Claims Representative

About the Role

This position is responsible for analyzing and processing insurance claims to determine the extent of the insurance carrier’s liability in a manner that supports the mission, values, and standards of the Company. You will adjudicate insurance claims, communicate with insureds, travel suppliers, medical facilities, and others, and maintain compliance with all state Department of Insurance regulations for claims files. Weekends may be required. This position reports to the Claims Supervisor.

Responsibilities

• Process all claims assigned in a timely, efficient, and accurate manner ensuring that all appropriate policies, procedures, and standard best practices are being followed.
• Review information on claim forms, Physician Statements, and other documentation to ascertain completeness and validity of claims.
• Correspond with insureds, physicians, agents, and other appropriate parties to obtain proper documentation and to finalize claims.
• Maintain proper reserves on each claim file.
• Ensure that proper file documentation is collected and maintained, including all records of correspondence and telephone conversations.
• 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 respond to Department of Insurance complaint letters.
• Respond to written and phone inquiries regarding claims status.
• Issue payments in a timely and accurate manner.
• Ensure that current Federal and State insurance claims regulations, laws, and best practices are being employed consistently for all jurisdictions.
• Answer questions and respond to inquiries from internal and external customers regarding coverage issues and general policy information.
• Assist in the mentoring and training of other employees as directed.
• Perform other duties or special projects as assigned by the management team.

Requirements

• High School Diploma or Equivalent (GED) required.
• Exceptional communication, problem-solving, and organizational skills.
• Strong reading, writing, comprehension, and proofreading skills.
• Knowledge of standard concepts, practices, regulations, and laws within the insurance field preferred.
• Bilingual English/Spanish language fluency – verbal, reading, and writing skills – is a plus.
• Previous claims and customer service experience are highly preferred.

Schedule

This is a hybrid role based out of our Pembroke Pines, FL office. You will work onsite 2-3 days a week and remotely 2-3 days a week. The position follows regular business hours (approximately 8:00 AM–5:00 PM), Monday through Friday, with occasional overtime as needed.

Benefits

• Generous employer contribution for health, dental, and vision insurance.
• Paid Maternity and Paternity Leave.
• Scholarship Program for Employee Dependents.
• Company match on 401k.
• Employee Assistance Program (EAP).
• Company-paid short-term and long-term disability insurance.
• Company-paid life insurance.
• Voluntary Pet Insurance.
• Voluntary Legal Benefit.
• Discounts on travel insurance.
• Time off policies including vacation days, sick days, personal days, holidays, and volunteer days (VTO).

Professional Development

• Diversity, Equity, and Inclusion (DEI) Committee.
• Career pathing and Individual Development Plans.
• Internal training and intern opportunities.
• Women in Business Mentorship Program.
• Employee awards and recognition.
• Education and professional development assistance program.

Redion is proudly part of the Generali Group, with North American brands including Redion Insurance Services, Inc., Redion US Holdings, Redion Medical Management, Inc., and Iris, Powered by Generali.