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Claims Associate Jobs in Florida (NOW HIRING)

Solis Health Plans

Claims Auditor I

Doral, FL · On-site

$23.73 - $35.60/hr

Job Summary The Claims Auditor is responsible for conducting comprehensive pre- and post-payment ... Audit work completed by claim examiners and associates to ensure accuracy in underpayment dispute ...

Assuranceamerica

Claims Adjuster Trainee

Tampa, FL

We believe in creating a culture where every associate can learn and grow. We strive to create a ... The Claims Adjuster Trainee will complete a series of Self-Study courses, classroom training and On ...

Elevance Health

Claims Auditor Lead

Lake Mary, FL · Hybrid

Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 - 2days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work ...

Elevance Health

Claims Auditor Lead

Tampa, FL · Hybrid

Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 - 2days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work ...

Elevance Health

Claims Auditor Lead

Miami, FL · Hybrid

Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 - 2days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work ...

Assuranceamerica

Casualty Claims Examiner

Tampa, FL · Remote

The Casualty Claims Examiner will work alongside claims management, providing direction and ... Skills & Competencies Communication and analytical ability at a level to interact with associates ...

Fortegra

Claims Coordinator

Jacksonville, FL · On-site

Associate's Degree or equivalent work experience preferred. * Minimum 3 years of relevant experience preferred. * Insurance claims experience preferred. Primary Job Functions: * Assist adjusters in ...

Fortegra

Claims Advisor

Jacksonville, FL · On-site

High School diploma or equivalent; associate's or bachelor's degree preferred. * Minimum 2-4 years of experience in claims processing, insurance, financial services, healthcare administration ...

Leading Edge

Healthcare Claims Supervisor

Tampa, FL · On-site

Associate degree in a field related to managing claims in the healthcare field such as business administration, accounting, finance, or a related field or equivalent experience; Bachelor level degree ...

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All JobsClaims Associate JobsClaims Associate Jobs in Florida

Claims Associate information

See Florida salary details

$10

$15

$22

How much do claims associate jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for claims associate in Florida is $15.68, according to ZipRecruiter salary data. Most workers in this role earn between $12.74 and $17.26 per hour, depending on experience, location, and employer.

What does a claims associate do?

A claims associate handles claims for an insurance company. As a claims associate, your job duties may include reviewing a customer’s insurance coverage and interviewing those who have filed a claim. Your job is to ensure that a claim is processed correctly, so the customer receives the financial payout to which they are entitled. In this career, you usually work in an office, but you may need to travel to gather information about the claim. There are positions in every insurance industry so that you may work in anything from auto to life insurance. This position requires excellent research and interpersonal skills, and experience in customer service is a plus. Additional qualifications may include an associate degree.

What does a claims associate do?

A Claims Associate is responsible for reviewing, processing, and managing insurance claims submitted by policyholders. Their duties include verifying information, evaluating the validity of claims, and ensuring all necessary documentation is complete. They often communicate with customers, healthcare providers, or other parties to gather additional information and resolve any issues. Claims Associates play a crucial role in ensuring claims are processed accurately and efficiently according to company policies and regulatory guidelines.

What are the key skills and qualifications needed to thrive as a claims associate?

To thrive as a Claims Associate, you need a solid understanding of insurance policies, attention to detail, and basic analytical skills, usually supported by a high school diploma or equivalent. Familiarity with claims management systems, CRM software, and sometimes industry certifications like AIC (Associate in Claims) are commonly required. Strong communication, problem-solving, and customer service abilities set top performers apart. These skills are essential for accurately processing claims, ensuring compliance, and providing a positive experience for clients and policyholders.

What are some common challenges a claims associate may face, and how can they effectively handle them?

Claims Associates often encounter challenges such as managing a high volume of claims, navigating complex policy details, and communicating with clients who may be experiencing stress or frustration. Effectively handling these situations requires strong organizational skills, attention to detail, and clear, empathetic communication. Many Claims Associates find success by proactively prioritizing tasks, seeking guidance from senior team members when needed, and utilizing available technology to streamline documentation and follow-ups.

What is the difference between Claims Associate vs Claims Examiner?

AspectClaims AssociateClaims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may prefer insurance-related certificationsHigh school diploma; insurance certifications like CPCU or similar beneficial
Work EnvironmentOffice setting, interacting with customers and internal teamsOffice setting, reviewing claims and documentation
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, adjusting departments
Common Search & ComparisonClaims Associate vs Claims Examiner

The main difference between a Claims Associate and a Claims Examiner lies in their responsibilities. Claims Associates typically handle initial customer interactions and basic claim processing, while Claims Examiners review and assess claims in detail, often making determinations on claim validity. Both roles require similar credentials and work in comparable environments, but Claims Examiners usually have more specialized knowledge and decision-making authority.

