ZipRecruiter

Log In

2

Director Remote Claims Jobs in Florida (NOW HIRING)

ARC Group

Medical Director

Jacksonville, FL · Remote

MEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity for a Medical Director! This ... Provide the clinical expertise, scientific literature analysis, claims data analytics to ...

Iatinsurancegroup

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 ... remote arrangements for the ideal candidate. This role is a true complex claims handling role that ...

Bosun

Full-Service Restoration Reviewer

Jacksonville, FL · On-site +1

$67K - $70K/yr

... remote Claims Force team. As a Full-Service Reviewer, you will be responsible for reviewing ... Confident in providing direct feedback and coaching to field teams * Strong organizational and time ...

ARC Group

Claims Adjustor (BI)

Oakland Park, FL · Remote

CLAIMS ADJUSTER (remote) ARC Group seeks two Bodily Injury Claims Adjuster to work in a remote contract role for our direct client based in Fort Lauderdale, FL. This is a 90 day contract to start and ...

CCMSI

Commercial Auto Claims Supervisor

Maitland, FL · Remote

Maitland, FL (Hybrid preferred, remote eligible) Schedule: 8:00 am-4:30 pm ET, M-F Salary Range ... directed handling instructions * Manage a personal inventory of complex, high-exposure, and ...

CCMSI

Commercial Auto Claims Supervisor

Maitland, FL · Remote

Maitland, FL (Hybrid preferred, remote eligible) Schedule: 8:00 am-4:30 pm ET, M-F Salary Range ... directed handling instructions * Manage a personal inventory of complex, high-exposure, and ...

USAA

Sr. Injury Claims Adjuster

Tampa, FL · On-site +1

$63K - $121K/yr

USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Directors. The above description reflects the details considered necessary to describe the ...

USAA

Sr. Injury Claims Adjuster

Tampa, FL · On-site +1

$63K - $121K/yr

USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Directors. The above description reflects the details considered necessary to describe the ...

USAA

Sr. Injury Claims Adjuster

Tampa, FL · On-site +1

$63K - $121K/yr

USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Directors. The above description reflects the details considered necessary to describe the ...

CCMSI

Multi-Line Claims Adjuster

Maitland, FL · On-site +1

$85K - $90K/yr

Hybrid - Maitland, FL (hybrid preferred, remote reporting considered) Hours: Monday - Friday, 8:00 ... Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.

CCMSI

Multi-Line Claims Adjuster

Maitland, FL · On-site +1

$85K - $90K/yr

Hybrid - Maitland, FL (hybrid preferred, remote reporting considered) Hours: Monday - Friday, 8:00 ... Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.

next page

Showing results 1-20

All JobsClaims JobsDirector Remote Claims JobsDirector Remote Claims Jobs in Florida

Director Remote Claims information

What does a director remote claims do?

A Director of Remote Claims oversees the operations and management of claims processing teams that work remotely, often for insurance or healthcare organizations. They develop strategies to improve efficiency, ensure compliance with policies and regulations, and monitor claim resolution metrics. Additionally, they are responsible for staff training, quality assurance, and implementing technology solutions to streamline remote workflows. Their role is crucial in ensuring that claims are handled accurately and promptly, even when teams are distributed across various locations.

What are the key skills and qualifications needed to thrive as a director remote claims, and why are they important?

To thrive as a Director of Remote Claims, you need in-depth knowledge of insurance claims processes, strong leadership experience, and typically a bachelor's degree in business, insurance, or a related field. Familiarity with claims management software, data analytics tools, and relevant certifications such as CPCU (Chartered Property Casualty Underwriter) are highly valuable. Exceptional communication, problem-solving, and team management skills help ensure effective oversight and support of remote teams. These skills and qualifications are crucial for maintaining efficient claims operations, ensuring regulatory compliance, and delivering excellent customer service in a remote environment.

What are some common challenges faced by a director remote claims and how can they be addressed?

A Director of Remote Claims often encounters challenges such as ensuring consistent communication across distributed teams, maintaining high productivity, and upholding compliance standards in a remote environment. Addressing these requires implementing robust digital collaboration tools, setting clear performance metrics, and conducting regular training on regulatory requirements. Building a strong remote culture through frequent check-ins and transparent leadership also helps foster team cohesion and accountability.

What is the difference between Director Remote Claims vs Claims Manager?

AspectDirector Remote ClaimsClaims Manager
CredentialsBachelor's degree, industry certifications (e.g., CPCU, ARM)Bachelor's degree, industry certifications often preferred
Work EnvironmentRemote leadership role overseeing multiple teamsRemote or on-site, managing claims staff directly
ResponsibilitiesStrategic planning, policy development, high-level oversightDaily claims processing, team supervision, customer service
Industry UsageCommon in insurance companies, large organizationsWidely used in insurance, healthcare, and related sectors

The main difference between a Director Remote Claims and a Claims Manager lies in scope and responsibilities. The Director focuses on strategic leadership and high-level oversight, while the Claims Manager handles daily operations and team management. Both roles require relevant industry certifications and can be remote, but the Director typically oversees multiple teams or departments.

What are the most commonly searched types of Remote Claims jobs in Florida?

The most popular types of Remote Claims jobs in Florida are:

What are popular job titles related to Director Remote Claims jobs in Florida?

For Director Remote Claims jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Director Remote Claims jobs in Florida look for?

The top searched job categories for Director Remote Claims jobs in Florida are:

What cities in Florida are hiring for Director Remote Claims jobs?

