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.
$36k-42k yearly est. Auto-Apply 60d+ ago
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Claims Adjuster (Bodily Injury)
Arc Group 4.3
Claims adjuster job in Oakland Park, FL
Job Description
CLAIMSADJUSTOR (remote - East Coast) ARC Group seeks a Bodily Injury ClaimsAdjuster to work in a remote hybrid role for our direct client based in FL. The ClaimsAdjustor 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 ClaimsAdjusters from surrounding gulf and eastern seaboard states will be considered.
The ClaimsAdjustor 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 ClaimsAdjustor 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
ClaimsAdjustor 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.
ClaimsAdjustor Qualifications:
3+ years of previous bodily injury insurance experience, investigations or other related fields with liability, and property damage, and commercial auto (preferred)
Experience in conflict resolution
Strong negotiation skills
Excellent written and verbal communication skills
Deadline and detail-oriented
Would you like to know more about our new opportunity? You can apply online while viewing all open jobs at *******************
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
We are proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse workforce.
We are a no-fee agency for candidates.
$43k-53k yearly est. 23d ago
Claims Adjuster - Bilingual (Spanish)
Responsive Auto Insurance Company
Claims adjuster job in Plantation, FL
Department: Claims
Schedule: Monday to Friday; flexibility for additional hours as needed.
Salary: Commensurate based on experience and qualifications
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. Responsive stands for making auto insurance simple, affordable, and hassle-free; a promise we deliver through innovation, feedback, and a commitment to excellence.
Why Join Responsive?
At Responsive, we're committed to supporting our team with comprehensive benefits and a positive work environment, including:
Employer-Paid Healthcare: Medical, dental, and vision plans with free preventative care.
Retirement Savings: 401(k) with company match.
Wellness Programs: Mental health support and wellness initiatives.
Career Development: Training and growth opportunities in a collaborative environment.
What You'll Do
As a ClaimsAdjuster, you'll guide customers through the claims process with empathy and expertise. From investigating coverage to resolving disputes, you'll handle claims from start to finish while maintaining strong relationships with customers and stakeholders. Responsibilities include:
Investigating, evaluating, and resolving insurance claims.
Reviewing policies to verify coverage and address coverage issues.
Managing customer interactions with professionalism and accuracy.
Responding to demands, requests, and questions with clear, well-documented communication.
Collaborating with attorneys, medical providers, and other stakeholders.
Maintaining detailed and timely records.
Ensuring compliance with federal, state, and company regulations.
Requirements
What We're Looking For
Education: Bachelor's degree OR high school diploma with 2+ years of relevant experience.
Licensing: Active Florida 6-20 All Lines Adjuster License.
Language Skills: Fluent in Spanish and English (written and verbal proficiency required).
Skills: Strong analytical, problem-solving, and communication skills. Proficiency in Microsoft Office.
Experience: Customer-focused with experience in high-volume environments that require time management and attention to detail.
Mindset: Self-motivated, team-oriented, and adaptable.
Our Culture
Responsive is a dynamic, inclusive workplace where integrity, innovation, and collaboration thrive. We foster an environment where employees are encouraged to:
Adapt: Embrace change and continuously improve.
Collaborate: Work transparently and respectfully with others.
Engage: Show curiosity and a commitment to serving customers and teammates.
Be Data-Driven: Leverage insights to drive decisions and improvements.
Responsive provides equal employment opportunities (EEO) to all employees and applicants, fostering a diverse and inclusive workplace.
$43k-53k yearly est. 60d+ ago
Medical Claim Adjuster
Larkin Community Hospital 4.5
Claims adjuster job in Miami, FL
JOB TITLE: Medical ClaimAdjuster
DEPARTMENT: Patient Accounts
SUPERVISOR: Business Office Director
Larkin Health System is an integrated healthcare delivery system accredited by the Joint Commission with locations in South Miami, Hialeah and Hollywood, Florida. Our network of acute care hospitals provide a complete continuum of healthcare services, including a full range of inpatient and outpatient services, and home health agencies in Miami-Dade and Broward County. We are heavily invested in training the next generation of health professionals, which is the core of our mission: to provide access to compassionate care of the highest quality in an educational environment.
