Top 72 Claims adjuster Jobs in Pinellas Park, Fl

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)
Ultimate Health Plans —Tampa, FL
- From $75,000 a year
- Full-time
- Anatomy knowledge
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Bodily Injury Claims Adjuster ($2,500 Sign-On Bonus) - Tampa, FL
GEICO —Tampa, FL
- Full-time
- Hybrid work
- Customer service
- Mid-level
- Office
Claims Representative - Tampa, FL
Federated Mutual Insurance Company —Tampa, FL
- $63,800 - $78,000 a year
- Full-time
- Office
- Analysis skills
- Bachelor's degree
- Health insurance
- 401(k)
Claims Specialist
GEICO —Tampa, FL
- $28.29 - $37.72 an hour
- Weekends as needed
- High school diploma or GED
- Entry level
- Paid holidays
- Health insurance
Property & Casualty Claims Executive
Higginbotham —Oldsmar, FL
- Microsoft Outlook
- Writing skills
- Mid-level
- Wellness program
- Paid holidays
Mechanical Claims Adjuster (Remote)
SilverRock Automotive, Inc. —Clearwater, FL
- Overtime
- Computer literacy
- Pass drug screening
- Mid-level
- Wellness program
- Disability insurance
Quick Apply
2d
Liability Claims Adjuster
Kin Insurance —Saint Petersburg, FL
- $80,000 - $100,000 a year
- Email
- Remote
- 1 year
- Senior level
- Paid parental leave
- Health savings account
2d
Claims Auto Adjuster
USAA —Tampa, FL
- $51,370 - $66,680 a year
- Weekends as needed
- Hybrid work
- Military
- Mid-level
- Office
- Paid holidays
- Health insurance
11d
Property Insurance Claims Examiners
WEST POINT UNDERWRITERS LLC —Pinellas Park, FL
- $60,000 - $85,000 a year
- Full-time
- Spanish
- 5 years
- Research
- Paid holidays
- Health insurance
Claims Adjuster Trainee
AssuranceAmerica —Tampa, FL
- Full-time
- Spanish
- Computer literacy
- Bachelor's degree
- On-the-job training
Claim Examiner- Liability
Broadspire Services, Inc. —Tampa, FL
- Full-time
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
- Paid parental leave
- Health savings account
Quick Apply
Senior Claims Adjuster - P & C Homeowners Insurance
Slide Insurance —Tampa, FL
- Remote
- Microsoft Excel
- Microsoft Outlook
- Data analysis skills
- Health insurance
Quick Apply
Auto Claims Adjuster
COVERAGEX LLC —Clearwater, FL
- $20 - $22 an hour
- ASE Certification
- Computer literacy
- Mid-level
Quick Apply
8d
Desk Adjuster - CAT - 1099
CCMS & Associates —Dunedin, FL
- Remote
- Background check
- Customer service
- Mid-level
Quick Apply
Sr. Claims Auto Adjuster
USAA —Tampa, FL
- $54,550 - $74,000 a year
- Weekends as needed
- Hybrid work
- Background check
- Military
- Office
- Paid holidays
- Health insurance
Manager, Claims and Safety Support
National Pool Partners, Inc. —Tampa, FL
- $90,000 - $110,000 a year
- Remote
- Clean driving record
- 5 years
- Driver's License
Quick Apply
Claims Analyst
Arrive Logistics —Tampa, FL
- Full-time
- Remote
- Customer service
- 3 years
- Finance
- Paid parental leave
- Paid holidays
Quick Apply
ESIS Claims Associate
Chubb —Tampa, FL
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
GAP Claims Adjuster
Integro Professional Services, LLC —Tampa, FL
- $52,000 - $65,000 a year
- Extended hours
- Mid-level
- Office
- 3 years
- Opportunities for advancement
Quick Apply
11d
Inside Senior Property Claims Adjuster
USAA —Tampa, FL
- $63,590 - $121,530 a year
- 8 hour shift
- Hybrid work
- Up to 50% travel
- Military
- Research
- Paid training
- Paid holidays

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claims adjuster jobs near pinellas park, fl

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)

Ultimate Health Plans -
Tampa, FL

Quick Apply

Job Details

Full-time
From $75,000 a year

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance
401(k) matching

Qualifications

Healthcare financial misconduct investigations
Customer communication
Anatomy knowledge
Microsoft Excel
Investigations regulatory compliance
Microsoft Outlook
Medicare
Managed care
Customer service
Managed care organization experience
Writing skills
Health insurance policy knowledge
Presentations for conferences or internal meetings
Investigative data analysis
Driver's License
Insurance regulation
Healthcare regulatory compliance research
Medicare regulations
Risk management
SharePoint
Medicaid regulations
Medicaid
Healthcare claims compliance audits
Research findings presentation
Medical terminology
Professional development training

Full Job Description

Company Overview

CSTS Customer Service and Technology Solutions LLC is a dedicated third-party administrator specializing in managing the administrative and operational functions for insurance plans. Our mission is to revolutionize the healthcare experience by delivering exceptional products and services to our partners, ensuring compliance and efficiency at every step.

