Claims representative jobs in Daytona Beach, FL - 30 jobs
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Claims Representative
Claim Specialist
Claims Adjuster
Claims Administrator
Claim Processing Specialist
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Claims Technician
Commercial Auto Claim Specialist
Cannon Cochran Management 4.0
Claims representative job in Maitland, FL
Commercial Auto - Multi Line Claim Specialist
Hours: Monday - Friday, 8:00 AM to 4:30 PM ET
Salary Range: $83,000-$100,000 (commensurate based on experience)
Build Your Career With Purpose at CCMSI
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.
We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified
Great Place to Work
, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.
The Multi-Line Claim Specialist position is responsible for the investigation and adjustment of assigned general liability claims.
Experience in commercial trucking with litigation and/or the ability to handle attorney represented settlements and some litigation. This role will be for a dedicated trucking client that will require consistent communication and trust building. Adjuster will need to be able to be available for calls but also provide reasoning and recommendation in a consultative manner. This role will join a small but mighty dedicated team. This position may be used as an advanced training position for promotion consideration for supervisory/management positions. The position is also accountable for the quality of multi-line claim services as perceived by CCMSI clients and within our corporate claim standards.
Responsibilities
Investigate, evaluate and adjust multi-line claims in accordance with established claim handling standards and laws.
Establish reserves and/or provide reserve recommendations within established reserve authority levels.
Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated multi-line claims. Negotiate any disputed bills or invoices for resolution.
Authorize and make payments of multi-line claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
Assist in the selection, referral and supervision of designated multi-line claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
Review and maintain personal diary on claim system.
Assess and monitor subrogation claims for resolution.
Compute disability rates in accordance with state laws.
Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the multi-line claim adjustment process.
Provide notices of qualifying claims to excess/reinsurance carriers.
Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent oral and written communication skills.
Initiative to set and achieve performance goals.
Good analytic and negotiation skills.
Ability to cope with job pressures in a constantly changing environment.
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with minimum supervision.
Discretion and confidentiality required.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
10+ years multi-line claim experience is required.
Bachelor's Degree is preferred.
Computer Skills
Proficient with Microsoft Office programs.
Certificates, Licenses, Registrations
Adjusters license may be required based upon jursidiction.
AIC, ARM or CPCU Designation preferred.
Nice to Have:
• Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required.
Why You'll Love Working Here
• 4 weeks PTO (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year
• Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
• Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
• Career growth: Internal training and advancement opportunities
• Culture: A supportive, team-based work environment
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
Quality claim handling - thorough investigations, strong documentation, well-supported decisions
Compliance & audit performance - adherence to jurisdictional and client standards
Timeliness & accuracy - purposeful file movement and dependable execution
Client partnership - proactive communication and strong follow-through
Professional judgment - owning outcomes and solving problems with integrity
Cultural alignment - believing every claimrepresents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us.
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits.
Visa Sponsorship:
CCMSI does not provide visa sponsorship for this position.
ADA Accommodations:
CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team.
Equal Opportunity Employer:
CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Background checks are conducted only after a conditional offer of employment.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:
Lead with transparency We build trust by being open and listening intently in every interaction.
Perform with integrity We choose the right path, even when it is hard.
Chase excellence We set the bar high and measure our success. What gets measured gets done.
Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
Win together Our greatest victories come when our clients succeed.
We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
#CCMSICareers #CCMSIMaitland #EmployeeOwned #ESOP #GreatPlaceToWorkCertified #ClaimsSpecialist #LiabilityClaims #HybridWork #FloridaJobs #InsuranceCareers #GeneralLiability #AutoClaims #MultiJurisdiction #FLAdjusters #CommercialAuto #NowHiring #InsuranceJobs #FLLiability #IND123 #LI-Hybrid
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$83k-100k yearly Auto-Apply 6d ago
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Inside Claims Rep- Maitland, FL
Sfbcic
Claims representative job in Maitland, FL
This job is with Florida Farm Bureau which is the Florida state office for Southern Farm Bureau Casualty Insurance Company, and we currently have an opening for an Inside ClaimsRepresentative to work in Maitland, FL. This position is responsible for resolving damage and injury claims caused by or incurred by insureds. Starting salary of $54,800. We offer many benefits including health, dental, vision, PTO, Extended Illness Leave, Pension and matching 401K.
ESSENTIAL DUTIES AND RESPONSIBILITES: Include the following. Other duties may be assigned.
Investigate, validate, evaluate, negotiate, and settle all claims as assigned.
Maintain claim files and follow departmental reporting procedures.
Submit reserve recommendations on assigned claims.
Communicate with customers and other Claims personnel regarding procedures, problems, and coverages.
Enroll in training and continuing education courses when and where required.
Negotiate fair settlements with individual claimants or attorneys.
Report risk reviews to Underwriting Department.
Regular and predictable attendance is required.
EDUCATION and/or EXPERIENCE:
Bachelor's degree from four-year college or university
Obtain Adjuster's license in 6 months
SKILLS/ABILITY
Strong Verbal communication & listening skills
Effective negotiation skills
Effective conflict management skills
Ability to simultaneously handle multiple priorities
Possesses strong product knowledge
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally required to sit at a desk or table with some walking, standing, bending, stooping or carrying of light objects. The employee frequently is required to perform continuous operations of personal computer for four hours or more and use their hands to finger, handle, or feel objects, tools, or controls; and talk or hear. Specific vision abilities required by this job include close vision.
$54.8k yearly 48d ago
Liability Claims Specialist (Construction Defect)
CNA Financial Corp 4.6
Claims representative job in Lake Mary, FL
You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
This individual contributor position works under moderate direction, and within defined authority limits, to manage third party liability construction defect commercial claims with moderate to high complexity and exposure. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s).