GENERAL JOB DESCRIPTION
Under the direction of the Business Office Director, the Medical ClaimAdjuster is responsible for reviewing and adjusting accounts in accordance with claims processing guidelines.
DUTIES AND RESPONSIBILITIES
Perform adjustments using technical and claims processing expertise.
Identify discrepancies in payments, adjust accounts based on expected amount.
Review and interpret contract language using provider contracts to confirm whether a claim is overpaid or underpaid.
Review denials and ensures posting reflects the appropriate denial reason code.
Review and handle relevant correspondences assigned to the team that may result in adjustments to accounts.
Preforms related duties as required.
QUALIFICATIONS FOR THE JOB
Education:
High School diploma of equivalent (additional certifications or education in medical billing/coding preferred)
Experience
:
1-2+ year's claims processing experience.
Other:
Strong understanding of medical terminology, CPT codes, ICD-10 codes, and insurance billing guidelines.
Excellent numerical and analytical skills, with a keen eye to detail.
Ability to interpret insurance EOBs and payment information accurately.
Strong problem-solving skills, with the ability to reconcile discrepancies and resolve payment-related issues effectively.
$44k-52k yearly est. 19d ago
Field Claims Adjuster
EAC Claims Solutions 4.6
Claims adjuster job in Fort Lauderdale, FL
At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at **********************
Overview:
Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution.
Key Responsibilities:
- Planning and organizing daily workload to process claims and conduct inspections
- Investigating insurance claims, including interviewing claimants and witnesses
- Handling property claims involving damage to buildings, structures, contents and/or property damage
- Conducting thorough property damage assessments and verifying coverage
- Evaluating damages to determine appropriate settlement
- Negotiating settlements
- Uploading completed reports, photos, and documents using our specialized software systems
Requirements:
- Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces
- Strong interpersonal communication, organizational, and analytical skills
- Proficiency in computer software programs such as Microsoft Office and claims management systems
- Self-motivated with the ability to work independently and prioritize tasks effectively
- High school diploma or equivalent required
- Previous experience in insurance claims or related field is a plus but not required
Next Steps:
If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps.
Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.
$43k-53k yearly est. Auto-Apply 32d ago
Independent Insurance Claims Adjuster in Fort Lauderdale, Florida
Milehigh Adjusters Houston
Claims adjuster job in Fort Lauderdale, FL
IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMSADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance ClaimsAdjuster? 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 ClaimsAdjuster, 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 ClaimsAdjuster 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 ClaimsAdjuster.
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 claimsadjusting.
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 claimsadjuster.
Don't miss out on this opportunity-let us assist you in advancing your career in claimsadjusting 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 ClaimsAdjuster. 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.
$43k-53k yearly est. Auto-Apply 60d+ ago
PIP Claims Adjuster (On-site)
Policy Services Company LLC
Claims adjuster job in Coral Springs, FL
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 Floridaadjuster 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
· FloridaAdjuster License.
$43k-53k yearly est. 19d ago
Complex Casualty Adjuster
Sedgwick 4.4
Claims adjuster job in Miami, FL
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. Adjustsclaims with complex coverage issues involving liability, damages, evidence, or other complex legal issues, while providing an exceptional customer experience.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Adjustsclaims 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**
$85k-120k yearly 60d+ ago
Seeking Injury Claims Adjusters!
Morgan & Morgan 4.5
Claims adjuster job in Miami, FL
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
Negotiate case settlements with insurance carriers and negotiate a deduction of outstanding medical balances with providers
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
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.
Negotiating skills.
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.
