Claims Representative

Career Opportunities with Customized Services Administrators, Inc. A great place to work. Current job opportunities are posted here as they become available. Subscribe to our RSS feeds to receive instant updates as new positions become available. Embark on a Journey That Makes a Difference. At Redion, every day is an opportunity to help people explore the world with confidence. We’re not just in the business of protection—we’re in the business of adventure and peace of mind. Whether it’s a backpacker trekking through the Andes, a family cruising the Mediterranean, or a solo traveler chasing the Northern Lights, we’re there to ensure their journey is safe and supported. From assisting with emergency medical claims to guiding customers through trip disruptions or ID theft, your work helps turn travel challenges into stories of resilience. Set Sail on a Career Path to Success. Our teams value curiosity and collaboration while priding ourselves on fostering a welcoming and inclusive atmosphere for our employees. Elevate your journey through our internal programs, including: 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 Passport to Perks Includes: 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 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) Your Role on the Expedition: 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. Primary responsibilities include efficient adjudication of insurance claims, both phone and written communication with insureds, travel suppliers, medical facilities, and others, as well as maintaining all state Department of Insurance regulations for claims files. Weekends may be required. This position reports to the Claims Supervisor. Chart Your Course: Claims Processing and Coordination 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. Customer Service Answer questions and respond to inquiries from internal and external customers regarding coverage issues and general policy information. Teamwork and Department Support Assist in the mentoring and training of other employees as directed. Perform other duties or special projects as assigned by the management team. Your Ticket to Success: Required Qualifications: 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 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. Preferred Qualifications: Position Coordinates: This is a hybrid role based out of our Pembroke Pines, FL office. As a hybrid role, you will be working onsite 2-3 days a week and working from home 2-3 days a week. Time for Take-off: While there is some flexibility in the hours, this position will be Monday-Friday during regular business hours (approximately 8:00am-5:00pm). Occasional overtime may be required according to business need. One team. Every destination. Redion is proudly part of the Generali Group and our products utilize a number of corporate and product brands. The brands for our North American team include the following: Redion Insurance Services, Inc.: US travel insurance brand for retail, tour operator, cruise and lodging partners. Learn more here . Redion US Holdings: The primary Corporate brand in the United States for our travel insurance, travel assistance, and beneficiary companion products. Learn more here . Redion Medical Management, Inc.: the industry standard for global medical cost containment and medical risk management solutions. Learn more here . Iris, Powered by Generali: identity and digital protection solution. Learn more here . California Residents - Privacy Notice for California Residents Seeking Employment with Redion is available here: CCPA Privacy Policy | Redion The Company is committed to providing equal employment opportunity in all our employment programs and decisions. Discrimination in employment on the basis of any classification protected under federal, state, or local law is a violation of our policy. Equal employment opportunity is provided to all employees and applicants for employment without regard age, race, color, religion, creed, sex, gender identity, gender expression, transgender status, pregnancy, childbirth, medical conditions related to pregnancy or childbirth, sexual orientation, national origin, ancestry, ethnicity, citizenship, genetic information, marital status, military status, HIV/AIDS status, mental or physical disability, use of a guide or support animal because of blindness, deafness, or physical handicap, or any other legally protected basis under applicable federal, state, or local law. This policy applies to all terms and conditions of employment, including, but not limited to, recruitment and hiring, classification, placement, promotion, termination, reductions in force, recall, transfer, leaves of absences, compensation, and training. Any employees with questions or concerns about equal employment opportunities in the workplace are encouraged to bring these issues to the attention of Human Resources. The Company will not allow any form of retaliation against individuals who raise issues of equal employment opportunity. All Company employees are responsible for complying with the Company’s Equal Opportunity Policy. Every employee is to treat all other employees equally and fairly. Violations of this policy may subject an employee to disciplinary action, up to and including termination of employment. #J-18808-Ljbffr Customized Services Administrators, Inc.