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Claims Processor Associate Jobs in Florida (NOW HIRING)

Elevance Health

Claims Auditor Lead

Tampa, FL · Hybrid

Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 - 2days per week ... Coaches, mentors and develops associates to ensure processes, guidelines and tools are utilized ...

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 ... Coaches, mentors and develops associates to ensure processes, guidelines and tools are utilized ...

Elevance Health

Claims Auditor Lead

Miami, FL · Hybrid

Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 - 2days per week ... Coaches, mentors and develops associates to ensure processes, guidelines and tools are utilized ...

Assuranceamerica

Casualty Claims Examiner

Tampa, FL · Remote

May assist with targeted audits of a particular process or function (e.g. total loss handling, BI ... Skills & Competencies Communication and analytical ability at a level to interact with associates ...

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Claims Processor Associate information

What does a claims processor associate do?

A Claims Processor Associate is responsible for reviewing, processing, and verifying insurance claims to ensure they are accurate and comply with policy guidelines. They investigate claim details, communicate with policyholders or medical providers for additional information, and enter claim data into company systems. Their role is crucial in ensuring timely and accurate payments or denials, helping both insurance companies and clients. Attention to detail, strong organizational skills, and excellent communication abilities are important for success in this position.

What are the key skills and qualifications needed to thrive as a claims processor associate, and why are they important?

To thrive as a Claims Processor Associate, you need strong attention to detail, analytical skills, and a high school diploma or equivalent, with some employers preferring experience in insurance or healthcare. Familiarity with claims management software, data entry systems, and basic office applications is typically required. Excellent organizational skills, clear communication, and the ability to work efficiently under deadlines are essential soft skills for this role. These abilities ensure accurate claims processing, minimize errors, and support timely service for clients and providers.

What are some common challenges faced by claims processor associates, and how can they be effectively managed?

Claims Processor Associates often encounter challenges such as handling a high volume of claims, navigating complex policy details, and meeting strict deadlines. Successfully managing these challenges requires strong organizational skills, attention to detail, and the ability to prioritize tasks effectively. Collaborating closely with team members and regularly communicating with supervisors can also help resolve discrepancies and ensure accuracy. Most organizations provide training and support to help associates stay updated on procedures and regulatory requirements, fostering a supportive work environment.

Is claims processing a stressful job?

Claims processing can be a stressful job due to tight deadlines, high volume of claims, and the need for accuracy. It often requires attention to detail, strong organizational skills, and the ability to handle complex or difficult cases. However, workload and stress levels vary depending on the employer and work environment.

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

The most popular types of Claims Processor jobs in Florida are:

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

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

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

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

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

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

Claims Processor Associate jobs near you
Infographic showing various Claims Processor Associate job openings in Florida as of August 2026, with employment types broken down into 1% As Needed, 72% Full Time, 25% Part Time, 1% Temporary, and 1% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution.

Claims Auditor Lead

Elevance Health

Tampa, FL • Hybrid

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 16 days ago

Elevance Health rating

7.5

Company rating: 7.5 out of 10

Based on 354 frontline employees who took The Breakroom Quiz

218th of 315 rated insurance

Job description

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-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unlessaccommodationis granted as required by law.

The Claims Auditor Lead is responsible for processing high dollar claims within Service Operations. Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy. Serves as the subject matter expert for the unit.

Primary duties may include, but are not limited to:

  • Responsible for all team training including but not limited to new hires, cross training, new product and system enhancements.

  • Conducts audits for new hires and/or any team member learning a new skill.

  • Reviews, interprets and maintains records of quality and productivity for entire team.

  • Coaches, mentors and develops associates to ensure processes, guidelines and tools are utilized correctly.

  • Utilizes inventory management strategies to monitor priorities and ensure timely turnaround of all claims.

  • Responsible for creating, updating and maintaining departmental policy and claims auditor procedure manuals for accuracy.

  • Independently analyzes and makes decisions on complex claim audit issues.

  • Serves as subject matter expert on policy, workflow and technical questions.

  • Interfaces with all levels of support including but not limited to production support, medical management, provider /vendor contracting and other audit teams.

  • Partners with Management on complex claims reviews and resolution.

  • Responsible for reviewing and resolving shared mailbox issues.

  • Interprets contracts, prepares monthly reports, and attends meetings as subject matter expert when requested.

  • Manages projects as assigned and may work across different platforms or lines of business.

  • Reviews and responds to external audit requests.

  • Performs audit reviews of and may adjudicate complex high dollar claims by completing an end to end audit with final approval authority.

Minimum Requirements:

Requires a HS diploma or GED and a minimum of 6 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.

Preferred Requirements:

  • Proficiency in Microsoft Office Suite is highly preferred.

  • Commercial Claims experience is highly preferred

  • CI&W and WGS experience is highly preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

What Elevance Health employees say

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

Social media

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