$33k-39k yearly est. Auto-Apply 23d ago
Senior Claims Specialist
DPR Construction 4.8
Claims adjuster job in Florida City, FL
The Senior Claims Specialist will be responsible for all aspects of complex Construction Defect and Property Damage incidents and claims for DPR (and DPR-related entities), as assigned. Reporting: Role reports to Insured Claims Manager and Insured Claims Leader
Specific Duties Include:
Claims & Incident Management (General):
* Initial triage and processing of incidents received from project teams for DPR (and DPR-related entities).
* Input and/or review all incidents reported in DPR's RMIS system.
* Working with the incident triage group to ensure timely and appropriate review of all incidents
* Ensure all necessary information is compiled to properly manage claims. This includes working with the DPR teams to collect relevant documents such as the Prime contract, Subcontracts, Certificates of Insurance, Owner Policy Documents, Project Documents and Project Specific Coverage information, etc.
* Assess all potential risks, as well as identify all contractual risk transfer mechanisms.
* Analyzing potential insurance coverage for all applicable lines of coverage and report, with all appropriate documents and information, potential claims for DPR (and DPR-related entities) to the broker for any applicable program (Traditional, CCIP, OCIP).
* Assist with the development and training of other DPR Workgroups (and DPR-related entities) around CD/PD Best Practices.
Construction Defect & Property Damage (CD/PD) Specific Claims Managment:
* Manage all assigned claims in DPR's RMIS system relating to Construction Defect and Property Damage matters for DPR (and DPR-related entities). This would include using all appropriate lines of coverage such as Commercial General Liability, Builder's Risk, Property, Contractor's Pollution Liability and Professional Liability, whether the policies are placed by DPR or our Clients.
* Act as a liaison between all parties involved, including but not limited to, carriers, clients, trade partners, brokers, consultants, attorneys and DPR project teams (and DPR-related entities), as it relates to claim progress, strategy, expenses, and settlements.
* Management of and coordination with DPR's consultants and outside attorneys throughout the claim process.
* Continuously analyze claim-specific details as the claim progresses to devise key strategies in conjunction with all internal stakeholders and outside consultants.
* Proactive management and coordination of all phases of the DPR CD/PD Claims Workflow.
Key Skills:
* Basic working knowledge and familiarity of:
* Commercial General Liability
* Property Insurance (Including Inland Marine and Builder's Risk
* Pollution Liability
* Professional Liability
* Controlled Insurance Programs (CCIP/OCIP)
* RMIS Systems
* Construction Industry Expertise
* Strategic thinking
* Strong written and oral communication skills
* High level of EQ (Soft skills)
* Self-Starter
* Highly organized and responsive; ability to meet deadlines
* Detail Oriented
* Contractual risk assessment
* Dispute management
* Integrity
* Ability to mentor and inspire others
* Team player
* Willingness to understand and advance the DPR Culture
* Proactive Learner
Qualifications:
* A minimum of 5-7 years relevant construction industry and/or insurance industry experience.
* Previous experience in construction company Risk Management highly desired.
* Position location - TBD based on location of most qualified candidate.
DPR Construction is a forward-thinking, self-performing general contractor specializing in technically complex and sustainable projects for the advanced technology, life sciences, healthcare, higher education and commercial markets. Founded in 1990, DPR is a great story of entrepreneurial success as a private, employee-owned company that has grown into a multi-billion-dollar family of companies with offices around the world.
Working at DPR, you'll have the chance to try new things, explore unique paths and shape your future. Here, we build opportunity together-by harnessing our talents, enabling curiosity and pursuing our collective ambition to make the best ideas happen. We are proud to be recognized as a great place to work by our talented teammates and leading news organizations like U.S. News and World Report, Forbes, Fast Company and Newsweek.
Explore our open opportunities at ********************
$70k-89k yearly est. Auto-Apply 60d+ ago
Patient Claims Specialist - Bilingual Only
Modernizing Medicine 4.5
Claims adjuster job in Boca Raton, FL
ModMed is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine!