Cities in Florida with the most Director Remote Claims job openings:

Director Remote Claims jobs near you

Medical Director

ARC Group

Jacksonville, FL • Remote

Full-time

Re-posted 21 days ago

Job description

MEDICAL DIRECTOR - REMOTE
ARC Group has an immediate opportunity for a Medical Director! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization and have a positive impact on the lives of millions of people.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Medicare Contractor Medical Director (CMD) provides medical leadership and decision making for an organization that serves as a Medicare Administrative Contractor (MAC). This role serves as a liaison between the Centers for Medicare and Medicaid Services (CMS) and stakeholders. CMDs play a vital role in developing Local Coverage Determinations (LCDs) and ensuring compliance with Medicare policies, reviewing medical claims, and promoting evidence-based healthcare.
ESSENTIAL DUTIES & RESPONSIBILITIES
Clinical Expertise and Consultation 30%
  • Provide leadership in clinical program outreach to the practitioner/provider/supplier/beneficiary community.
  • Provide direction and assistance to clinical staff in conducting provider education, as well as assist in the development of clinical guidelines as needed.
  • Keep clinical knowledge up to date and abreast of medical practice and technology changes.
  • Serve as a subject matter expert in medical and clinical areas relevant to the Medicare program.
  • Provide clinical consultation to internal teams (e.g., medical review staff, appeals teams) and external stakeholders.
  • Provide the clinical expertise, scientific literature analysis, claims data analytics to effectively focus medical polical policy and reviews on identified problem areas.
Collaboration and Leadership 30%
  • Collaborate with CMS and other Medicare Contractors (e.g., A/B or DME MACs and others) to develop and update medical policies and articles based on clinical evidence and regulatory requirements.
  • Work with multidisciplinary teams within the MAC to improve processes and ensure compliance with CMS directives.
  • Liaise with CMS staff, medical societies, and other stakeholders to align goals and address emerging issues.
  • Represent the MAC at CMS meetings and industry conferences.
  • Strengthen the quality improvement procedures with emphasis on decision consistency and clinical education of clinical staff through various mechanisms including but not limited to overseeing Inter-Reviewer Reliability (IRR) reviews.
Program Integrity 20%
  • Support program integrity initiatives, including identifying trends in inappropriate billing practices or noncompliance.
  • Ensure the proper application of Medicare regulations, national and local coverage determinations (NCDs and LCDs), and clinical guidelines.
  • Participate in all phases of LCD development by leading the Local Coverage Determination (LCD) process to include development, revision, retirement, education, and decision making.
  • Collaborate with investigative teams and law enforcement when required.
Medical Review (MR) and Appeals 10%
  • Oversee medical review activities to ensure appropriate and consistent decisions on claim determinations including pre- and post-payment determinations.
  • Provide leadership in developing and implementing MR Quality Assurance Programs.
  • Provide leadership in effectively focusing MR and developing internal MR guidelines.
  • Review complex or high-level appeals and provide guidance on the application of Medicare policies.
  • Provide support to the claim appeal process including assistance in the development of position papers and participation in the administrative process when needed such as Administrative Law Judge (ALJ) hearings.
Provider Education and Communication 10%
  • Provide leadership in the provider community (including interacting with hospital/specialty associations).
  • Educate providers, individually or as a group, regarding identified problems or medical policy.
  • Maintain Professional and Organization Relationships
    Performs other duties as the supervisor may, from time to time, deem necessary.
  • Travel within and outside the assignedjurisdictions, as needed. Expected to be no more than 3-4 weeks/year but could vary based on business needs.
REQUIRED QUALIFICATIONS
  • MD or DO degree from accredited Medical School
  • Minimum of three years clinical practice experience as an attending physician
  • Extensive knowledge of the Medicare program, particularly the coverage and payment rules
  • Work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines.
  • Knowledge, skill, and experience to evaluate clinical evidence, and to develop evidence-based medical necessity standards within the Medicare fee-for-service benefit structure
  • Ability to develop strategies and processes to ensure evidence-based decision-making for policy in the Medicare population
  • Basic understanding of medical coding conventions
  • Ability to effectively communicate, collaborate with, and provide education on health care policy issues to both internal team members and external entities
  • Ability to work collaboratively with internal staff to evaluate aberrancies, determine appropriate billing, coding, pricing, and utilization of services
  • Proficiency with effective public speaking and ability educate providers
  • Ability to work collaboratively with clinical and non-clinical team members
  • Ability and desire to educate team members and external entities (i.e., CMS, providers, other federal agencies, law enforcement, etc.)
  • Computer literacy, including proficiency using word processing, spreadsheets, presentation, and virtual meeting applications
  • Ability to complete independent or computer-based training and education
    Certifications, Licenses, Registration:
  • Current, active, valid, unrestricted license to practice medicine in at least one state or territory within the United States, never suspended or revoked in any state or territory of the United States
  • Eligible for licensure within jurisdiction of enterpriseoperations
  • Board Certified Doctor of Medicine or a Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties for at least three years
PREFERRED QUALIFICATIONS
  • Experienced Physical Medicine and Rehabilitation (PM&R), Oncology, Radiology, Ophthalmology or Infectious Diseases professionals with five years of clinical practice
  • MBA, MHA, MS in Management, or formal accredited coursework in medical systems management
  • Demonstrated successful working experience in organized medicine group(s) (e.g., AMA, specialty society, state health department) as a committee chairperson or other leadership
  • Medical Director experience in Medicare-related or commercial healthcare organization
  • Coding and billing experience utilizing HCPCs, CPT, and ICD-10 codes
  • Experience using GRADE methodology for literature analysis and performing systematic reviews
  • Experience working with physician groups, beneficiary organizations, and/or congressional offices

Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke at johnb@arcgonline.com or apply online while viewing all of our open positions at www.arcgonline.com.
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.