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Claim Reviewer Jobs in Florida (NOW HIRING)

Zelis

Clinical Nurse Reviewer

Saint Petersburg, FL · On-site

Conduct prompt claim review to support internal inventory management to achieve greatest possible savings for clients. What You'll Do: * Conduct routine reviews of medical records and supporting ...

Zelis

Clinical Nurse Reviewer

Saint Petersburg, FL · On-site

Conduct prompt claim review to support internal inventory management to achieve greatest possible savings for clients. What You'll Do: * Conduct routine reviews of medical records and supporting ...

Zelis

Clinical Nurse Reviewer

Saint Petersburg, FL

Conduct prompt claim review to support internal inventory management to achieve greatest possible savings for clients. What You'll Do: * Conduct routine reviews of medical records and supporting ...

Zelis

Inpatient DRG Reviewer

Saint Petersburg, FL · On-site

$79K - $99K/yr

Conduct prompt claim review to support internal inventory management to achieve greatest savings for clients. What You Will Do: * Perform comprehensive inpatient DRG validation reviews to determine ...

Zelis

Inpatient DRG Reviewer

Saint Petersburg, FL

Conduct prompt claim review to support internal inventory management to achieve greatest savings for clients. What you will do: * Perform comprehensive inpatient DRG validation reviews to determine ...

CCMSI

Claim Assistant

Maitland, FL

$18 - $19/hr

In this role, you will provide essential clerical and organizational support to Claims Adjusters as they review and manage claims. This position plays a key part in keeping claim files accurate ...

CCMSI

Claim Assistant

Maitland, FL · On-site

$18 - $19/hr

In this role, you will provide essential clerical and organizational support to Claims Adjusters as they review and manage claims. This position plays a key part in keeping claim files accurate ...

CCMSI

Claim Assistant

Maitland, FL · On-site

$18 - $19/hr

In this role, you will provide essential clerical and organizational support to Claims Adjusters as they review and manage claims. This position plays a key part in keeping claim files accurate ...

CCMSI

Claim Assistant

Maitland, FL · On-site

$18 - $19/hr

In this role, you will provide essential clerical and organizational support to Claims Adjusters as they review and manage claims. This position plays a key part in keeping claim files accurate ...

Chubb Corporation

Claim Director

Tampa, FL · On-site

$120 - $180/hr

The Claim Director, under minimal direction from the manager, investigates and settles claims ... Reviewing legal budgets and legal and third-party vendor's bills. Presenting litigation strategy ...

The Whiteside Agency

Cyber Claim Counsel

Tampa, FL · On-site

$111K - $184K/yr

The BSI Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition ... Strengthen the ability to negotiate settlements/resolutions, review releases and settlement ...

Solis Health Plans

Claim Examiner I

Miami, FL · On-site

$19 - $23/hr

... claim processing, including new claims, reprocessed claims, overturned disputes, and appeals. The ... Review, analyze, and process medical claims in accordance with Medicare and DSNP benefit structures ...

Solis Health Plans

Claim Examiner I

Miami, FL · On-site

$19 - $23/hr

... claim processing, including new claims, reprocessed claims, overturned disputes, and appeals. The ... Review, analyze, and process medical claims in accordance with Medicare and DSNP benefit structures ...

FCCI Insurance Group

Claim Assistant

Sarasota, FL · On-site

$18.58 - $28.62/hr

We are seeking an organized professional for our Claim Assistant role to provide administrative ... For further information, please review the Know Your Rights notice from the Department of Labor.

FCCI Insurance Group

Claim Assistant

Sarasota, FL · On-site

$18.58 - $28.62/hr

We are seeking an organized professional for our Claim Assistant role to provide administrative ... For further information, please review the Know Your Rights notice from the Department of Labor.

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Claim Reviewer information

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How much do claim reviewer jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for claim reviewer in Florida is $14.83, according to ZipRecruiter salary data. Most workers in this role earn between $12.60 and $16.15 per hour, depending on experience, location, and employer.

What is a claim reviewer?

A Claim Reviewer is responsible for evaluating insurance claims to determine their validity and compliance with policy terms. They review documentation, investigate details, and assess whether claims should be approved, denied, or require further information. Claim Reviewers work closely with policyholders, healthcare providers, or other relevant parties to ensure accurate claim processing. Their role helps prevent fraud, control costs, and ensure fair payouts.

What does a claim reviewer do?

As a Claim Reviewer, your day typically involves reviewing submitted claims to verify accuracy, completeness, and compliance with policy guidelines. You'll analyze supporting documentation, collaborate with adjusters or other team members for additional information, and ensure decisions are well-documented and justified. Expect to handle multiple cases simultaneously, requiring good time management and organizational skills. Communication with customers or policyholders may occur when clarifications or follow-ups are needed. The work is often structured yet dynamic, offering meaningful variety and opportunities to develop knowledge within the insurance industry.