Is being a claims associate hard?

Claims associates handle insurance claims processing, which requires attention to detail, strong communication skills, and knowledge of insurance policies. The job can be challenging due to the need for accuracy, meeting deadlines, and managing complex cases, but it is generally manageable with proper training and experience.

What is a claims associate in claims?

A claims associate is a professional who reviews, processes, and manages insurance claims to determine coverage and settlement amounts. They often work with claim documentation, use claims management software, and ensure compliance with company policies and industry regulations.
More about Claims Associate jobs

What are the most commonly searched types of Claims jobs in Florida?

The most popular types of Claims jobs in Florida are:

What are popular job titles related to Claims Associate jobs in Florida?

For Claims Associate jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Claims Associate jobs in Florida look for?

The top searched job categories for Claims Associate jobs in Florida are:

What cities in Florida are hiring for Claims Associate jobs?

Cities in Florida with the most Claims Associate job openings:

Claims Associate jobs near you
Infographic showing various Claims Associate job openings in Florida as of September 2026, with employment types broken down into 59% Full Time, and 41% Contract. Highlights an 59% In-person, and 41% Remote job distribution, with an average salary of $32,622 per year, or $15.7 per hour.

Claims Auditor I

Doral, FL • On-site

Solis Health Plans
Insurance Services • 11 - 50 employees
Learn more about Solis Health Plansexternal

$23.73 - $35.60/hr

Full-time

Posted 6 days ago

Job description

Job Summary

The Claims Auditor is responsible for conducting comprehensive pre- and post-payment audits of claims processed by New Day Claim Examiners and Associates handling claim underpayment disputes. This role ensures payment accuracy, procedural compliance, and adherence to CMS Medicare guidelines within a managed care health plan environment. The auditor works independently to evaluate claims processing quality, identify discrepancies, and support continuous improvement initiatives.

Key Responsibilities

Primary duties may include, but are not limited to:

  • Perform pre- and post-payment audits of claims, including high-dollar and complex claims, across Medicare managed care lines of business. 
  • Audit work completed by claim examiners and associates to ensure accuracy in underpayment dispute processing.
  • Validate claim payment accuracy by reviewing: 
  • Member eligibility 
  • Coding (CPT, HCPCS, ICD) 
  • Pricing and reimbursement methodologies 
  • Authorization requirements 
  • Medical necessity in accordance with CMS guidelines 
  • Ensure adherence to internal policies, CMS Medicare regulations, and clinical guidelines. 
  • Independently interpret medical policies, regulatory requirements, and reimbursement guidelines. 
  • Maintain acceptable audit inventory levels and turnaround times. 

Audit & Documentation

  • Document audit findings in detail, including: 
  • Decision rationale and methodology
  • Identified processing or system errors 
  • Financial impact and discrepancies 
  • Produce audit reports used for: 
  • Financial reconciliation 
  • Trend analysis 
  • Compliance reporting 
  • Track and trend audit outcomes to identify systemic issues and opportunities for improvement. 

Quality & Process Improvement

  • Provide structured feedback and coaching insights to claim examiners and associates. 
  • Identify root causes of claim processing errors and recommend corrective actions. 
  • Partner with leadership and cross-functional teams to drive quality improvement initiatives. 
  • Initiate and support system enhancement requests related to coding, pricing, or workflow inefficiencies. 
  • Refer overpayment and recovery opportunities to the appropriate Recovery Team. 

Collaboration & Communication

  • Collaborate with internal departments (e.g., Clinical, Provider Relations, Compliance) to resolve complex claims issues. 
  • Contact providers or internal stakeholders to obtain necessary documentation or clarification. 
  • Serve as a subject matter expert (SME) on claims auditing standards and Medicare requirements. 

Minimum Qualifications

  • High School Diploma or GED required. 
  • Minimum of 5 years of claims processing experience, preferably within healthcare or insurance.
  • At least 1 year of experience in a quality audit or claims auditing role.
  • Experience with Medicare (CMS) guidelines and managed care environments strongly preferred. 
  • Equivalent combination of education and experience may be considered.

Preferred Qualifications

  • Strong knowledge of: 
  • Medical terminology 
  • Claims processing systems 
  • Coding methodologies (CPT, HCPCS, ICD-10) 
  • Proven understanding of claims adjudication principles, reimbursement methodologies, and audit techniques. 
  • Ability to interpret medical policies and clinical guidelines independently. 
  • Experience auditing underpayment disputes or payment integrity functions. 

Skills & Competencies

  • Strong analytical, research, and problem-solving skills 
  • High attention to detail and accuracy 
  • Ability to work independently in a production-driven environment 
  • Effective written and verbal communication skills 
  • Ability to manage multiple priorities and meet deadlines 
  • Proficiency in identifying trends and recommending process improvements