established standards. Analyzes claims activities; prepare and present reports to management and other internal business partners and clients. Miscellaneous tasks to include assignment of survey inspections and provide support in a collaborative effort as needed to department manager as well as co-workers. Attend seminars and workshops to ascertain new development and/or further skills relating to required duties. Provides guidance and assistance to less experienced claims staff and other functional areas. Handling of the duty phone on a rotational basis Performs other job-related duties as assigned. PHYSICAL REQUIREMENTS: While performing the duties of this job, the employee is regularly required to sit and use his/her fingers. The employee frequently is required to talk and/or hear. The employee is continuously required to sit. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus. SAFETY REQUIREMENTS: Report safety hazards. Immediately report incidents involving injury, illness, or property damage. Wear appropriate PPE as instructed by immediate supervisor. Comply with all company safety policies, procedures, and rules. Refuse any unsafe task or operation. Participate in safety meetings and training. Be constantly aware of their personal safety and that of their coworkers. SUPERVISION RECEIVED AND EXERCISED: Receives direct supervision from the Insurance and Claims Manager and the Insurance and Claims Supervisor. Does not exercise supervision over any position. CONDITIONS: Indoors office, controlled temperature environment. The noise level in the work environment is usually quiet. DISCLAIMER: We are an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other protected characteristic as outlined by federal, state, or local laws. If an applicant with a disability is unable or limited in their ability to use or access our online application center as a result of their disability, they can request reasonable accommodations by sending an email to [email protected] The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Job DescriptionDescription: The ideal candidate is an experienced, all-lines adjuster, with at least one year of PIP handling experience for Florida PIP claims, specifically with experience clearing coverage and qualifying claimants for benefits under the policy. The candidate has a strong background in insurance claims processing, excellent communication skills, and the ability to handle complex situations with empathy and professionalism. Adjusters are responsible for assigned files within their department matched to their expertise in claims handling. They must follow protocols set forth by department supervisors/managers and operate within their stated authority and handle claims in accordance with the Florida adjuster code of ethics. Essential Duties and Functions The essential functions include, but are not limited to the following: · Evaluate auto insurance claims promptly and accurately to determine coverage, liability, and settlement options. · Conduct thorough investigations into the circumstances surrounding each claim, including obtaining statements, collecting evidence, and analyzing policy provisions. · Maintain detailed and organized claim files, documenting all relevant information, correspondence, and decisions made throughout the claims process. · Communicate effectively with policyholders, claimants, witnesses, and other involved parties to gather information, explain coverage, and provide updates on claim status. · Negotiate settlements within authorized limits, considering factors such as liability, damages, and policy coverage. · Provide exceptional customer service to policyholders and claimants, addressing inquiries, concerns, and complaints in a timely and professional manner. · Ensure compliance with insurance regulations, company policies, and industry standards in all aspects of claims handling. · Collaborate with internal teams, including underwriters, legal counsel, and other claims professionals, to resolve complex claims and mitigate risk effectively. · Identify opportunities for process improvement and contribute to the development of best practices within the claims department. · Perform quality reviews of claim files to ensure accuracy, consistency, and adherence to company guidelines. · Ensure timecards are reviewed daily for accurate hours worked. Requirements: Minimum Qualifications (Knowledge, Skills, and Responsibilities) · Strong knowledge of insurance principles, regulations, and industry standards. · Excellent analytical skills with the ability to assess liability and evaluate damages. · Exceptional communication and interpersonal skills, both written and verbal. · Proficiency in insurance claims software, preferably Microsoft Office suite. · Demonstrated ability to manage multiple priorities and meet deadlines in a fast-paced environment. · Commitment to providing outstanding customer service and maintaining professionalism in challenging situations. Required Education and Experience: · High School Diploma or equivalent experience in auto claims insurance, business administration, or a related field; Bachelor's or Associates degree preferred. · Minimum of 1+ years of PIP handling experience for Florida PIP claims · Florida Adjuster License.