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Claims Processor Jobs in Miami, FL (NOW HIRING)

ARC Group

Claims Adjustor (BI)

Oakland Park, FL · Remote

CLAIMS ADJUSTER (remote) ARC Group seeks two Bodily Injury Claims Adjuster to work in a remote contract role for our direct client based in Fort Lauderdale, FL. This is a 90 day contract to start and ...

Elevance Health

Claims Representative I

Miami, FL · On-site

$16.23 - $24.36/hr

Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made. * Researches and analyzes claims issues. Minimum Qualifications: * Requires HS ...

Elevance Health

Claims Representative I

Miami, FL · On-site

$16.23 - $24.36/hr

Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made. * Researches and analyzes claims issues. Minimum Qualifications: * Requires HS ...

Elevance Health

Claims Representative I

Miami, FL · On-site

$16.23 - $24.36/hr

Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made. * Researches and analyzes claims issues. Minimum Qualifications: * Requires HS ...

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All JobsClaims Processor JobsClaims Processor Jobs in Miami, FL

Claims Processor information

See Miami, FL salary details

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How much do claims processor jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for claims processor in Miami, FL is $18.33, according to ZipRecruiter salary data. Most workers in this role earn between $15.62 and $19.76 per hour, depending on experience, location, and employer.

What is a claims processor?

A claims processor reviews insurance claims. Their responsibilities include verifying insurance policy coverage and making sure client information is accurate. After they determine there is a covered loss, a processor documents the information and makes sure all the required paperwork is complete. Other duties include modifying new or existing policies.

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

Claims Processors often encounter challenges such as managing high volumes of claims, handling complex or incomplete documentation, and meeting strict accuracy and timeliness standards. To navigate these, strong organizational skills, effective communication with colleagues and claimants, and attention to detail are crucial. Utilizing workflow management tools and maintaining open channels with supervisors and other departments can help address issues quickly and ensure claims are processed efficiently. Regular training and staying updated on policy changes also support success in this role.

Is claims processing a stressful job?

Claims processing is often considered a routine administrative role that involves reviewing and verifying insurance claims. While it can involve tight deadlines and attention to detail, the level of stress varies depending on workload, workplace environment, and individual coping skills.

What is the difference between Claims Processor vs Claims Examiner?

AspectClaims ProcessorClaims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may require certificationHigh school diploma; certification often preferred
Work EnvironmentOffice setting, processing claims efficientlyOffice setting, reviewing and approving claims
Employer & Industry UsageInsurance companies, healthcare providersInsurance companies, government agencies
Common Search & ComparisonClaims Processor vs Claims Examiner

Claims Processors primarily handle the data entry and initial processing of insurance claims, focusing on accuracy and efficiency. Claims Examiners review claims for validity, compliance, and coverage before approval. While both roles work within the insurance industry and require similar credentials, Claims Examiners typically perform more detailed reviews and decision-making tasks. Understanding these differences helps job seekers identify the right role based on their skills and career goals.

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

To thrive as a Claims Processor, you need strong analytical abilities, attention to detail, and knowledge of insurance policies, typically supported by a high school diploma or associate degree. Familiarity with claims management software, data entry systems, and sometimes industry certifications like AIC (Associate in Claims) is valuable. Excellent organization, communication, and customer service skills help you efficiently resolve claims and interact with clients. These competencies ensure accuracy, minimize errors, and maintain trust in the claims process.

Do you need a degree to be a claims processor?

A claims processor typically does not need a college degree, but employers often prefer candidates with a high school diploma or equivalent. Relevant skills include attention to detail, communication, and familiarity with claims processing software, and some positions may offer on-the-job training or certification programs.

What does a claims processor do?

A Claims Processor is responsible for reviewing, evaluating, and processing insurance claims submitted by policyholders. They verify the accuracy of the information provided, ensure all required documentation is present, and determine if the claim meets the policy's terms and conditions. Claims Processors work with both customers and insurance adjusters to resolve any discrepancies and help facilitate timely payments. Their role is essential in ensuring that claims are handled efficiently and fairly.
More about Claims Processor jobs
What are the most commonly searched types of Claims Processor jobs in Miami, FL? The most popular types of Claims Processor jobs in Miami, FL are:
What are popular job titles related to Claims Processor jobs in Miami, FL? For Claims Processor jobs in Miami, FL, the most frequently searched job titles are:
What job categories do people searching Claims Processor jobs in Miami, FL look for? The top searched job categories for Claims Processor jobs in Miami, FL are:
What cities near Miami, FL are hiring for Claims Processor jobs? Cities near Miami, FL with the most Claims Processor job openings:
Claims Processor jobs near you
Infographic showing various Claims Processor job openings in Miami, FL as of August 2026, with employment types broken down into 89% Full Time, 9% Part Time, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $38,127 per year, or $18.3 per hour.

Billing & Claims Analyst

Porter Cares, Inc.

Pompano Beach, FL • On-site

$58K - $75K/yr

Full-time

Re-posted 9 days ago

Job description

 
Porter is hiring a Billing & Claims Analyst to join our Team!
 
Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter's Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member's specific needs, and directs Porter's team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience. 
 
 
 
 

ABOUT THE ROLE

Our organization operates in a payer-contracted services model - delegated services, in-home assessments, HEDIS gap closure, and risk adjustment visits - billed through Athena in a mix of penny-claim/encounter-reporting and full-cost claim arrangements. Because Athena's default logic is built for traditional fee-for-service billing, our claims regularly get flagged, held, or underpaid in ways that don't reflect actual problems.

We're hiring a Billing & Claims Analyst to be the day-to-day set of eyes on our claims: tracking what's been submitted, what's stuck, what's been paid, and what's been invoiced separately - and flagging patterns to the Revenue Cycle & Claims Operations Lead so they can be fixed at the source.

KEY RESPONSIBILITIES

Reporting & Reconciliation

  • Build and maintain recurring reports in Athena covering claim submission status, hold/edit queues, and payment status.
  • Reconcile claims sent to payers against invoices sent separately for encounter/penny-claim arrangements, confirming amounts match and nothing has fallen through the cracks.
  • Track partial payments and underpayments, flagging cases where Athena has applied a standard allowable amount or co-insurance deduction that conflicts with the actual contracted rate.
  • Maintain claim-aging reports so nothing sits in a hold queue unnoticed.

Claims Monitoring & First-Line Troubleshooting

  • Monitor daily/weekly claim submission activity to confirm claims are actually reaching payers, not just leaving Athena.
  • Review current holds in Athena, distinguish routine/expected holds from ones tied to our known penny-claim or allowable-amount issues, and route the latter for escalation.
  • Perform basic first-line correction on claims where the fix is known and documented, escalating anything new or ambiguous.

Support for Systemic Fixes

  • Document recurring issues (e.g., a specific hold code affecting a specific payer or claim type) with enough detail for the Operations Lead to escalate to Athena or the payer.
  • Support testing and validation whenever a new custom rule or workflow change is implemented in Athena, confirming it behaves as expected across a sample of claims.
  • Contribute claim-level detail to the 90-day Athena assessment and any future EMR evaluation.

REQUIRED QUALIFICATIONS

  • 1-3+ years of experience in medical billing, claims processing, or revenue cycle operations.
  • Working proficiency in Athena (or comparable EMR/RCM system) - running reports, navigating claim status and hold queues, and pulling claim-level detail.
  • Strong Excel skills (pivot tables, VLOOKUP/XLOOKUP, basic reconciliation building); SQL or other data-query experience is a plus but not required.
  • High attention to detail and comfort with repetitive reconciliation work - this role lives in the data, not just the summary.
  • Clear written communication for documenting issues and escalations.

PREFERRED QUALIFICATIONS

  • Prior exposure to value-based care, risk adjustment, HEDIS, or delegated/capitated billing models.
  • Experience with encounter data reporting or non-standard (non-FFS) claim types.
  • Familiarity with payer portals for claim status verification.
$58,000 - $75,000 a year

COMPENSATION & BENEFITS

Competitive wage and benefits package.
Opportunities for professional growth and continuing education.
A supportive, collaborative work environment.
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
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