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Health Insurance Claims Processor Jobs in Florida

Wellcove

Claims - Claims Examiner

Pensacola, FL · On-site

High school diploma or equivalent required; associate or bachelor's degree preferred * 2+ years of experience in insurance claims, healthcare administration, or Long-Term Care claims processing

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All JobsHealth Insurance Claims Processor JobsHealth Insurance Claims Processor Jobs in Florida

Health Insurance Claims Processor information

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$8

$16

$25

How much do health insurance claims processor jobs pay per hour?

As of Jul 29, 2026, the average hourly pay for health insurance claims processor in Florida is $16.69, according to ZipRecruiter salary data. Most workers in this role earn between $13.65 and $19.04 per hour, depending on experience, location, and employer.

What is the difference between Health Insurance Claims Processor vs Medical Billing Specialist?

AspectHealth Insurance Claims ProcessorMedical Billing Specialist
CredentialsHigh school diploma; certifications like Certified Claims Professional (CCP)High school diploma; certifications like Certified Medical Billing Specialist (CMBS)
Work EnvironmentInsurance companies, healthcare providers, claims departmentsMedical offices, billing companies, healthcare facilities
Primary ResponsibilitiesReview and process insurance claims, ensure accuracy, follow up on denialsPrepare and submit medical bills, verify insurance coverage, manage patient accounts

While both roles involve handling healthcare financial transactions, the Health Insurance Claims Processor primarily focuses on reviewing and processing insurance claims submitted by providers, whereas the Medical Billing Specialist manages the billing process from patient registration to payment collection. Both roles require knowledge of insurance policies and coding, but their daily tasks and work environments differ slightly.

What does an insurance claims processor do?

An insurance claims processor reviews and evaluates insurance claims to determine coverage eligibility and payout amounts. They verify policy details, process claim documentation, and ensure claims are handled accurately and efficiently, often using specialized software. Attention to detail and knowledge of insurance policies are essential for this role.

Is claims processing a stressful job?

Health insurance claims processing can be stressful due to the need for accuracy, attention to detail, and meeting deadlines. The role often involves handling complex information and resolving discrepancies, which can contribute to work-related stress, especially during high-volume periods or when dealing with difficult cases.

What does a Health Insurance Claims Processor do?

A Health Insurance Claims Processor reviews and evaluates insurance claims submitted by policyholders or healthcare providers. They verify the accuracy of the information, ensure that the claims comply with policy terms, and determine the amount payable for each claim. Claims processors may also correspond with providers or claimants for additional documentation, resolve discrepancies, and help prevent fraudulent claims. Their work ensures that claims are processed efficiently and payments are made accurately according to insurance policies.

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

To thrive as a Health Insurance Claims Processor, you need attention to detail, knowledge of insurance policies and medical terminology, and typically a high school diploma or equivalent. Familiarity with claims management software, electronic health record (EHR) systems, and basic coding (ICD-10, CPT) is standard in this role. Strong organizational skills, problem-solving abilities, and effective communication help you manage claims efficiently and resolve discrepancies. These competencies ensure accurate processing, minimize errors, and support timely reimbursement within the healthcare system.

How to become a health insurance claims processor?

To become a health insurance claims processor, candidates typically need a high school diploma or equivalent, along with strong attention to detail and computer skills. Some employers prefer candidates with experience in healthcare or insurance, and training is often provided on the job. Certification is not mandatory but can improve job prospects and may include courses in medical billing or claims processing.

What is the highest paying adjuster job?

The highest paying adjuster jobs are typically senior or specialized claims adjuster roles, such as catastrophe or large-loss adjusters, which often require extensive experience and certifications like the Chartered Property Casualty Underwriter (CPCU). These positions can offer higher salaries due to the complexity and severity of claims handled, with some earning over $100,000 annually.

What are some common challenges Health Insurance Claims Processors face, and how can they effectively manage them?

Health Insurance Claims Processors often encounter challenges such as interpreting complex policy language, managing high volumes of claims, and ensuring compliance with changing regulations. To effectively manage these challenges, processors benefit from developing strong attention to detail, staying up to date with industry guidelines, and utilizing time management strategies. Collaboration with other departments such as customer service and medical coding teams is also key to resolving discrepancies and ensuring accurate claim outcomes.
What are popular job titles related to Health Insurance Claims Processor jobs in Florida? For Health Insurance Claims Processor jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Health Insurance Claims Processor jobs in Florida look for? The top searched job categories for Health Insurance Claims Processor jobs in Florida are:
Health Insurance Claims Processor jobs near you
Infographic showing various Health Insurance Claims Processor job openings in Florida as of July 2026, with employment types broken down into 88% Full Time, 10% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $34,720 per year, or $16.7 per hour.

Health Insurance Claims Adjuster

TMobile

Clearwater, FL • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 9 days ago

T-Mobile rating

7.3

Company rating: 7.3 out of 10

Based on 643 frontline employees who took The Breakroom Quiz

59th of 96 rated telecommunications companies

Job description

Health Insurance Claims Adjuster

Insurance Administrative Solutions

Clearwater, FL

About Insurance Administrative Solutions

Insurance Administrative Solutions, L.L.C. ("IAS"), an Integrity company headquartered in Clearwater, Florida, is a third-party administrator providing business process outsourcing for insurance carriers. Formed in 2002, IAS administers policies for insureds residing all across the United States.

Job Summary: Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines.

Primary Responsibilities other duties may be assigned as necessary:

  • Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.

  • Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions.

  • Interpret contract benefits in accordance with specific claim processing guidelines.

  • Coordinate daily workflow to coincide with check cycle days to meet all service guarantees.

  • Based on established guidelines and/or historical knowledge an adjuster will need to recognize red flags for potential fraud or waste and escalate accordingly.

  • Adjusters who handle the potential fraud or waste claims will investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner.

  • Understand broad strategic concept of our business and link these to the day-to-day business functions of claims processing.

  • Maintain external contact with providers/agents/policyholders.

Primary Skills & Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

  • A high school diploma or GED equivalent

  • Minimum of 1 year proven health insurance claims adjudication experience.

  • Insurance background preferred; previous Medical/prescription claims preferred.

  • Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required.

  • Familiarity with medical terminology, procedures and diagnosis codes preferred.

  • Ability to read and interpret EOB's claim history, and excellent research skills.

  • Familiarity with Microsoft Office products; familiarity with Qiclink software a plus.

  • Ability to calculate deductible and co-insurance amounts.

  • Ability to adapt and respond to different types of people and tasks.

  • Excellent communication and documentation skills.

  • Ability to multi-task, prioritize, and manage time effectively and efficiently.

  • Reliable transportation and the ability to be punctual and dependable.

Benefits Available

  • Medical/Dental/Vision Insurance

  • 401(k) Retirement Plan

  • Paid Holidays

  • PTO

  • Community Service PTO

  • FSA/HSA

  • Life Insurance

  • Short-Term and Long-Term Disability

About Integrity

Integrity is one of the nation's leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead.

Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge. Why? Because we put our people first! At Integrity, you can start a new career path at company you'll love, and we'll love you back. We're proud of the work we do and the culture we've built, where we celebrate your hard work and support you daily. Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.

Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are - in person, over the phone or online. Integrity's employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit Integrity.com.

Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.

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