JOB DESCRIPTION:
Essential Duties & Responsibilities:
Performs a combination of duties in accordance with departmental guidelines:
* Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
* Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information.
* Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols.
* Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
* Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims.
* Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
* Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
* Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation.
* Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
* Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.
* May serve as a mentor/coach to less experienced claim professionals
May perform additional duties as assigned.
Reporting Relationship
Typically Manager or above
Skills, Knowledge & Abilities
* Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
* Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed.
* Demonstrated ability to develop collaborative business relationships with internal and external work partners.
* Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions.
* Demonstrated investigative experience with an analytical mindset and critical thinking skills.
* Strong work ethic, with demonstrated time management and organizational skills.
* Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
* Developing ability to negotiate low to moderately complex settlements.
* Adaptable to a changing environment.
* Knowledge of Microsoft Office Suite and ability to learn business-related software.
* Demonstrated ability to value diverse opinions and ideas
Education & Experience:
* Bachelor's Degree or equivalent experience.
* Typically a minimum four years of relevant experience, preferably in claim handling.
* Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience.
* Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
* Professional designations are a plus (e.g. CPCU)
#LI-KP1
#LI-Hybrid
In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
$54k-103k yearly Auto-Apply 29d ago
Claims Representative
Everstaff 3.8
Claims representative job in Daytona Beach, FL
Join a Leading Team - Direct Hire | Sign-On Bonus | Hybrid Opportunity! We're hiring detail-oriented and customer-focused ClaimsRepresentatives for a reputable client located in Daytona Beach. In this role, you'll be responsible for efficiently reviewing, processing, and resolving insurance claims while ensuring full compliance with internal policies and industry regulations.
What's In It for You?
Pay: $17
Direct hire opportunity with a stable organization
Sign-on bonus available
Hybrid schedule available after training
Comprehensive benefits package: medical, dental, and vision insurance
Ongoing professional development and training opportunities
Work Schedule
Training: Monday-Friday, 8:00 AM - 4:30 PM
Post-Training: Flexible shifts available between 6:00 AM - 8:00 PM
Key Responsibilities
Accurately review and process insurance claims within specified timeframes
Communicate with policyholders, claimants, and other involved parties to gather information and provide claim updates
Maintain thorough and accurate records in internal claims systems
Ensure adherence to regulatory guidelines and company policies
Keep current with industry standards and procedural updates
Qualifications & Skills
High school diploma or equivalent required
Experience in claims processing, insurance, or customer service is a plus
Strong problem-solving and analytical abilities
Clear and professional verbal and written communication skills
Ability to handle multiple tasks and prioritize effectively in a fast-paced environment
Proficiency in Microsoft Office Suite; experience with claims management software is a bonus
Familiarity with insurance procedures and compliance regulations is preferred
Ready to bring your attention to detail and customer service skills to a growing team? Apply today!
All qualified applicants will receive consideration for employment without regard to race, color, religion, ethnicity, national origin, sex, gender identity, sexual orientation, disability status, protected veteran status or any other protected status under the law. EverStaff is an equal opportunity employer (M/F/D/V/SO/GI).
$17 hourly 42d ago
Copay Support/Claims Processing Specialist
Assistrx 4.2
Claims representative job in Maitland, FL
The Copay Support/Claims Processing Specialist is a critical role within the organization and is responsible for servicing inbound calls, EOB faxes, and mail (emails, USMail) from pharmacies, patients, Sites of Care, Health Care Providers, copay vendors (PDMI, FHA and Merchant Card processors) and other sources. Required engagement is with pharmacy claim adjudicators, third party medical claim administrators, merchant vendors, finance for manual claim reimbursement, Sites of Care and Health Care Providers.
The Copay Support/Claims Processing Specialist will adjudication, troubleshoot claim rejections, claim reversals, allocation deficiencies, identifying group accumulator and maximizers, provide alternate payment processing method, handle paperwork related to medical procedures, treatments and services submitted by the site of care or health care providers that meet the program business rules for determination of approval, denial, or pending for submission of required information for final determination as well as claim appeal handling.
Quality control of commercial copay programs.
Collaborate with internal HUB teams on enrollment discrepancies (missing info and duplicates)
Partners with claim adjudication vendors ensure proper claims processing and data integrity.
Monitor and remediate medical and pharmacy manual data entry errors
Serve as Subject Matter Expert for internal and external stakeholders on medical and pharmacy Copay claim adjudication issues and platform logic variations.
Provide ongoing insights on specific program trends and system/process opportunities.
Patient and Prescriber Support:
Act as the primary point of contact for handling inquiries from prescribers, patients, external clients, and internal program team members.
Subject Matter Expert on reviewing and processing of medical claims submitted for copay programs where the therapy is primarily processed through a medical benefit
Thorough understanding of copay program design and elements eligible for payment processing
Ensure proper CMS form and EOB is provided for each eligible item
Validate required elements for payment approval are present
If not partner with HUB to secure missing information
Create manual medical reimbursement record for submission to finance
Review Directive Analytics against Net-Suite and make necessary corrections
Identify applicable programs and guide stakeholders through next steps for patient support.
Accept inbound calls, team chats, and emails. Ensure one-call resolution for patients and providers.
Communicate status updates across all patient support activities in a holistic, clear, and professional manner.
Liaise with program-specific AssistRx resources to secure outcomes and resolve escalations.
Maintain accurate documentation and ensure protection of patient and prescriber information.
Requirements
High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience.
