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Claims Operations Associate Jobs in Florida (NOW HIRING)

Fortegra

Claims Advisor

Jacksonville, FL · On-site

High School diploma or equivalent; associate's or bachelor's degree preferred. * Minimum 2-4 years ... Identifies workflow improvement opportunities and communicates operational challenges or process ...

Elevance Health

Cost of Care Manager

Miami, FL · Hybrid

... claims operations, and potential payment leakage. * Collaborates with actuarial and finance ... The health of our associates and communities is a top priority for Elevance Health. We require all ...

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 ... Knowledge of Federal and State codes related to fiscal operations of healthcare services

Fortegra

Claims Advisor

Jacksonville, FL · On-site

High School diploma or equivalent; associate's or bachelor's degree preferred. * Minimum 2-4 years ... Identifies workflow improvement opportunities and communicates operational challenges or process ...

Fortegra

Claims Advisor

Jacksonville, FL · On-site

High School diploma or equivalent; associate's or bachelor's degree preferred. * Minimum 2-4 years ... Identifies workflow improvement opportunities and communicates operational challenges or process ...

LotSolutions, Inc.

Claims Advisor

Jacksonville, FL · On-site

High School diploma or equivalent; associate's or bachelor's degree preferred. * Minimum 2-4 years ... Identifies workflow improvement opportunities and communicates operational challenges or process ...

Elevance Health

Cost of Care Manager

Miami, FL · Hybrid

... claims operations, and potential payment leakage. * Collaborates with actuarial and finance ... The health of our associates and communities is a top priority for Elevance Health. We require all ...

Elevance Health

Cost of Care Manager

Tampa, FL · Hybrid

... claims operations, and potential payment leakage. * Collaborates with actuarial and finance ... The health of our associates and communities is a top priority for Elevance Health. We require all ...

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Claims Operations Associate information

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How much do claims operations associate jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for claims operations 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 is a claims operations associate?

A Claims Operations Associate is a professional who supports the processing and administration of insurance claims. They handle tasks such as reviewing claim forms, verifying information, entering data into systems, and assisting claims adjusters or examiners with documentation and communications. Their role is crucial in ensuring that claims are processed efficiently, accurately, and in compliance with company policies and regulatory requirements. Claims Operations Associates may work for insurance companies, healthcare providers, or third-party administrators.

What skills and qualifications are needed to be a claims operations associate?

To thrive as a Claims Operations Associate, you need strong analytical abilities, attention to detail, and a solid understanding of insurance processes, often supported by a bachelor's degree or relevant experience. Familiarity with claims management systems, Microsoft Office Suite, and sometimes industry certifications like AIC (Associate in Claims) are typically required. Excellent communication, organizational skills, and problem-solving abilities help you manage complex claims and collaborate effectively with internal and external stakeholders. These competencies ensure accurate, efficient claims processing and contribute to customer satisfaction and organizational compliance.

What challenges might a claims operations associate encounter in their daily work?

As a Claims Operations Associate, you may encounter challenges such as managing a high volume of claims while ensuring accuracy and compliance with regulations. Balancing timely processing with the need to investigate discrepancies or incomplete information can be demanding. Additionally, you'll often coordinate with adjusters, customers, and other departments, so strong communication and organizational skills are essential. Staying up to date with changing policies or industry standards can also be a key part of the role.

What is the difference between Claims Operations Associate vs Claims Analyst?

AspectClaims Operations AssociateClaims Analyst
CredentialsHigh school diploma or equivalent; some roles may require relevant certificationsHigh school diploma; some roles may prefer certifications like CPCU or similar
Work EnvironmentOffice setting, handling claims processing and customer interactionsOffice or remote, analyzing claims data and making decisions
Employer & IndustryInsurance companies, third-party administratorsInsurance firms, claims departments
Search & Comparison IntentUnderstanding entry-level claims roles and responsibilitiesAnalyzing claims data and decision-making processes

The Claims Operations Associate typically handles claims processing tasks, customer service, and administrative duties within an insurance setting. In contrast, a Claims Analyst focuses more on analyzing claims data, assessing risks, and making decisions based on policy details. Both roles require knowledge of insurance policies and claims procedures, but the Claims Analyst often involves more analytical skills and data interpretation.