Your Role:
* Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections
* Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates
* Input and update patient account information and document calls into the Practice Management system
* Special Projects: Other duties as required to support and enhance our customer/patient-facing activities
Skills & Requirements:
* High School Diploma or GED required
* Availability to work 9:30-5:30pm PST or 11:30am to 8:30 pm EST
* Minimum of 1-2 years of previous healthcare administration or related experience required
* Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs)
* Manage/ field 60+ inbound calls per day
* Bilingual is a requirement (Spanish & English)
* Proficient knowledge of business software applications such as Excel, Word, and PowerPoint
* Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone
* Ability and openness to learn new things
* Ability to work effectively within a team in order to create a positive environment
* Ability to remain calm in a demanding call center environment
* Professional demeanor required
* Ability to effectively manage time and competing priorities
#LI-SM2
$78k-98k yearly est. Auto-Apply 34d ago
Public Adjuster
The Misch Group
Claims adjuster job in Miami, FL
Department
Insurance & Financial Services
Employment Type
Full Time
Location
Florida
Workplace type
Hybrid
Compensation
$90,000 - $170,000 / year
Key Responsibilities Skills, Knowledge and Expertise Benefits About The Misch Group Stone Hendricks Group is a direct-hire search firm that brings together years of experience and a diverse range of talent to connect businesses with exceptional job candidates. With a focus on timely and effective recruitment, we understand the power of a well-formed employee base in helping businesses achieve their goals. We offer our services to businesses of all sizes, providing qualified candidates for blue- and grey-collar roles, as well as white-collar and executive positions. The success of our direct-hire search process is driven by our advanced training, proprietary technology, and extensive network across industries. At Stone Hendricks Group, we value integrity and prioritize connectedness, commitment, and candor in our interactions with both employers and job seekers. Our clients consider us trusted advisors, relying on the highly personalized service we provide and our ability to find candidates that are an ideal fit for their unique needs. Choose Stone Hendricks Group for unsurpassed direct-hire search services that match successful organizations with talented job candidates.
$40k-55k yearly est. 53d ago
Public Adjuster
Icbd Holding LLC
Claims adjuster job in West Palm Beach, FL
Public Adjuster
Are you a licensed public adjuster looking to stand out in an established but growing company? Get more opportunity to work the big claims at a premier Florida public adjusting firm-Sentry Public Adjusting. We are looking for a hard-working closer who wants be part of a fast growing, professional, ethical and ambitious Public Adjusting Company.
About Sentry Public Adjusting
Sentry Public Adjusting is a full-service public adjusting firm covering the State of Florida. Our team includes licensed adjusters, certified claim estimators, administrative claim support specialists and mortgage liaisons-everything necessary for an adjuster to be successful.
We offer a competitive base salary plus commission commensurate with experience. Our benefits package includes medical, dental, vision, short/long-term disability, life insurance, and 401(k). Our aggressive structure provides an incentive to work hard, help many people in challenging times, and will allow the right candidate to far exceed annual base pay.
Your Position
The licensed Public Adjuster follows up on qualified leads and develops a working relationship with local property managers and businesses who may experience future losses. The public adjuster networks contacts and follows up on client references to help bring in new clients.
What You Will be Doing
· Working efficiently with and managing adjuster apprentices
· Onboarding, signing up, and maintaining communication with clients
· Overseeing claims process from beginning to end
. Maintaining internal systems such as Salesforce and ClaimWizard
· Negotiating, corresponding, and dealing with insurance carriers
· Following up to ensure claims are being properly handled by deadlines
. Attendance at Home Shows on occasional weekends will be required.
· Traveling -regularly travel to appointments within our operational area.
Your Qualifications
· Florida Public Adjuster license 3-20 PCA or licensed in a reciprocal state
· Experience in real estate, construction, or insurance fields is helpful but not necessary
· Strong writing and communication skills including attention to detail
· Proficiency with Microsoft Office
· Highly organized with the ability to juggle multiple deadlines in a fast-paced environment
· Ability to read and interpret contracts
Working Conditions
Candidates must meet the company's hiring criteria to include a pre-employment background investigation and drug test. We are an Equal Opportunity Employer and a drug-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. Must be able to separate personal issues with work issues to ensure healthy relationships with clients.
