Claims Adjudication Specialist

Fortegra; Jacksonville (FL); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k)

Tuition assistance

Job summary

Fortegra in Jacksonville, FL is seeking a Claims Advisor to deliver professional, responsive service while adjudicating and processing claims accurately. You will evaluate documentation, policy coverage, and eligibility to determine outcomes and ensure regulatory compliance.

This role requires strong attention to detail, solid decision-making, and the ability to handle multiple claims in a fast-paced environment, including communicating with members, providers, and vendors through phone, email,

Qualifications

• High School diploma or equivalent; associate's or bachelor's degree preferred.
• 2–4 years of experience in claims processing or related field preferred.
• Strong customer service skills with professional, empathetic communication.
• Detail-oriented with ability to review documentation and interpret policies.
• Ability to analyze information, problem solve, and exercise sound judgment.
• Experience handling confidential information with discretion.
• Proficient data entry and ability to navigate multiple systems.

Responsibilities

• Reviews and adjudicates claims by analyzing documentation, coverage, eligibility, and endorsements to determine outcomes.
• Provides professional customer service through phone, email, text, and chat across multiple channels.
• Communicates to obtain claim information, explain decisions, and deliver a positive customer experience.
• Ensures timely claim processing in accordance with guidelines and regulatory standards.
• Manages multiple tasks and systems in a fast-paced environment.
• Investigates potentially fraudulent or questionable claims and escalates as needed.
• Maintains accurate claim documentation and supporting statistics for audits and reporting.
• Keeps knowledge of state regulations, anti-fraud requirements, and production standards.

Skills

Customer service

Attention to detail

Analytical thinking

Problem solving

Effective communication

Education

High School diploma

Associate's or Bachelor's degree preferred

Tools

Claims processing software

Job description

Fortegra in Jacksonville, FL is seeking a Claims Advisor to deliver professional, responsive service while adjudicating and processing claims accurately. You will evaluate documentation, policy coverage, and eligibility to determine outcomes and ensure regulatory compliance.

This role requires strong attention to detail, solid decision-making, and the ability to handle multiple claims in a fast-paced environment, including communicating with members, providers, and vendors through phone, email,