Role Description Baptist Metro Square currently hiring for a Full-Time Claims Resolution Specialist I to join our team here in Jacksonville. As a Claims Resolution Specialist I, you will be responsible for: - Appropriately resolving each medical claim sent to commercial insurance companies, third party organizations and/or government payers. - Having experience and demonstrated competency in at least 2 of the following areas within the revenue Cycle: Registration, Eligibility, Charge Capture, Clearinghouse, Payment Posting, Claim Denial, and Credit Management. - Analyzing explanation of benefits to ensure proper payment to Baptist Health from paying entities. - Communicating with third-party representatives as necessary to complete claims processing and/or resolve problem claims. - Following up daily on post processing activity including but not limited to, rejected billings, adjustments, corrected claims, overpayments, and denied claims. - Working all assigned accounts on worklist in order depending on balance and age. - Identifying and communicating trends in denials to leadership. - Communicating with various departments to resolve any outstanding issues with claims to resolve denials. - Possessing up-to-date knowledge related to CPT codes, ICD/10 codes. Qualifications - 1-2 years Customer Service Experience Required - 1-2 years Healthcare experience required - 1-2 years Insurance experience required Requirements - High School Diploma Required Company Description Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital.

Role Description This is a remote position. This examiner will handle either FL, NY, GA, or TX claims and must have the appropriate adjuster's license. Responsible for the prompt review of policy information including all relevant endorsements and vehicle schedules to determine coverage for loss/damage/injury. Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client. Duties and Responsibilities - Review, process and conclude assigned claims including investigation and evaluation of complex Commercial Auto and General Liability Casualty Claims. - Review and interpret policies, coverage determination. - Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion. - Maintain an ongoing diary. - Continually assess exposure and evaluate for accurate reserves and settlement recommendation. - Prepare Loss Reports providing thorough analysis of liability and damages. - Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client. - Document all correspondence, reports, discussions, and decisions in the claim file record. - Provide outstanding service to the client. - Assist Supervisors and Claim Department with requested tasks or special projects. - Other duties as assigned. Qualifications - High School Diploma or GED required; bachelor’s degree in related field (preferred) and a minimum of seven+ (7) years’ commercial auto and general liability casualty related experience; or equivalent combination of advanced education and experience. - At least 10 years of Commercial Automobile and General Liability claims experience required. - Knowledge of claims handling concepts, practices, and techniques, including but not limited to coverage issues and product line knowledge. - Demonstrated verbal and written communications skills. - Demonstrated advanced analytical, decision-making and negotiation skills. - Computer proficiency. Preferred Skills - Ability to communicate effectively and clearly, both orally and in writing. - Ability to manage relationships in a fast-paced environment, while demonstrating problem-solving and decision-making skills to work with customers. - Good analytical abilities to review, exercise judgment and evaluate claims to make sound decisions with a minimal amount of supervision. - Excellent customer service skills. - An understanding of the litigation process and case valuation in multiple jurisdictions. - Ability to carry out detailed written or verbal instructions, respond to requests effectively and efficiently, and exhibit good common sense. - An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision. - Time management skills, organizational skills, and ability to prioritize issues and tasks. - Ability to effectively operate computer equipment and applications. - Independence, flexibility, and creativity. Other Qualifications - Multi-state adjuster licensure within home state or designated state and/or the ability to obtain licenses through home state reciprocity or through state adjuster examinations. - AICPCU industry designation. Mental and Physical Requirements - Mental Effort: - Follow one- or two-step instructions; routine, repetitive task. - Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. - Follow written, verbal, or diagrammatic instructions; several concrete variables. - Solve practical problems; variety of variables with limited standardization; interpret instructions. - Logical or scientific thinking to solve problems; several abstract and concrete variables. - Wide range of intellectual and practical problems; comprehend most obscure concepts. - Mathematical Development: - Simple addition and subtraction; copying figures, counting, and recording. - Add, subtract, multiply, and divide whole numbers. - Arithmetic calculations involving fractions, decimals, and percentages. - Arithmetic, algebraic, and geometric calculations. - Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. - Language Development: - Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. - Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information. - Ability to compose original correspondence, follow technical manuals, and have increased contact with people. - Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people. - Physical Effort: - Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. - Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm. - Grasping: Applying pressure to an object with the fingers and palm. - Talking: Expressing or exchanging ideas by means of the spoken word. - Hearing: Perceiving the nature of sounds with or without correction. - Repetitive Motion: Substantial movements (motions) of the wrists, hands, and/or fingers.