This is not a work from home position, and you shall be expected to adhere to normal office hours when not on appointments.
As per the nature of the work appointments are governed by the requirements of our customer base, so a willingness to work outside of normal office hours and at weekends will at times be expected.
Staffing Agencies
Unsolicited resumes from search firms will not be honored as valid. Consequently, we politely ask agencies not to solicit our business managers directly as well. Thank you in advance.
Job Type: Full-time
$40k-55k yearly est. Auto-Apply 60d+ ago
Liability Field Adjuster - Miami, FL
CCMS & Associates 3.8
Claims adjuster job in Miami, FL
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)
$47k-63k yearly est. Auto-Apply 60d+ ago
Manager I Claims
1 Legacy
Claims adjuster job in Miami, FL
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.
$41k-82k yearly est. 17h ago
Healthcare Claims Supervisor
Provider Network Solutions 4.1
Claims adjuster job in Miami, FL
Full-time Description
The Claims Supervisor manages the operational activities and staff of the Claims Department in accordance with the Company guidelines, client needs, and State and Federal requirements.
Duties and Responsibilities
• Oversee and manage daily activities and functions of the Claims Examiners processing claims for services that are capitated with the health plan.
• Responsible for overseeing the claim department's daily operations, including but not limited to, running daily/frequent reports to ensure claims are processed timely, accurately, and in compliance with all federal and state healthcare plan laws and regulations.
• Develop, implement, and update Claims Policies and Procedures to ensure compliance with CMS, Medicaid, HIPPA regulations, and health plan requirements.
• Report overpayments, underpayments, and other irregularities.
• Manage and close out claims open tickets and provider claims disputes.
• Ensure optimal handling of all claims, investigate claims issues, and provide claims training for all business units.
• Work together with Provider Servicing and participate in provider education, as necessary.
• Maintain a fully comprehensive understanding of the covered benefits, coding, and reimbursement policies and contracts.
• Act as Subject Matter Expert in issues related to claims processing, payment dispute resolution, cost containment, audit processes, and contract interpretation.
• Actively collaborate with management and staff to ensure that “best practices” are followed and continually seek efficient and innovative processes, technologies, and approaches to optimize the use of resources and enhance operations.
• Conduct analysis around various claims payment processes to ensure accuracy of system configuration and provider payments.
• Investigate and resolve problem claims, while focusing on improving errors and problems to prevent future occurrences.
• Perform and execute various claims process testing requests to ensure desired results are met to support accurate claims payments.
• Analyze and adjudicate complex claims when examiner is requesting Supervisor review.
• Adjudicate claims by, including but not limited to, applying medical necessity guidelines, determining coverage and completing eligibility verification, identifying discrepancies and applying all cost containment measures when necessary.
• Process medical claims by approving or denying documentation, calculating benefits due initiating a payment or denial letter when necessary.
• Follow any center for Medicare and Medicaid (CMS) changes affecting claims processing.
• Perform pre-payment audit and payment cycle.
• Complies with performance standards as set forth by the department head.
• Follow company policies, procedures, and guidelines to ensure legal compliance.
• Update claims knowledge by participating in educational opportunities, whether system oriented or medical coding/terminology/interpretation.
• Update and maintain departmental and specialty network standards of operating procedure (SOP).
• Regularly meet with VP of Operations - to discuss and resolve reimbursement issues or billing obstacles.
• Performs one on one meeting with the individual staff members.
Requirements
Knowledge
• Bachelor's Degree or equivalent experience
• 3-5 years of Claims Management experience in the healthcare organization preferred
• 3-5 years of experience where you were responsible for setting standards and goals that met or exceeded company and client Service Level Agreements (SLA's).
Skills
• Intermediate Excel knowledge required.