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Complex Casualty Adjuster **PRIMARY PURPOSE** **:** Handles complex, technically challenging claims on automobile, homeowner, and excess liability policies. Adjusts claims with complex coverage issues involving liability, damages, evidence, or other complex legal issues, while providing an exceptional customer experience. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Adjusts claims that arise on Automobile, Homeowner and Excess Liability policies. + Develops exposures and evaluates injury claims based on damages, the insurance contract, company policies, and applicable state laws. + Investigates and evaluates coverage, liability and damages in handling of claims involving serious and catastrophic injuries, coverage, and other legal issues. + Ensures timely referral of suits to counsel and evaluates changes in exposure through the course of discovery, considering costs and strategic plan of actions to prepare for trial or determine settlement capability. + Responsible for managing defense counsel in litigation of serious and complex claim, litigated claims as well as complex coverage scenarios; manages defense counsel in litigation of serious and complex claims. + Formulates effective plans to bring the claims to resolution while focusing on indemnity and expense leakage. + Evaluates coverage and drafts coverage letters to include both reservation of rights and coverage denials. + Maintains proper reserves on all pending claims. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Travel as required **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. State mandated adjusting licenses as required. Insurance designations such as CPCU, AIC, ARM preferred. **Experience** Eight (8) years of related experience to include experience in personal lines claims, evaluating coverage and drafting coverage letters to include both reservation of rights and coverage denials, or equivalent combination of education and experience required. Experience with commercial lines claims and litigation in multiple states preferred. **Skills & Knowledge** + Exposure to and knowledge of affluent market segment + Strong knowledge of tort theories, legal concepts, negotiation strategies, and litigation management + Excellent oral and written communication skills, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent interpersonal skills + Excellent negotiating skills + Ability to create and complete comprehensive, accurate and constructive written reports + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Computer keyboarding, travel as required **Auditory/Visual** **:** Hearing, vision and talking As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($85,000 - $120,000 USD annually). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Loyalty MGA is looking for a detail-oriented and customer-focused Total Loss Claims Adjuster to handle claims involving total loss vehicles. This position offers a hybrid work schedule upon successfully completing the company's probation period. This role involves investigating, evaluating, and resolving total loss claims efficiently while providing excellent customer service. Key Responsibilities: Investigate, evaluate, and resolve total loss claims in compliance with company policies and procedures. Determine the value of totaled vehicles using industry tools and guidelines. Communicate with policyholders, claimants, and third parties to gather necessary information and explain the claims process. Coordinate with appraisers, salvage vendors, and other relevant parties to ensure timely resolution of claims. Review and verify all claim documentation, including police reports, repair estimates, and titles. Negotiate settlements with claimants, ensuring fairness and adherence to policy terms. Maintain accurate records of claim activities and decisions in the claims management system. Ensure compliance with state regulations and company policies throughout the claims process. Identify potential fraud indicators and escalate suspicious claims as needed. Provide exceptional customer service by addressing questions and concerns promptly and professionally. 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. Bilingual in English and Spanish is required