Role Description This is a remote position. This examiner will handle either FL, NY, GA, or TX claims and must have the appropriate adjuster's license. Responsible for the prompt review of policy information including all relevant endorsements and vehicle schedules to determine coverage for loss/damage/injury. Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client. Duties and Responsibilities - Review, process and conclude assigned claims including investigation and evaluation of complex Commercial Auto and General Liability Casualty Claims. - Review and interpret policies, coverage determination. - Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion. - Maintain an ongoing diary. - Continually assess exposure and evaluate for accurate reserves and settlement recommendations. - Prepare Loss Reports providing thorough analysis of liability and damages. - Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client. - Document all correspondence, reports, discussions and decisions in the claim file record. - Provide outstanding service to the client. - Assist Supervisors and Claim Department with requested tasks or special projects. - Other duties as assigned. Qualifications - High School Diploma or GED required; bachelor’s degree in related field (preferred) and a minimum of seven+ (7) years’ commercial auto and general liability casualty related experience; or equivalent combination of advanced education and experience. - At least 10 years of Commercial Automobile and General Liability claims experience required. - Knowledge of claims handling concepts, practices, and techniques, including but not limited to coverage issues and product line knowledge. - Demonstrated verbal and written communications skills. - Demonstrated advanced analytical, decision-making and negotiation skills. - Computer proficiency. Preferred Skills - Ability to communicate effectively and clearly, both orally and in writing. - Ability to manage relationships in a fast-paced environment, while demonstrating problem-solving and decision-making skills to work with customers. - Good analytical abilities to review, exercise judgment and evaluate claims to make sound decisions with a minimal amount of supervision. - Excellent customer service skills. - An understanding of the litigation process and case valuation in multiple jurisdictions. - Ability to carry out detailed written or verbal instructions, respond to requests effectively and efficiently, and exhibit good common sense. - An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision. - Time management skills, organizational skills and ability to prioritize issues and tasks. - Ability to effectively operate computer equipment and applications. - Independence, flexibility, and creativity. Other Qualifications - Multi-state adjuster licensure within home state or designated state and/or the ability to obtain licenses through home state reciprocity or through state adjuster examinations. - AICPCU industry designation. Mental and Physical Requirements - Mental Effort: - Follow one- or two-step instructions; routine, repetitive tasks. - Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. - Follow written, verbal, or diagrammatic instructions; several concrete variables. - Solve practical problems; variety of variables with limited standardization; interpret instructions. - Logical or scientific thinking to solve problems; several abstract and concrete variables. - Wide range of intellectual and practical problems; comprehend most obscure concepts. - Mathematical Development: - Simple addition and subtraction; copying figures, counting, and recording. - Add, subtract, multiply, and divide whole numbers. - Arithmetic calculations involving fractions, decimals, and percentages. - Arithmetic, algebraic, and geometric calculations. - Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. - Language Development: - Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. - Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information. - Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence. - Ability to compose original correspondence, follow technical manuals, and have increased contact with people. - Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures. - Physical Effort: - Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects.

Role Description Responsible for investigating and confirming the facts of loss for the most complex automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority. Mentors and provides direction to junior employees. We’re looking for a skilled Bodily Injury Litigation Adjuster with Homeowner Liability or Commercial General Liability experience to join our team! In this role, you’ll manage complex injury claims, including fractures, bilateral fractures, fatalities etc. We’re open to candidates located in Eastern or Central time zones who are eager to make an impact and grow their career in both Bodily Injury Litigation and Homeowner Liability. Key Responsibilities - Recognizes and identifies body parts of a vehicle or understanding other potential property damage - Identifies customer needs and works to meet those needs using appropriate customer service skills - Determines subrogation or fraud potential and how to handle for the most complex cases - Applies advanced understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department - Recommends process improvements - Applies increased experience in the Sr Adjuster level or a rotation into a specialty position (Coverage, Investigation Specialist, Total Loss, Initial Handler, Extended Handler, Litigation, etc.) - For claims involving injuries (if handled), learns how to review, evaluate, and negotiate moderate to complex/Catastrophic injury claims - Handles investigation regarding all aspects of the most complex auto claims (coverage, liability and damages) with the exercise discretion and independence within increased level of authority Qualifications - 3 or more years of experience (Preferred) Requirements - This job does not have supervisory duties. Benefits - Comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse. - Monthly connectivity reimbursement for employees eligible to work from home to help offset internet costs. - Must have a dedicated, private workspace free from distractions when working from home. - Reliable internet is required, with minimum speeds of 50 MB download and 5 MB upload.