• Demonstrated experience developing and lading process improvement projects that drove operations efficiencies.
• An entrepreneurial mindset geared toward creating, executing, and continuously improving health plan operations and implementations.
Salary Description $60,000.00 - $65,000.00 per year
$60k-65k yearly 8d ago
Field Claims Investigator
Phoenix Loss Control
Claims adjuster job in Fort Lauderdale, FL
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.
$25 hourly 25d ago
Claims Specialist
Solis Health Plans, Inc.
Claims adjuster job in Doral, FL
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.
$34k-62k yearly est. Auto-Apply 3d ago
Sr. Property Field Adjuster - Martin County, FL
Vitus Search Group
Claims adjuster job in Boca Raton, FL
Position is responsible for prompt and thorough investigation of routine to moderately complex residential property claims. This is a field-based position involving on-site inspection of insured properties. Regular travel within assigned territory is required. The territory for this position is Martin County, FL
Essential Functions:
Prompt and courteous servicing of property claims, including insured and agency contact and follow through.
Communicate and interact with a variety of individuals to foster the timely resolution of claims, including, but not limited to, policyholders, public adjusters, attorneys, vendors, and experts.
Timely identification, analysis and resolution of coverage issues arising in claims investigation.
Factual investigation of cause of loss.
Coverage determination based on a variety of policy and endorsements.
Maintain proper file documentation reflecting progressive claim handling.
Coverage and Payment Letters necessary to settle and conclude the claim.
Qualifications
Required Education and Experience:
Must maintain a Florida All-Lines adjuster (620) license.
5+ years of property claimsadjustment experience required including at least 2 years of field experience.
2+ years adjusting interior perils.
Preferred Qualifications:
Excellent verbal and written communication skills.
Exceptional customer service skills.
Strong organizational and time management skills.
Knowledge of property insurance policy and coverage analysis.
Must be able to work under deadlines.
Proficient in MS Office, including Word, Excel, PowerPoint, and Outlook.
Strong skills and experience with Xactimate estimating program.
$45k-61k yearly est. 60d+ ago
Claims Manager
Harmony Plus
Claims adjuster job in Doral, FL
The Credit and Collection Manager - Claims has the responsibility of leading and coordinating activities related to credit management, collections and claims administration. His main objective is to ensure efficiency in the recovery of outstanding accounts and the effective resolution of claims, thus contributing to cash flow and customer satisfaction.
- Main responsibilities:
Evaluate the creditworthiness of new clients and establish appropriate credit limits.
Continuously monitor existing accounts, identifying possible risks and taking preventive measures.
Develop effective collection strategies to minimize overdue balances.
Collaborate with the sales team to address problematic accounts and facilitate payment recovery.
Supervise and lead the claims handling process, ensuring timely responses and satisfactory resolutions.
Collaborate closely with relevant departments to address and correct issues that led to complaints.
Generate periodic reports on the performance of credits, collections and claims.
Identify opportunities to improve efficiency in credit, collections and claims management.
Implement best practices and procedures to optimize existing processes.
Ensure compliance with regulations and policies related to credit management, collections and claims.
- Position Requirements:
Minimum of 2 years previous experience in credit, collection or claims management roles.
Solid knowledge of accounting and financial practices.
Analytical skills and ability to make data-driven decisions.
Excellent communication and negotiation skills.
Customer orientation and ability to build strong relationships.
Experience in leadership and team management.
Native bilingual (Spanish / English)
$1,000 per week (negotiable depending on experience)
Schedule Monday to Friday
100% in person - Doral FL location
Package Details
How much does a claims adjuster earn in Weston, FL?
The average claims adjuster in Weston, FL earns between $39,000 and $58,000 annually. This compares to the national average claims adjuster range of $40,000 to $64,000.
Average claims adjuster salary in Weston, FL
$48,000
What are the biggest employers of Claims Adjusters in Weston, FL?
The biggest employers of Claims Adjusters in Weston, FL are: