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Direct Claims Jobs in Florida (NOW HIRING)

Claims Schedule/Hours: As required Job Summary: Directs the activities of claims administration staff in providing the timely and accurate processing of claims, encounters, and OPL recoveries.

Investigate claims and direct the activities of outside adjusters and investigators. * Issue denial of benefits letters when appropriate. * Process attorney represented claims files. * Review and ...

Claims Major Case Director

Sarasota, FL · On-site +1

$92K - $130K/yr

IAT Insurance Group has an immediate need for a Major Case Unit Director that can report to one of ... This role is a true complex claims handling role that is tasked with managing those claims that are ...

Proactively communicate and set accurate claims expectations with customers throughout the Claims ... Assign, direct, and monitor vendors conducting mitigation and/or other services during the ...

Responsibilities The Claims Specialist under the supervision of the Director of Claims is responsible for proactively investigating, managing, and resolving Workers' Compensation, General Liability ...

Showing results 21-40

Direct Claims information

What is a direct claim?

Direct claims refer to insurance claims that are filed directly by the policyholder with their own insurance company, rather than going through a third party or the at-fault party's insurer. This process is common in situations like auto accidents, where the policyholder seeks compensation for damages or losses under their own policy. Direct claims help streamline the process, reduce delays, and ensure the policyholder receives prompt assistance and settlements. They are often associated with 'first-party' insurance coverage, such as collision, comprehensive, or health insurance claims.

What are the key skills and qualifications needed to thrive as a direct claims specialist?

To thrive as a Direct Claims Specialist, you need a solid understanding of insurance policies, claims processes, and relevant legal regulations, often supported by a degree in business, finance, or a related field. Familiarity with claims management software, customer relationship management (CRM) systems, and sometimes industry certifications like AIC or CPCU is typical. Exceptional attention to detail, problem-solving abilities, and strong communication skills set top performers apart in this role. These skills and qualifications ensure claims are processed accurately and efficiently, leading to customer satisfaction and minimized risk for the insurer.

What are some common challenges faced by professionals in direct claims roles, and how can they effectively manage these challenges?

Professionals in Direct Claims often face the challenge of balancing a high volume of claims with the need for thorough investigation and timely resolution. Managing customer expectations and handling sensitive situations, such as denied claims or complex cases, can also be demanding. Effective communication, strong organizational skills, and staying updated on policy guidelines are crucial for success. Building collaborative relationships with adjusters, underwriters, and other departments helps ensure accurate and efficient claims processing.

What is the difference between Direct Claims vs Claims Adjuster?

AspectDirect ClaimsClaims Adjuster
CredentialsInsurance license, knowledge of policiesInsurance license, sometimes certifications like AIC or CPCU
Work EnvironmentCustomer service, office or remoteFieldwork, office, or remote
Employer & IndustryInsurance companies, agenciesInsurance companies, third-party administrators
Search & Comparison IntentUnderstanding direct claims handlingEvaluating claims adjustment roles

Direct Claims professionals primarily handle claims directly from policyholders, focusing on processing and resolving claims within the insurance company. Claims Adjusters evaluate, investigate, and settle claims, often working in the field or remotely. Both roles require insurance licensing, but Claims Adjusters may have additional certifications. While their work overlaps in claims processing, Direct Claims roles are more customer-facing, whereas Claims Adjusters focus on assessment and negotiation.

What cities in Florida are hiring for Direct Claims jobs?

Cities in Florida with the most Direct Claims job openings:

Claims Operations Director

EmergencyMD

Tallahassee, FL • On-site

$80 - $100/hr

Other

This job post has expired today. Applications are no longer accepted.


Job description

Department:

Claims

Schedule/Hours:

As required

Job Summary:

Directs the activities of claims administration staff in providing the timely and accurate processing of claims, encounters, and OPL recoveries. Directs the activities related to billing and reconciliation of premium payment by employers and individuals. Directs the activities of contract administration function in appropriate and timely software updates, code/fee configurations, and overall provider and contract administration. Directs the activities of payment integrity staff in root cause analysis of claims related issues, third party vendor oversight, and claims related risk adjustment processes. Supports the implementation of software enhancements.

Minimum Qualifications:

Bachelor's degree (BA/BS) from four-year college or university; or one to two years' related experience and/or training; or equivalent combination of education and experience. Ten years related experience preferred.

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