Associate's Degree (AA) or equivalent from a two-year college or technical school, or six months to one year related experience and/or training, or equivalent combination of education and experience.
Computer skills required: Contract Management Systems; Microsoft Office
Other skills required: Pharmacy Data Management (PDMI), PNC Card Platform
COMPETENCIES:
Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.
Innovation - Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention.
Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.
Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
Benefits
Supportive, progressive, fast-paced environment
Competitive pay structure
Matching 401(k) with immediate vesting
Medical, dental, vision, life, & short-term disability insurance
Why Choose AssistRx:
Preloaded PTO: 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary.
Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary.
Impactful Work: Join a team that is at the forefront of revolutionizing healthcare by improving patient access to essential medications.
Flexible Culture: Many associates earn the opportunity to work from home after 120 days. Enjoy a flexible and inclusive work culture that values work-life balance and diverse perspectives.
Career Growth: We prioritize a “promote from within mentality”. We invest in our employees' growth and development via our Advance Gold program, offering opportunities to expand skill sets and advance within the organization.
Innovation: Contribute to the development of groundbreaking solutions that address complex challenges in the healthcare industry.
Collaborative Environment: Work alongside talented professionals who are dedicated to collaboration, learning, and pushing the boundaries of what's possible.
Tell your friends about us! If hired, receive a $750 referral bonus!
Wondering how we recognize our employees for delivering best in class results? Here are some of the awards that our employees receive throughout the year!
#TransformingLives Honor: This quarterly award program is a peer to peer honor that recognizes and highlights some of the amazing ways that our team members are transforming lives for patients on a daily basis.
Values Award: This quarterly award program recognizes individuals who exhibit one, or many, of our core company values; Excellence, Winning, Respect, Inspiration, and Teamwork.
Vision Award: This annual award program recognizes an individual who has gone above and beyond to support the AssistRx vision to transform lives through access to therapy.
AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws.
All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check.
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position.
AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire.
$73k-106k yearly est. Auto-Apply 3d ago
Claims Specialist - Auto
Philadelphia Insurance Companies 4.8
Claims representative job in Lake Mary, FL
Marketing Statement:
Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best.
We are looking for a Claims Specialist - Auto to join our team.
JOB SUMMARY
Investigate, evaluate and settle more complex first and third party commercial insurance auto claims.
JOB RESPONSIBILITIES
Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner.
Communicates with all relevant parties and documents communication as well as results of investigation.
Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts.
Travel is required to attend customer service calls, mediations, and other legal proceedings.
JOB REQUIREMENTS
High School Diploma; Bachelor's degree from a four-year college or university preferred.
10 plus years related experience and/or training; or equivalent combination of education and experience.
• National Range : $82,800.00 - $97,300.00
• Ultimate salary offered will be based on factors such as applicant experience and geographic location.
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Benefits:
We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online.
Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************
$82.8k-97.3k yearly Auto-Apply 60d+ ago
Independent Insurance Claims Adjuster in Deltona, Florida
Milehigh Adjusters Houston
Claims representative job in Deltona, FL
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.
$42k-52k yearly est. Auto-Apply 60d+ ago
Daytona Beach Property Adjuster
Cenco Claims 3.8
Claims representative job in Daytona Beach, FL
CENCO Claims is hiring a field-based Residential Property Claims Adjuster to service daily claims in the Daytona Beach, FL area. This role is ideal for adjusters looking for steady work, flexible scheduling, and reliable support from an established claims team.
Role Overview:
Inspect residential properties to evaluate loss and damage
Write accurate estimates using Xactimate
Document claims with detailed photos and organized reporting
Communicate clearly and professionally with policyholders and carriers
Deliver complete claim files within required timeframes
Qualifications:
Proficiency with Xactimate estimating software
Working knowledge of residential property damage and repair methods
Strong organizational skills and attention to detail
Dependable transportation and a valid driver's license
Active Florida or designated home state adjuster license
What You Can Expect:
Competitive compensation per assignment
Consistent residential claim volume in the Daytona Beach market
Flexible scheduling based on your availability
Ongoing guidance and support from experienced claims staff
Opportunities for continued assignments and long-term collaboration
Ready to get started? Apply today and put your skills to work with CENCO Claims.
$42k-58k yearly est. Auto-Apply 60d+ ago
Claims Specialist
Mindlance 4.6
Claims representative job in Lake Mary, FL
My name is Pondsy Anthony , and I am Recruiting Specialist with Mindlance Inc . I have reviewed your resume and at a first glance find it to be a good fit for a Position that we are exclusively recruiting for. We are working very closely with our Client based in
FL
to fill this requirement urgently. This is a 4+ months of contract position with a possible extension depending on performance. You can get back to me at
************
to discuss in detail.
Job Description
Job Title: Claim Specialist
Client Location : 255 Technology Park, Lake Mary, FL 32746
Contract Duration : 4+ months (High possibility of Extension)
***Info about Schedules:
- Candidates being selected need to be open for the contractor shift of either
9a-6p or 10a-7p or 11-8.
- If contractors are hired on, they have to be available for shifts like 11a-8p
and 12p-9p. Please let candidates know this!
Looking for :-
Candidates must have reimbursement experience that is within the past 6 months
Prior authorization - submission, review, support, completion, verification
Appeal - submission, review, support, completion, verification, coordination
Reimbursement - investigation, verification
JOB SUMMARY:
The primary function/purpose of this job:-
Verify member submitted claims forms, member's eligibility and pharmacy
information is complete and accurate, updating system information as needed.