How much do claims operations associates make in the US?

Claims operations associates in the US typically earn an average salary ranging from $40,000 to $60,000 per year, depending on experience, location, and company size. Entry-level roles may start lower, while experienced professionals or those with specialized skills can earn higher salaries. Benefits often include health insurance, paid time off, and opportunities for advancement.

Is claims processing a stressful job?

Claims processing as a Claims Operations Associate can be stressful due to the need for accuracy, attention to detail, and meeting deadlines. The role often involves handling complex cases and working under time pressure, which can contribute to job-related stress. However, workload and stress levels vary depending on the employer and individual workload management skills.

What cities in Florida are hiring for Claims Operations Associate jobs?

Cities in Florida with the most Claims Operations Associate job openings:

Claims Operations Associate jobs near you
Infographic showing various Claims Operations Associate job openings in Florida as of August 2026, with employment types broken down into 85% Full Time, 12% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $32,622 per year, or $15.7 per hour.

Medicaid Claims Examiner

Coral Gables, FL • On-site

DOCTORS HEALTHCARE PLANS, INC.
Health Care and Social Assistance • 51 - 200 employees
Learn more about DOCTORS HEALTHCARE PLANS, INC.external

Full-time

Medical

Posted 24 days ago

Job description

Position Purpose: The Medicaid Claims Examiner is responsible for reviewing, analyzing, processing, and adjudicating Medicaid claims to ensure compliance with federal and state regulations, provider contracts, and health plan policies. The examiner investigates claim discrepancies, resolves pended claims, and ensures accurate and timely reimbursement while maintaining high standards of quality and productivity.
Essential Duties and Responsibilities:
  • Review and process Medicaid professional, institutional, and ancillary claims.
  • Analyze claims for completeness, accuracy, medical necessity, and policy compliance.
  • Apply Medicaid benefits, provider contract provisions, fee schedules, and reimbursement methodologies.
  • Research and resolve claim edits, denials, suspensions, and payment discrepancies.
  • Verify member eligibility, authorization requirements, coordination of benefits (COB), and third-party liability information.
  • Interpret and apply CMS, state Medicaid, and health plan guidelines during claims adjudication.
  • Communicate with providers, internal departments, and vendors to obtain missing or clarifying information.
  • Inter-department collaboration for timely Medicaid encounter remediation and resubmission to the State.
  • Management and remediation of Medicaid encounter rejections
  • Collaborating with provider relations and other departments, as necessary for timely encounter resubmission to the Agency for Healthcare Administration
  • Maintain accurate documentation of claim determinations and adjustments.
  • Meet departmental productivity, accuracy, and turnaround-time standards.
  • Participate in audits, quality reviews, and process improvement initiatives.
Required Qualifications:
  • High School Diploma or GED required; Associate's or Bachelor's degree preferred.
  • 1-3 years of healthcare claims processing experience; Medicaid experience preferred.
  • Knowledge of medical terminology, CPT, HCPCS, ICD-10, revenue codes, and billing practices.
  • Understanding of Medicaid regulations, CMS guidelines, and managed care operations.
  • Proficiency with claims processing systems and Microsoft Office applications.
  • Strong analytical, organizational, and problem-solving skills.
  • Excellent verbal and written communication skills.

Preferred Qualifications:
  • Experience with Medicaid Managed Care Organizations (MCOs).
  • Familiarity with provider contracts and reimbursement methodologies.
  • Knowledge of coordination of benefits (COB), subrogation, and fraud, waste, and abuse (FWA) principles.

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.

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