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

**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 *************************************************************

Work Arrangement: ON SITE This role is responsible for the direct supervision and development of internal and external claims staff, ensuring timely, accurate, and compliant investigation, evaluation, and resolution of property claims. The Claims Manager plays a critical role in driving operational excellence, loss control, customer satisfaction, and regulatory compliance while supporting catastrophe readiness and response. Key Responsibilities Provide leadership, oversight, and direct supervision of property claims adjusters to ensure compliance with company procedures, policy language, and regulatory requirements. Review new property claims and assign cases appropriately based on complexity, workload, and expertise. Evaluate claims and provide guidance and settlement authority to claims staff. Conduct open and closed file reviews to assess quality, accuracy, and operational effectiveness. Perform case reviews and prepare settlement evaluations, including oversight of large or complex claims. Manage loss costs, loss adjustment expenses, and claim reserves to support financial performance. Analyze reports and data to identify trends, risks, and improvement opportunities; communicate findings to leadership. Collaborate with policyholders, independent adjusting firms, attorneys, vendors, and other stakeholders as needed. Identify complex claims and develop appropriate strategies and resolution plans. Research, interpret, and apply policy language and applicable state laws and regulations. Personally handle high-exposure or complex claims, including negotiations and settlement discussions. Attend mediations, settlement conferences, and legal proceedings as required. Participate in system testing, process improvements, and departmental initiatives. Support catastrophe planning and response efforts, including extended hours during CAT events. Assist with department policy and procedure development, strategic planning, and goal setting. Communicate effectively with Claims leadership, Underwriting, Human Resources, Finance/Accounting, agents, and external partners. Build, mentor, and develop high-performing claims teams focused on quality service and continuous improvement. Support recruiting, interviewing, hiring, onboarding, and performance management of claims and related staff. Maintain compliance with all federal and state regulations, company policies, and ethical standards. Travel, including overnight, may be required. Qualifications Associate's Degree required; Bachelor's Degree preferred (or equivalent combination of education and directly related experience). Active Florida 6-20 Adjuster License required. Minimum 4 years of supervisory experience leading personal and/or commercial property claims professionals. Extensive knowledge of property claims handling, practices, and legal terminology. Proven experience training and coaching staff on claims processes and procedures. Strong understanding of insurance operations and cross-functional collaboration. Hands-on experience with Xactimate, XactAnalysis, and XactNet. Proficiency in Microsoft Office; experience with internet research tools preferred. Customer-focused leader with strong communication and relationship-building skills. Results-driven with excellent analytical, problem-solving, and decision-making abilities. Ability to work independently in a fast-paced, deadline-driven environment with shifting priorities. Highly organized, detail-oriented, and collaborative team leader. Equal Employment Opportunity We are an Equal Opportunity Employer and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.

Job Description Job Type: Contract Workplace Type: Hybrid (50% remote, 50% fieldwork) Compensation: $25/hr plus $.50/mi Phoenix Loss Control (PLC) is a US-based business services provider in the cable, telecom, and utilities sector. PLC's core service is outside plant damage investigation, recovery, and prevention. Across the US and parts of Canada, we help our clients recover the costs of third-party damage to their infrastructure, such as underground fiber optic or gas lines. PLC currently employs over 140 people, servicing some of the largest cable and telecoms operators (e.g., Comcast, Spectrum, AT&T, and Google). PLC is currently aggressively expanding its business and looking for talented and energetic people to bring onboard to help drive growth. POSITION SUMMARY Outside Plant Damage (OPD) costs our clients over 30 million annually. Field investigators are needed to collect, access, and report these damages. This is a part-time, on-call contract job to help support our clients with damage recovery. For our field investigators, each day and every investigation is different. We need inquisitive, self-driven individuals who are comfortable rolling up their sleeves and working in a constantly changing, dynamic environment. Duties Conduct on-site field investigations Write detailed but concise investigation reports using diverse sources of information, types of evidence, witness statements, and costing estimates Develop and maintain comprehensive knowledge of local and state statutes, laws, and regulations for underground and aerial cables and utility service lines Remain prepared and willing to respond to damage calls within a timely manner Complete damage investigations within 7 days and then work with and support our claims managers to complete the investigation and begin the recovery process Respond to damages same day if received during business hours (if not, first response following day) Accurately record all time, mileage, and other associated specific items Requirements Interpersonal skills to gather information and conduct field interviews with involved parties including contractors and technicians, witnesses, law enforcement, and possible damagers Smartphone to gather photos, videos, and other information while conducting investigations Computer, with high-speed internet access, to upload and download reports, research cases, and to interact with our claims system and other databases and portals Exceptional attention to detail and strong written and verbal communication skills Proven ability to operate independently and prioritize while adhering to timelines Strong and objective analytical skills Valid driver's license, current insurance, and reliable vehicle with ability to respond to damages at any time Safety vest, work boots, and hard-hat Preferred Qualifications and Skills Current or previous telecommunication or utility experience Knowledge of underground utility locating procedures and systems Investigation, inspection, or claims/field adjusting Criminal justice, legal, or military training or work experience Engineering, infrastructure construction, or maintenance background Remote location determined at discretion of investigations manager This is a contract position. There are no benefits offered with this position.

