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Claims Processing Jobs in Florida (NOW HIRING)

1 Legacy, Inc

Manager I Claims

Miami, FL

Assure timely and accurate processing of Medicare claims and encounters, and respond to provider telephone calls, written inquiries, and appeals. The compilation of all information and documents ...

Vandelay Administrative Services LL

Be Seen First

Claims Representative

Boynton Beach, FL · On-site

$20 - $24/hr

Position Overview Responsible for receiving and processing all lawsuits for Active Clients and the creation of new profiles for prospects with pre-existing lawsuits. The Claims Agent is responsible ...

Vandelay Administrative Services LL

Be Seen First

Claims Representative

Boynton Beach, FL · On-site

$20 - $24/hr

Position Overview Responsible for receiving and processing all lawsuits for Active Clients and the creation of new profiles for prospects with pre-existing lawsuits. The Claims Agent is responsible ...

Imagenet

Healthcare Claims Team Lead - Remote

Tampa, FL · On-site +1

Support development of process documentation, job aids, and knowledge base materials * Validate workflows for claims processing, including escalation paths and exception handling * Ensure processes ...

Imagenet

Healthcare Claims Team Lead - Remote

Tampa, FL · Remote

Support development of process documentation, job aids, and knowledge base materials * Validate workflows for claims processing, including escalation paths and exception handling * Ensure processes ...

TMobile

Health Insurance Claims Adjuster

Clearwater, FL · On-site

Interpret contract benefits in accordance with specific claims processing guidelines. Primary Responsibilities other duties may be assigned as necessary: * Examine/perform/research & make decisions ...

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Claims Processing information

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How much do claims processing jobs pay per hour?

As of Jun 10, 2026, the average hourly pay for claims processing in Florida is $14.32, according to ZipRecruiter salary data. Most workers in this role earn between $12.21 and $15.43 per hour, depending on experience, location, and employer.

What is the difference between Claims Processing vs Claims Adjuster?

AspectClaims ProcessingClaims Adjuster
CredentialsHigh school diploma or equivalent; certifications varyHigh school diploma; often state licensing or certifications
Work EnvironmentOffice-based, administrative settingFieldwork and office-based, investigative environment
Industry UsageInsurance companies, healthcare providersInsurance companies, claims departments
Job FocusReviewing and processing claims for paymentInvestigating claims, determining liability and settlement

Claims Processing involves reviewing and managing insurance claims to ensure proper payment, focusing on administrative tasks. Claims Adjusters investigate claims, assess damages, and determine liability. While both roles work within the insurance industry, Claims Processing is more administrative, whereas Claims Adjusters are investigative and evaluative.

What is a claims processing job?

A claims processing job involves reviewing, verifying, and managing insurance claims to determine their validity and appropriate payout. It requires attention to detail, knowledge of insurance policies, and often involves using specialized software to track claim status and ensure timely resolution.

What are some common challenges faced by professionals in claims processing, and how can they be managed effectively?

Professionals in claims processing often deal with high volumes of work, tight deadlines, and complex cases that require attention to detail. Managing these challenges involves staying organized, utilizing claims management software efficiently, and continuously updating knowledge of insurance policies and regulations. Effective communication with team members and other departments is also crucial to resolve discrepancies quickly and ensure accurate claim adjudication. Many organizations offer ongoing training and mentorship to help staff adapt to changes and improve efficiency.

What are the key skills and qualifications needed to thrive as a Claims Processor, and why are they important?

To thrive as a Claims Processor, you need a solid understanding of insurance policies and claims procedures, typically supported by a high school diploma or equivalent and relevant on-the-job training. Familiarity with claims management software, data entry systems, and basic office applications is essential. Strong attention to detail, analytical thinking, and effective communication skills help you resolve claims accurately and efficiently. These skills ensure the timely and proper handling of claims, enhancing customer satisfaction and minimizing errors or fraudulent activity.

What is claims processing?

Claims processing is the procedure by which insurance companies or organizations review and manage claims submitted by policyholders or clients. This involves verifying the details of the claim, ensuring all necessary documentation is provided, assessing the validity of the claim, and determining the appropriate payout or resolution. Claims processors play a crucial role in ensuring claims are handled efficiently, accurately, and in compliance with company policies and regulations.
What are the most commonly searched types of Claims Processing jobs in Florida? The most popular types of Claims Processing jobs in Florida are:
What are popular job titles related to Claims Processing jobs in Florida? For Claims Processing jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Claims Processing jobs in Florida look for? The top searched job categories for Claims Processing jobs in Florida are:
What cities in Florida are hiring for Claims Processing jobs? Cities in Florida with the most Claims Processing job openings:
Claims Processing jobs near you

Manager I Claims

1 Legacy, Inc

Miami, FL

Full-time

Posted 26 days ago

Job description

Company Description

Finance / Accounting - Claims Review and Adjusting

Healthcare / Health Services

Job Description

Responsibilities in this senior position will include, but are not limited to:
Responsible for directing the planning, design, development, implementation and evaluation of policies and procedures that assure accurate, timely claims and encounter processing and provider inquiries (written or verbal).
Assure timely and accurate processing of Medicare claims and encounters, and respond to provider telephone calls, written inquiries, and appeals.
The compilation of all information and documents required for claims and encounter processing and related inquiries to assure compliance with all applicable rules, regulations, and external and internal policies and procedures
The review of provider contracts and configuration of these contracts within the claims processing system to assure accurate payments to our providers
Collaboration and communication with other SHP departments on claims and encounter issues, related projects and inter-departmental operations issues
Development and maintenance of well-defined processes to enter, adjust, manage and report claims and encounters data
Preparation and timely submission of management and regulatory reports
Generation of configuration requests to assure accurate, timely administration of providers claims and processing and reporting of encounters
Maintain a full comprehensive understanding of the covered benefits, coding and reimbursement policies and contracts
Production and submission of reports as required
Analyze, track and trend claims and encounters data; identify any potential service or systems issues;implement interventions and determine success of interventions

Qualifications

Requirements:
BA/BS degree preferred with at least 5 years of relevant professional experience, and the following OR any combination of education and experience which would provide an equivalent background:
Minimum of 2 years of managerial experience at the department manager level preferred.
Minimum of 5 years of Medicare/Medicaid claims experience that demonstrates progressive growth within claims operations.
Extensive knowledge of claims policies and procedures, including industry standards from Medicaid, CMS, and CCI Edits.
Excellent oral and writing skills.
Highly developed quantitative and qualitative analytical skills.
Highly developed project management skills.

Additional Information

All your information will be kept confidential according to EEO guidelines.

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