Superior data entry proficiency is expected in order to provide accurate and
timely processing of claims submitted by member, pharmacy or appropriate
agency. Moderate knowledge of drugs and drug terminology used daily. Process
claims according to client specific guidelines while identifying claims
requiring exception handling. Navigate daily through several platforms to
research and accurately finalize claim submissions. Oral or written
communication with internal departments, members, pharmacies or agencies to resolve
claim issues. Adhere to strict HIPAA regulations especially when communicating
to others outside of Express Scripts. Prioritize and coordinate influx of daily
workload for claims processing, returned mail and out-going correspondence and
e-mails to assure required turnaround time is met. Assess accuracy of system
adjudication and alert management of potential problems affecting the integrity
of claim processing. Analyze claims for potential fraud by member or pharmacy.
May be required to work on special projects for claims team.
SCOPE OF JOB
Reimbursement
verification of enrollments
MINIMUM QUALIFICATIONS TO ENTER THE JOB:
Formal Education and/or Training: High school diploma or equivalent required, some
college or technical training preferred
YEARS OF EXPERIENCE:
Two years' experience in P.B.M. environment is helpful but not required.
KNOWLEDGE AND ABILITIES:
• Strong data entry and 10-key skills
• Retail pharmacy, customer service experience helpful but not required
• PC and MS Office literate
• Strong attention to detail
• Excellent retention and judgment ability
• Proficient written and oral communication skills
• Ability to work in fast-paced, production environment
• Reliable, self-motivated with excellent attendance
• Team player who has the ability to stay on task with little supervision
Qualifications
•
Prior authorization - submission, review, support, completion, verification
• Appeal - submission, review, support, completion, verification, coordination
• Reimbursement - investigation, verification
Additional Information
All your information will be kept confidential according to EEO guidelines.
$37k-51k yearly est. 1d ago
Field Claims Adjuster
EAC Claims Solutions 4.6
Claims representative job in Deltona, 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.
$42k-51k yearly est. Auto-Apply 6d ago
Claims Adjuster Trainee
Frontline Homeowners Insurance
Claims representative job in Lake Mary, FL
Job Description
Claims Adjuster Trainee
Onsite in Lake Mary, FL
At Frontline Insurance, we are on a mission to Make Things Better, and our Claims Adjuster Trainee plays a pivotal role in achieving this vision. We strive to provide high quality service and proactive solutions to all our customers to ensure that we are making things better for each one.
What makes us different? At Frontline Insurance, our core values - Integrity, Patriotism, Family, and Creativity - are at the heart of everything we do. We're committed to making a difference and achieving remarkable things together. If you're looking for a role, as a Claims Adjuster Trainee, where you can make a meaningful impact and grow your career, your next adventure starts here!
Our Claims Adjuster Trainee enjoy robust benefits:
Health & Wellness: Company-sponsored Medical, Dental, Vision, Life, and Disability Insurance (Short-Term and Long-Term).
Financial Security: 401k Retirement Plan with a generous 9% match
Work-Life Balance: Four weeks of PTO and Pet Insurance for your furry family members.
What you can expect as a Claims Adjuster Trainee:
Orientation & Licensing - Complete onboarding and obtain required state licensing.
Policy Interpretation - Learn insurance policy provisions and coverage details.
Application & Assessment - Apply specific regulations and complete final evaluation.
Customer Service & Communication - Develop skills for effective client interaction and support.
Claims Lifecycle & Systems - Understand end-to-end claims process and system navigation.
Property Construction & Materials - Gain knowledge of building components and materials
Estimating- Learn fundamentals of property damage estimation.
Investigation & Evidence - Acquire techniques for gathering and evaluating claim evidence.
Coverage Evaluation - Assess policy coverage and determine claim applicability.
Subrogation & Liability - Understand recovery processes and liability principles.
Dispute Resolution - Learn strategies for resolving conflicts and claim disputes.
Field Operations - Participate in on-site inspections and fieldwork procedures.
Obtain the Florida Adjuster's license within 60 days of hire
Obtain all other required state licenses within 90 days of hire.
As necessary, upon acquisition of required licensing:
Deliver empathetic, customer-focused service throughout the claim lifecycle: coverage analysis, investigation, evaluation, reserving, negotiation, and resolution.
Apply policy interpretation and coverage evaluation skills to ensure fair and transparent claim outcomes.
Conduct thorough claim investigations, including on-site inspections, recorded statements, and other evidence gathering.
Utilize estimating tools and systems to assess property damage accurately.
Collaborate with team members and stakeholders to resolve disputes and support subrogation and liability processes.
Maintain compliance with internal quality standards and state regulations.
Assist with catastrophe operations as required, including, but not limited to working extra hours during major events or deploying to affected areas to help policyholders.
What we are looking for as a Claims Adjuster Trainee:
Bachelor's degree is preferred or minimum one year of work or customer service experience.
Strong organizational, time management, and communication skills.
Proficiency in Microsoft Office (Word, Excel, Outlook)
Ability to work independently and collaboratively in a fast-paced, high-volume environment.
Why work for Frontline Insurance?
At Frontline Insurance, we're more than just a workplace - we're a community of innovators, problem solvers, and dedicated professionals committed to our core values: Integrity, Patriotism, Family, and Creativity. We provide a collaborative, inclusive, and growth-oriented work environment where every team member can thrive.
Frontline Insurance is an equal-opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
$42k-52k yearly est. 26d ago
Claims Specialist
Partnered Staffing
Claims representative job in Lake Mary, FL
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Description
Kelly Services is currently seeking several Claims Specialist for our client's Lake Mary, FL location.