The Claims FWA Manager is responsible for leading initiatives to detect, prevent, and mitigate fraud, waste, and abuse within claims operations, with a strong focus on cost containment and operational efficiency. Reporting directly to the COO, this role plays a critical part in safeguarding financial integrity, optimizing claims processes, and deploying advanced tools and analytics to reduce exposure to fraudulent activities while maintaining a positive customer experience. ESSENTIAL JOB DUTIES AND RESPONSIBILITIES: • Claims Cost Containment & Risk Mitigation: · Develop and implement strategies to reduce fraudulent and abusive claims, minimizing financial leakage. · Analyze claims data to identify patterns, anomalies, and high-risk areas for cost containment. • Investigations & Analytics: · Lead investigations into suspicious claims and provider activities, ensuring timely resolution and recovery. · Coordinate reviews with Risk and Legal areas, to ensure accurate fraud assessments. · Utilize predictive modeling, data mining, and fraud detection tools to enhance claims oversight. • IT Collaboration & Tool Deployment: · Partner with IT teams to define requirements for fraud detection and claims analytics tools. · Lead User Acceptance Testing (UAT) and oversee deployment of new systems and enhancements with embedded FWA controls. · Drive automation and digitalization initiatives to improve fraud detection and claims efficiency. • Strategic Leadership & Cross-Functional Collaboration: · Work closely with Provider Relations, IT, Finance, Underwriting, Legal and Customer Service to embed FWA controls into claims workflows. · Act as a key liaison for strategic projects impacting claims operations and fraud prevention. · Provide regular updates to the COO on fraud trends, cost containment results, and technology initiatives. • Reporting & Continuous Improvement: · Develop dashboards and management reports highlighting fraud trends, cost savings, and operational improvements. · Recommend process enhancements based on data-driven insights and emerging fraud schemes. • Training & Awareness: · Deliver training programs to claims teams on fraud detection techniques and cost containment strategies. · Promote a culture of vigilance and accountability across claims operations. Qualifications DESIRED MINIMUM QUALIFICATIONS AND EDUCATION: • Education: · Bachelor's degree in Business Administration, Finance, Insurance, or related field. • Experience: · Minimum 8-10 years in health or medical insurance claims operations with a strong focus on fraud detection and cost containment. · Proven track record in managing FWA programs and leading investigative teams. · International Health Insurer experience preferred • Technical Skills: · Expertise in claims systems, fraud detection platforms, and data analytics tools. · Advanced Microsoft Excel and familiarity with SQL or similar query languages. • Certifications (Preferred): · Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), or equivalent. • Language Requirements: · Bilingual (Spanish and English) required; Portuguese preferred. • Additional Skills: · Strong analytical and investigative skills with attention to detail. · Excellent communication and stakeholder engagement abilities. · Ability to lead projects and thrive under pressure in a fast-paced environment.