What are the key skills and qualifications needed to thrive in the claim reviewer position?

To thrive as a Claim Reviewer, you need a strong understanding of insurance policies, claims processing procedures, and attention to detail, often supported by relevant experience or education in insurance or a related field. Familiarity with claims management software, document imaging systems, and occasionally industry certifications (such as AIC or CPCU) are valuable assets. Strong analytical thinking, clear communication, and organizational skills help Claim Reviewers manage case loads and coordinate with different teams. Possessing these skills ensures accurate evaluations, timely processing, and maintains compliance and customer satisfaction in the claims process.

What are popular job titles related to Claim Reviewer jobs in Florida?

For Claim Reviewer jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Claim Reviewer jobs in Florida look for?

The top searched job categories for Claim Reviewer jobs in Florida are:

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Claim Reviewer jobs near you
Infographic showing various Claim Reviewer job openings in Florida as of August 2026, with employment types broken down into 80% Full Time, 18% Part Time, and 2% Contract. Highlights an 81% Physical, 6% Hybrid, and 13% Remote job distribution, with an average salary of $30,854 per year, or $14.8 per hour.

Hospice Physician Audit Reviewer (Remote)

VITAS Healthcare

Miramar, FL

Full-time

Posted 12 hours ago

Posted today

VITAS Healthcare rating

7.0

Company rating: 7.0 out of 10

Based on 114 frontline employees who took The Breakroom Quiz

40th of 242 rated social care providers

Job description

Hospice Physician Audit Reviewer will have experience supporting external government record requests by preparing chart summaries and expert testimony at administrative hearings as needed. In addition, although this position's responsibilities will usually be conducted from their home office, this role is also involved in travel to provider locations to provide in-person trainings and partner with program support initiatives as needed. Work remote.  
Experience:

  • The medical review physician should review the documentation submitted and identify the following content that support's the patient's appropriateness, including any higher level of care billed, if applicable: clinical history and physical findings, documentation of functional status and symptoms, and pertinent changes in plans of care.
  • The medical review physician should review certification / recertification worksheets and narratives, plans of care review, and interdisciplinary team notes to ensure that they collectively reflect and support the patient's hospice benefit appropriateness. Where there are inconsistencies or omissions, the physician should provide explanation or suggest correction.  
  • The medical review physician should prepare a summary (demographics, time of admission, course of care under review, disposition, statement of eligibility) outlining the patient's hospice benefit appropriateness and focus on bringing the claim reviewer's attention to the specific documentation that supports the patient's hospice eligibility, as well as any additional supportive documentation that may be added at the time of the appeal. Where appropriate, the medical review physician should reference evidence based guidelines or journal articles. 
  • If a detailed claim denial explanation was provided in the claim review summary, the medical review physician should: 1. Verify whether the claim denial code is legitimate for the level of care on date(s) in contention, 2. Identify if there are discrepancies between the claim review explanation and supporting documentation, 3. Address each claim denial reason with the necessary explanation and supportive documentation, 4. Identify whether there are additional chart documents not included in the first submission that establish hospice appropriateness. 
  • The chart review note submitted by medical review physician in preparation for submission of appeal, should summarize findings recorded elsewhere in the record and not conflict with daily progress notes. New information should be supported by additional documentation that has been accessed from the chart. 
  • Performs related duties as required. This position description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Education: 

  • Board eligible / certified in Hospice and Palliative Medicine, Family Medicine, Internal Medicine, or other related specialty with a working knowledge of the principles of palliative medicine and symptom management.
  • Completion of designated application and verification of credentials and qualifications.

Certification & Licensure:

  • Licensed to practice medicine or osteopathy in the state in which the program is operating.

Physical Requirements:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

SPECIAL INSTRUCTIONS TO CANDIDATES

  • EOE/AA M/F/D/V

What VITAS Healthcare employees say

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About VITAS Healthcare

Sourced by ZipRecruiter

VITAS Healthcare, located in Miami, FL, US, is a pioneer in the American healthcare industry, specifically within the realm of hospice care and palliative services. The company began its operations in 1978 under the visionaries Hugh Westbrook and Esther Colliflower,both social workers, who identified the need for compassionate end-of-life care. Recognizing the dire need to fill the void in hospice care, they established VITAS Healthcare with the mission to provide patients experiencing end-of-life stages with high-quality care, demonstrating respect for every individual's decisions and maintaining a supportive environment for both the patients and their loved ones. A noteworthy achievement of VITAS is that it was the first organization to have its hospice program licensed in Florida prompting a nationwide shift in the way end-of-life care services were handled.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Miami, FL, US

Year founded

1978

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