In addition to working with the world's most recognized and trusted name in staffing, Kelly employees can expect:
Competitive pay
Paid holidays
Year-end bonus program
Recognition and incentive programs
Access to continuing education via the Kelly Learning Center
Pay $15 - $16 per hour
Schedule: Monday through Friday - 9:00am - 6:00pm
Duration: 4 months possible extension (Possible temp - perm)
Anticipated start date: 10/31/2016 to 03/31/2017
SUMMARY
Responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved.
MAJOR JOB DUTIES AND RESPONSIBILITIES
Verify member submitted claims forms, member's eligibility and pharmacy information is complete and accurate, updating system information as needed.
Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency.
Moderate knowledge of drugs and drug terminology used daily.
Process claims according to client specific guidelines while identifying claims requiring exception handling.
Navigate daily through several platforms to research and accurately finalize claim submissions.
Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues.
Adhere to strict HIPAA regulations especially when communicating to others outside
Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met.
Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing.
Analyze claims for potential fraud by member or pharmacy.
May be required to work on special projects for claims team.
EDUCATION/EXPERIENCE
High School Diploma or GED Required
1-3 years of Call Center and Reimbursement experience required
Knowledge of completed benefits verifications, submitted test claims, completed or reviewed prior authorizations required
Strong data entry and 10-key skills
Proficient in MS Word and Excel
Additional Information
Why Kelly?
As a Kelly Services candidate you will have access to numerous perks, including:
Exposure to a variety of career opportunities as a result of our expansive network of client companies
Career guides, information and tools to help you successfully position yourself throughout every stage of your career
Access to more than 3,000 online training courses through our Kelly Learning Center
Group-rate insurance options available immediately upon hire*
Weekly pay and service bonus plans
$15-16 hourly 1d ago
Claims Administrator - Westcor Land Title Insurance Company
ArdÁN
Claims representative job in Maitland, FL
********************************************************************************
Claims Administrator will handle title insurance and related claims. The ideal candidate should have strong communication skills, both verbal and written. He/She must be detail oriented, organized, and flexible in regards to assigned work. This is a full-time position working in a fast paced department, where deadlines are critical.
Essential Functions
Investigate, evaluate and determine coverage and possible claim resolutions
Determine need to retain outside counsel; manage claims and/or litigation to final resolution
Negotiate with claimant / opposing counsel / third parties for resolution
Participate in mediations and other required court appearances
Review and approve invoices for costs and attorneys' fees
Perform and assist in initial evaluation for recovery
Maintain documentation of claim file activity
Evaluate and respond to clearance / curative demands
Other activities/projects as assigned.
Qualifications:
Has at least 3-5 years experience in the Title Insurance Industry or working as a Title Examiner or Closer
Must be a self-starter, detail-oriented with strong organizational and verbal/written communication skills.
Ability to multitask in a fast-paced team oriented environment.
Possess consistent attention to detail and be committed to accuracy.
Advanced proficiency in Word, Outlook, & Excel.
Education and Experience:
• Bachelor's degree
• 3 - 5 years experience in title insurance or related field
• Basic knowledge of title industry Reasoning Ability:
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit. The employee is occasionally required to stand; walk; use hands and fingers to type and write. The employee may occasionally lift and/or move up to 15pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception, and ability to adjust focus.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations maybe made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
Ardán offers some great perks:
Health, dental, and vision benefits
Employer paid disability and life insurance
Flexible spending accounts
401K with company match
Paid time off and company paid holidays
Wellness resources
NOTE: This job description is not intended to be an exhausted list of duties, responsibilities, or qualifications associated with the job.
$32k-37k yearly est. 24d ago
Claims Administrator - Westcor Land Title Insurance Company
Ardan Inc.
Claims representative job in Maitland, FL
********************************************************************************
Claims Administrator will handle title insurance and related claims. The ideal candidate should have strong communication skills, both verbal and written. He/She must be detail oriented, organized, and flexible in regards to assigned work. This is a full-time position working in a fast paced department, where deadlines are critical.
Essential Functions
Investigate, evaluate and determine coverage and possible claim resolutions
Determine need to retain outside counsel; manage claims and/or litigation to final resolution
Negotiate with claimant / opposing counsel / third parties for resolution
Participate in mediations and other required court appearances
Review and approve invoices for costs and attorneys' fees
Perform and assist in initial evaluation for recovery
Maintain documentation of claim file activity
Evaluate and respond to clearance / curative demands
Other activities/projects as assigned.
Qualifications:
Has at least 3-5 years experience in the Title Insurance Industry or working as a Title Examiner or Closer
Must be a self-starter, detail-oriented with strong organizational and verbal/written communication skills.
Ability to multitask in a fast-paced team oriented environment.
Possess consistent attention to detail and be committed to accuracy.
Advanced proficiency in Word, Outlook, & Excel.
Education and Experience:
• Bachelor's degree
• 3 - 5 years experience in title insurance or related field
• Basic knowledge of title industry Reasoning Ability:
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit. The employee is occasionally required to stand; walk; use hands and fingers to type and write. The employee may occasionally lift and/or move up to 15pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception, and ability to adjust focus.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations maybe made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
Ardán offers some great perks:
Health, dental, and vision benefits
Employer paid disability and life insurance
Flexible spending accounts
401K with company match
Paid time off and company paid holidays
Wellness resources
NOTE: This job description is not intended to be an exhausted list of duties, responsibilities, or qualifications associated with the job.
$32k-37k yearly est. 26d ago
Claims Administrator - Westcor Land Title Insurance Company
Westcor 4.0
Claims representative job in Maitland, FL
********************************************************************************
Claims Administrator will handle title insurance and related claims. The ideal candidate should have strong communication skills, both verbal and written. He/She must be detail oriented, organized, and flexible in regards to assigned work. This is a full-time position working in a fast paced department, where deadlines are critical.
Essential Functions
Investigate, evaluate and determine coverage and possible claim resolutions
Determine need to retain outside counsel; manage claims and/or litigation to final resolution
Negotiate with claimant / opposing counsel / third parties for resolution
Participate in mediations and other required court appearances
Review and approve invoices for costs and attorneys' fees
Perform and assist in initial evaluation for recovery
Maintain documentation of claim file activity
Evaluate and respond to clearance / curative demands
Other activities/projects as assigned.
Qualifications:
Has at least 3-5 years experience in the Title Insurance Industry or working as a Title Examiner or Closer
Must be a self-starter, detail-oriented with strong organizational and verbal/written communication skills.
Ability to multitask in a fast-paced team oriented environment.
Possess consistent attention to detail and be committed to accuracy.
Advanced proficiency in Word, Outlook, & Excel.
Education and Experience:
• Bachelor's degree
• 3 - 5 years experience in title insurance or related field
• Basic knowledge of title industry Reasoning Ability:
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit. The employee is occasionally required to stand; walk; use hands and fingers to type and write. The employee may occasionally lift and/or move up to 15pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception, and ability to adjust focus.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations maybe made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
Ardán offers some great perks:
Health, dental, and vision benefits
Employer paid disability and life insurance
Flexible spending accounts
401K with company match
Paid time off and company paid holidays
Wellness resources
NOTE: This job description is not intended to be an exhausted list of duties, responsibilities, or qualifications associated with the job.
$30k-36k yearly est. 25d ago
Commercial Auto Claim Specialist
Ccmsi 4.0
Claims representative job in Maitland, FL
Commercial Auto - Multi Line Claim Specialist
Hours: Monday - Friday, 8:00 AM to 4:30 PM ET
Salary Range: $83,000-$100,000 (commensurate based on experience)
Build Your Career With Purpose at CCMSI
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.
We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified
Great Place to Work
, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.
The Multi-Line Claim Specialist position is responsible for the investigation and adjustment of assigned general liability claims.
Experience in commercial trucking with litigation and/or the ability to handle attorney represented settlements and some litigation. This role will be for a dedicated trucking client that will require consistent communication and trust building. Adjuster will need to be able to be available for calls but also provide reasoning and recommendation in a consultative manner. This role will join a small but mighty dedicated team. This position may be used as an advanced training position for promotion consideration for supervisory/management positions. The position is also accountable for the quality of multi-line claim services as perceived by CCMSI clients and within our corporate claim standards.
Responsibilities
Investigate, evaluate and adjust multi-line claims in accordance with established claim handling standards and laws.
Establish reserves and/or provide reserve recommendations within established reserve authority levels.
Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated multi-line claims. Negotiate any disputed bills or invoices for resolution.
Authorize and make payments of multi-line claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
Assist in the selection, referral and supervision of designated multi-line claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
Review and maintain personal diary on claim system.
Assess and monitor subrogation claims for resolution.
Compute disability rates in accordance with state laws.
Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the multi-line claim adjustment process.
Provide notices of qualifying claims to excess/reinsurance carriers.
Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent oral and written communication skills.
Initiative to set and achieve performance goals.
Good analytic and negotiation skills.
Ability to cope with job pressures in a constantly changing environment.
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with minimum supervision.
Discretion and confidentiality required.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
10+ years multi-line claim experience is required.
Bachelor's Degree is preferred.
Computer Skills
Proficient with Microsoft Office programs.
Certificates, Licenses, Registrations
Adjusters license may be required based upon jursidiction.
AIC, ARM or CPCU Designation preferred.
Nice to Have:
• Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required.
Why You'll Love Working Here
• 4 weeks PTO (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year
• Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
• Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
• Career growth: Internal training and advancement opportunities
• Culture: A supportive, team-based work environment
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
Quality claim handling - thorough investigations, strong documentation, well-supported decisions
Compliance & audit performance - adherence to jurisdictional and client standards
Timeliness & accuracy - purposeful file movement and dependable execution
Client partnership - proactive communication and strong follow-through
Professional judgment - owning outcomes and solving problems with integrity
Cultural alignment - believing every claimrepresents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us.
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits.
Visa Sponsorship:
CCMSI does not provide visa sponsorship for this position.
ADA Accommodations:
CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team.
Equal Opportunity Employer:
CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Background checks are conducted only after a conditional offer of employment.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:
Lead with transparency We build trust by being open and listening intently in every interaction.
Perform with integrity We choose the right path, even when it is hard.
Chase excellence We set the bar high and measure our success. What gets measured gets done.
Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
Win together Our greatest victories come when our clients succeed.
We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
#CCMSICareers #CCMSIMaitland #EmployeeOwned #ESOP #GreatPlaceToWorkCertified #ClaimsSpecialist #LiabilityClaims #HybridWork #FloridaJobs #InsuranceCareers #GeneralLiability #AutoClaims #MultiJurisdiction #FLAdjusters #CommercialAuto #NowHiring #InsuranceJobs #FLLiability #IND123 #LI-Hybrid
$83k-100k yearly Auto-Apply 20d ago
Claim Specialist
Mindlance 4.6
Claims representative job in Lake Mary, FL
Business Claim Specialist Visa GC/Citizen Division Pharmaceutical Pay $16.00/hr. Contract 5 Month Timings Mon - Fri between 9.00AM - 6.00PM The primary function/purpose of this job. Verify member submitted claims forms, member's eligibility and pharmacy information is complete and accurate, updating system information as needed. Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency. Moderate knowledge of drugs and drug terminology used daily. Process claims according to client specific guidelines while identifying claims requiring exception handling. Navigate daily through several platforms to research and accurately finalize claim submissions. Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues. Adhere to strict HIPAA regulations especially when communicating to others outside the client. Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met. Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing. Analyze claims for potential fraud by member or pharmacy. May be required to work on special projects for claims team.