At Morgan & Morgan, the work we do matters. For millions of Americans, we're their last line of defense against insurance companies, large corporations or defective goods. From attorneys in all 50 states, to client support staff, creative marketing to operations teams, every member of our firm has a key role to play in the winning fight for consumer rights. Our over 6,000 employees are all united by one mission: For the People. Summary We are seeking a Case Manager to join our team. As a Case Manager you must be highly organized and able to work on a varied caseload. The Case Manager will assist the attorney in developing settlements, preparing documents and correspondence as needed. The ideal candidate is customer focused and empathetic. Responsibilities Daily interaction with existing and potential clients, via telephone and in person. Order medical records from providers and communicate with clients and providers during the course of treatment. Obtain documents necessary to support injury and/or liability positions Interact with insurance carriers and healthcare providers to secure records and account balances Work directly with multiple coworkers involved in the management and support of case files Maintain organized case files. Prepare comprehensive demands and assemble support for submission to carriers under the direct supervision of an attorney Interact with attorneys and present case synopsis when required Manage case files from intake to closing under the direction of an attorney Performs other related duties as assigned to meet the needs of the business. Qualification Bachelor's degree (preferred) Prior experience as a Personal Injury Case Manager preferred. At least 2 years of working in a legal position or insurance adjuster experience preferred. Ability to be a team player and follow procedures. Proactive interaction with clients, insurance companies and medical providers. Must possess the ability to multi-task, prioritize, and manage workload with a positive attitude and minimal supervision. Highly organized with the ability to juggle multiple deadlines in a fast-paced environment Strong writing and communication skills along with attention to detail Extensive computer and database expertise, Microsoft Word, Excel, Outlook, and type no less than 35 wpm. Not remote eligible. #LI-MP1 Benefits Morgan & Morgan is a leading personal injury law firm dedicated to protecting the people, not the powerful. This success starts with our staff. For full-time employees, we offer an excellent benefits package including medical and dental insurance, 401(k) plan, paid time off and paid holidays. Equal Opportunity Statement Morgan & Morgan provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. 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. Privacy Policy Here is a link to Morgan & Morgan's privacy policy.

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

Job Description CCMS & Associates is looking for 1099 Field Liability Adjusters. We are answering a call to action to add to our existing roster. The time is now to get on with our innovative team! We are seeking auto/homeowners/general liability field adjusters with at least 5 years of field experience. Requirements: Minimum 5 years auto and/or premise liability adjusting experience Working computer/laptop - internet access and Microsoft Word required Must demonstrate strong time management and customer service skills State adjusters license (where applicable) Must have a valid drivers license Responsibilities: Conduct in-depth investigations into liability claims to gather facts regarding the loss Investigate claims by obtaining recorded statements from insureds, claimants, or witnesses, and by interviewing fire, police, or other government officials as well as inspecting claimed damages Inspect damage to property and obtain personal injury information to assist in determining liability Maintain acceptable product quality through compliance with established best practices Knowledge and Skills: In-depth knowledge of property and liability insurance coverage and industry standards Ability to prepare full-captioned reports by collecting and summarizing required information Strong verbal and written communication skills Prompt, reliable, and friendly Detail-oriented individual to accurately gather and analyze information to avoid errors Preferred but Not Required: College degree Professional designations and certifications All candidates must pass a full background check (void in states where prohibited) Powered by JazzHR 5N24n1uB9U

will include, but are not limited to: Responsible for directing the planning, design, development, implementation and evaluation of policies and procedures that assure accurate, timely claims and encounter processing and provider inquiries (written or verbal). Assure timely and accurate processing of Medicare claims and encounters, and respond to provider telephone calls, written inquiries, and appeals. The compilation of all information and documents required for claims and encounter processing and related inquiries to assure compliance with all applicable rules, regulations, and external and internal policies and procedures The review of provider contracts and configuration of these contracts within the claims processing system to assure accurate payments to our providers Collaboration and communication with other SHP departments on claims and encounter issues, related projects and inter-departmental operations issues Development and maintenance of well-defined processes to enter, adjust, manage and report claims and encounters data Preparation and timely submission of management and regulatory reports Generation of configuration requests to assure accurate, timely administration of providers claims and processing and reporting of encounters Maintain a full comprehensive understanding of the covered benefits, coding and reimbursement policies and contracts Production and submission of reports as required Analyze, track and trend claims and encounters data; identify any potential service or systems issues;implement interventions and determine success of interventions Qualifications Requirements: BA/BS degree preferred with at least 5 years of relevant professional experience, and the following OR any combination of education and experience which would provide an equivalent background: Minimum of 2 years of managerial experience at the department manager level preferred. Minimum of 5 years of Medicare/Medicaid claims experience that demonstrates progressive growth within claims operations. Extensive knowledge of claims policies and procedures, including industry standards from Medicaid, CMS, and CCI Edits. Excellent oral and writing skills. Highly developed quantitative and qualitative analytical skills. Highly developed project management skills. Additional Information All your information will be kept confidential according to EEO guidelines.