Position Overview

CSTS is seeking an experienced and highly The SIU Lead/Investigator is responsible for supporting the prevention, detection, investigation, reporting (when appropriate), and recovery of money related to health care Fraud, Waste, and Abuse (FWA). The SIU Lead is accountable for managing the day-to-day SIU activities. This position will ensure compliance with federal and state guidance related to FWA, and for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care.

Job Duties

Responsible for developing leads presented to the SIU to assess and determine whether potential FWA is corroborated by evidence.
Claims review for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims.
Lead investigation caseloads, document all case files appropriately to meet regulatory guidelines. Completing investigations within the mandated period of time required by state and/or federal contracts and/or regulations.
Communicate orally and in writing with all customers, internal and external, regarding findings.
Prepare reports to document findings and maintain up-to-date case files for management review.
Collaborate with other departments within UHP and outside vendors to ensure the success of the UHP SIU program.
Provide inter-departmental input regarding controls for preventing and monitoring FWA issues.
Develop strategies to create and maintain a FWA Unit that has the flexibility, knowledge, situational awareness, and capacity to successfully address the dynamic FWA environment.
Provide recommendations or intervention strategies to correct and/or prevent abusive practices, including proposals to recover inappropriately paid monies or to suspend or terminate program participation.
Lead the development and delivery of educational awareness and training programs for the organization and providers.
Maintain outcome-focused SIU Policies & Procedures that are consistent with all applicable contractual and regulatory requirements.
Develop and maintain a high degree of rapport and cooperation with the Federal, State, and local law enforcement and regulatory agencies which can assist in investigative efforts.
Prepares appropriate FWA referrals to regulatory agencies and law enforcement.
Present provider review findings to internal and external entities as requested.
Other duties as assigned

Job Qualifications

Required Education

Bachelor’s degree or associate degree, in criminal justice or equivalent combination of education and experience.

Required Experience/Knowledge, Skills & Abilities

1-3 years of Medicare managed care compliance and/or investigation experience, unless otherwise required by state contract.
Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions.
Knowledge of Managed Care and the Medicaid and Medicare programs.
Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.
Understanding of datamining and use of data analytics to detect fraud, waste, and abuse.
Proven ability to research and interpret regulatory requirements.
Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels.
Excellent oral and written communication skills; presentation skills with ability to create and deliver training, informational and other types of programs.
Excellent skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet as well as proficiency with incorporating/merging documents from various applications.
Strong logical, analytical, critical thinking and problem-solving skills.
Initiative, excellent follow-through, persistence in locating and securing needed information.
Fundamental understanding of audits and corrective actions.
Detail-oriented, self-motivated, able to meet tight deadlines.
Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities.
Collaborative and team-oriented

Required License, Certification, Association:

Valid driver’s license required.

Preferred Experience:

At least 5 years of experience in FWA and/or compliance in Medicare managed care organizations is required.

Preferred License, Certification, Association:

Health Care Anti-Fraud Associate (HCAFA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)

CSTS is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Pay: From $75,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Vision insurance

Application Question(s):

How many years of Medicare Advantage experience do you have?
Can you describe your experience with Medicare or Medicaid fraud and waste investigations?
How do you prioritize and manage your workload when dealing with multiple fraud cases at once?

Work Location: In person

Quick Apply

Refine Your Search

claims adjuster jobs in pinellas park, fl

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)

Bodily Injury Claims Adjuster ($2,500 Sign-On Bonus) - Tampa, FL

Claims Representative - Tampa, FL

Claims Specialist

Property & Casualty Claims Executive

Mechanical Claims Adjuster (Remote)

Liability Claims Adjuster

Claims Auto Adjuster

Property Insurance Claims Examiners

Claims Adjuster Trainee

Claim Examiner- Liability

Senior Claims Adjuster - P & C Homeowners Insurance

Auto Claims Adjuster

Desk Adjuster - CAT - 1099

Sr. Claims Auto Adjuster

Manager, Claims and Safety Support

Claims Analyst

ESIS Claims Associate

GAP Claims Adjuster

Inside Senior Property Claims Adjuster

I want to receive the latest job alert for claims adjuster in pinellas park, fl

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