ESSENTIAL FUNCTIONS:
The 6-10 major responsibility areas of the job. Weight: (%)
(Total = 100%)
1. Manage member and client expectations related to claim reimbursements. Input claim requests into adjudication platform maintaining compliance to performance guarantees, HIPAA guidelines and service standards, which include production and accuracy standards. Processing according to client guidelines making exceptions upon member appeal and client approval. Recognize and escalate appropriate system crises/problems and fraudulent claims to management. 40 %
2. Identify claims requiring additional research, navigate through appropriate system platforms to perform research and resolve issue or forward as appropriate 15 %
3. Research to define values for missing information not submitted with claim but required for processing. Identify drug form, type and strength to manually determine correct NDC number value which will allow claim to process. Continue researching values if system editing does not accept original assigned value. Utilize anchor platform, internet resources and/or contacting retail pharmacist as resources for missing values. 15 %
4. Initiate correspondence to members, pharmacies or other internal departments for missing information, claim denials or other claim issues. 15 %
5. Evaluate claim submission, ensure all required information is present and determine what action should be taken. Confirm patient eligibility and verify patient information matches system. Update member's address to match claim form if necessary. 5 %
6. Identify exception handling and process per client requirements. Monitor system to ensure client specific documentation related to claims processing and benefits is current and system editing is operating appropriately. 5 %
7. Variety of other miscellaneous duties as assigned 5 %
SCOPE OF JOB
Provide quantitative data reflecting the scope and impact of the job - such as budget managed, sales/revenues, profit, clients served, adjusted scripts, etc.
Maintain an average of 30 Commercial claims per hour (cph) or 35 Work Comp claims per hour (cph).
Qualifications
Formal Education and/or Training:
High school diploma or equivalent required, some college or technical training preferred
Years of Experience:
Two years' experience in P.B.M. environment is helpful but not required.
Computer or Other Skills:
Strong data entry, 10-key skills, general PC skills and MS Office experience
Knowledge and Abilities:
• Strong data entry and 10-key skills
• Retail pharmacy, customer service experience helpful but not required
• PC and MS Office literate
• Strong attention to detail
• Excellent retention and judgment ability
• Proficient written and oral communication skills
• Ability to work in fast-paced, production environment
• Reliable, self-motivated with excellent attendance
• Team player who has the ability to stay on task with little supervision
Additional Information
Thanks & Regards,
Ranadheer Murari
|
Recruitment Executive
|
Mindlance, Inc.
|
W
:
************
***************************
$16 hourly Easy Apply 1d ago
Claims Specialist
Partnered Staffing
Claims representative job in Lake Mary, FL
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.
Job Description
Kelly Services is currently seeking several Claims Specialist for our client's Lake Mary, FL location.
In addition to working with the world's most recognized and trusted name in staffing, Kelly employees can expect:
Competitive pay
Paid holidays
Year-end bonus program
Recognition and incentive programs
Access to continuing education via the Kelly Learning Center
Pay $15 - $16 per hour
Schedule: Monday through Friday - 9:00am - 6:00pm
Duration: 4 months possible extension (Possible temp - perm)
Anticipated start date: 10/31/2016 to 03/31/2017
SUMMARY
Responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved.
MAJOR JOB DUTIES AND RESPONSIBILITIES
Verify member submitted claims forms, member's eligibility and pharmacy information is complete and accurate, updating system information as needed.
Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency.
Moderate knowledge of drugs and drug terminology used daily.
Process claims according to client specific guidelines while identifying claims requiring exception handling.
Navigate daily through several platforms to research and accurately finalize claim submissions.
Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues.
Adhere to strict HIPAA regulations especially when communicating to others outside
Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met.
Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing.
Analyze claims for potential fraud by member or pharmacy.
May be required to work on special projects for claims team.
EDUCATION/EXPERIENCE
High School Diploma or GED Required
1-3 years of Call Center and Reimbursement experience required
Knowledge of completed benefits verifications, submitted test claims, completed or reviewed prior authorizations required
Strong data entry and 10-key skills
Proficient in MS Word and Excel
Additional Information
Why Kelly?
As a Kelly Services candidate you will have access to numerous perks, including:
Exposure to a variety of career opportunities as a result of our expansive network of client companies
Career guides, information and tools to help you successfully position yourself throughout every stage of your career
Access to more than 3,000 online training courses through our Kelly Learning Center
Group-rate insurance options available immediately upon hire*
Weekly pay and service bonus plans
$15-16 hourly 60d+ ago
Claims Operations Technician, Claims Reporting
CNA Financial Corp 4.6
Claims representative job in Lake Mary, FL
You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
CNA seeks to offer a comprehensive and competitive benefits package to our employees that helps them - and their family members - achieve their physical, financial, emotional and social wellbeing goals.
For a detailed look at CNA's benefits, check out our Candidate Guide.
Under general supervision, responsible for timely and accurate processing of loss submissions via phone and electronic methods such as internet, fax, and email. Analyzes and troubleshoots to resolve complex activities.
JOB DESCRIPTION:
Working hours for this role are 10AM to 6PM Eastern.
Essential Duties & Responsibilities
* Completes regulatory forms timely in accordance with regulations by evaluating claim information. Provides information to claim adjusting staff from regulatory websites.
* Completes data or makes data corrections based on set requirements or procedures within claim file information utilizing multiple claim systems that support P&C Claim.
* Performs various financial transactions such as paying bills, payment transfer, cashier processing, etc. utilizing set procedures and guidelines.
* Collaborates with underwriting, insureds, claimants, providers, vendors or claim adjusters utilizing various methods to obtain and provide information related to claim support activities.
* Completes form letters or documents based on procedures or set requirements.
* May receive new claim notices, confirm coverage, and/or verify applicability of coverage to the claim.
* Serves as Day to day resource for procedural or process questions.
* Accountable for reviewing and reconciling reports for data or financial transactions related to claims.
* May perform routine processing within designated authority on medical only claims, following jurisdictional parameters.
* May complete special projects as necessary.
Reporting Relationship
Typically supervisor or above
Skills, Knowledge and Abilities
* Ability to navigate multiple system applications.
* Knowledge of P&C insurance products and services.
* Ability to produce high quality outcomes in a highly productive environment.
* Ability to evaluate information within a claim file to execute upon various tasks.
* Strong data entry skills and attention to detail.
* Good verbal and written communication skills.
* Good organizational and follow-up skills.
* Good listening and customer service skills.
* Ability to work independently.
* Ability to make sound judgments based on available information.
* Knowledge of Microsoft Office Suite and other business related software.
Education and Experience
* High school diploma, GED or equivalent experience. Some college preferred.
* Typically a minimum of one to three years experience in office operations and one to two years experience in Property and Casualty line of business preferred.
* Call center experience is also preferred
#LI-AR1
#LI-Hybrid
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
$30k-37k yearly est. Auto-Apply 56d ago
Multi-Line Claim Specialist (Property and Casualty)
Cannon Cochran Management 4.0
Claims representative job in Maitland, FL
Multi Line Claim Specialist (Property & Casualty)
Schedule: 8:00 am-4:30 pm ET
Salary Range: $80,000-$88,000
Build Your Career With Purpose at CCMSI
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.
We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day
The Multi-Line Claim Specialist position is responsible for the investigation and adjustment of assigned general liability claims. This desk will focus on Property & Casualty claims. Experience and/or active licensure in one or more of the following jurisdictions is required: GA, AL, MS, TN, CA, LA, SC, KY. Duties will include reviewing coverage, writing ROR's, coverage denials, experience handling BOP, CPP policies, litigation, GL, complex BI and Property claims, Inland Marine, commercial auto PD/BI, FPPC. This position may be used as an advanced training position for promotion consideration for supervisory/management positions. The position is also accountable for the quality of multi-line claim services as perceived by CCMSI clients and within our corporate claim standards.
Responsibilities
Investigate, evaluate and adjust multi-line claims in accordance with established claim handling standards and laws.
Establish reserves and/or provide reserve recommendations within established reserve authority levels.
Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated multi-line claims. Negotiate any disputed bills or invoices for resolution.
Authorize and make payments of multi-line claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
Assist in the selection, referral and supervision of designated multi-line claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
Review and maintain personal diary on claim system.
Assess and monitor subrogation claims for resolution.
Compute disability rates in accordance with state laws.
Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the multi-line claim adjustment process.
Provide notices of qualifying claims to excess/reinsurance carriers.
Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent oral and written communication skills.
Initiative to set and achieve performance goals.
Good analytic and negotiation skills.
Ability to cope with job pressures in a constantly changing environment.
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with minimum supervision.
Discretion and confidentiality required.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
8+ years multi-line claim experience is required.
Bachelor's Degree is preferred.
Experience with Crime/Fidelity claims.
Nice to Have:
Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required.
Computer Skills
Proficient with Microsoft Office programs.
Certificates, Licenses, Registrations
Adjusters license may be required based upon jursidiction.
AIC, ARM or CPCU Designation preferred.
Why You'll Love Working Here
4 weeks
(Paid time off that accrues throughout the year in accordance with company policy)
+ 10 paid holidays in your first year
Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
Career growth: Internal training and advancement opportunities
Culture: A supportive, team-based work environment
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
Quality claim handling - thorough investigations, strong documentation, well-supported decisions
Compliance & audit performance - adherence to jurisdictional and client standards
Timeliness & accuracy - purposeful file movement and dependable execution
Client partnership - proactive communication and strong follow-through
Professional judgment - owning outcomes and solving problems with integrity
Cultural alignment - believing every claimrepresents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us.
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.
CCMSI posts internal career opportunities in compliance with applicable state and local promotion transparency laws.
Visa Sponsorship:
CCMSI does not provide visa sponsorship for this position.
ADA Accommodations:
CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
Equal Opportunity Employer:
CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:
Lead with transparency We build trust by being open and listening intently in every interaction.
Perform with integrity We choose the right path, even when it is hard.
Chase excellence We set the bar high and measure our success. What gets measured gets done.
Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
Win together Our greatest victories come when our clients succeed.
We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
#EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #CCMSICareers #ESOP #EmployeeOwned #FloridaJobs #IND123 #LI-Hybrid #MultiLine
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How much does a claims representative earn in Daytona Beach, FL?
The average claims representative in Daytona Beach, FL earns between $24,000 and $46,000 annually. This compares to the national average claims representative range of $28,000 to $53,000.
Average claims representative salary in Daytona Beach, FL
$34,000
What are the biggest employers of Claims Representatives in Daytona Beach, FL?
The biggest employers of Claims Representatives in Daytona Beach, FL are: