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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

Florida Public Adjusting

Claims Handler

Hollywood, FL · On-site

... insurance claim services across Florida and Northeast states, supporting policyholders through every stage of the claims process. The organization's licensed and bonded public adjusters are ...

New

Trinity Health

$18.50 - $24.66/hr

Claims Processing Tech - Eddy Senior Care- FT Days Location: 433 River St, Troy, NY Narrative: Eddy ... High School Diploma required along * 2-3 years of experience in a billing position or a health care ...

Trinityhealth

$18.50 - $24.66/hr

Claims Processing Tech - Eddy Senior Care- FT Days Location: 433 River St, Troy, NY Narrative: Eddy ... High School Diploma required along * 2-3 years of experience in a billing position or a health care ...

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Health Insurance Claims Processor information

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

As of Sep 2, 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 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?

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.

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 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.

How to become a health insurance claims processor?

To become a health insurance claims processor, candidates typically need a high school diploma or equivalent and should develop skills in data entry, attention to detail, and knowledge of insurance policies. Some employers prefer candidates with postsecondary education or certifications in health insurance or medical billing, and on-the-job training is common. Proficiency with claims processing software and understanding of healthcare terminology are also beneficial.

Is a health insurance claims processor job in demand?

The demand for health insurance claims processors remains steady due to ongoing healthcare industry needs and the increasing complexity of insurance claims. Employment in this field is expected to grow as insurance companies seek skilled workers familiar with claims processing software and regulations. Job opportunities are often available in healthcare organizations, insurance companies, and third-party administrators.

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 August 2026, with employment types broken down into 2% As Needed, 77% Full Time, 16% Part Time, and 5% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $34,720 per year, or $16.7 per hour.

Claims - Claims Examiner

Wellcove

Pensacola, FL • On-site

Full-time

Re-posted 28 days ago

Job description

Who We Are
Wellcove has been recognized as the nation's leading full-service senior market solutions provider for over 25 years. Our solutions span the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don't stop there. Wellcove also addresses challenges faced in accident & health, disability, and supplemental health insurance programs.
Our team provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are able to do this because of our dedicated associates, innovative solutions, and state-of-the-art technology.
The Long-Term Care (LTC) Claims Examiner is responsible for the accurate and timely adjudication of long-term care insurance claims. This role ensures compliance with policy provisions, regulatory requirements, and company standards while delivering a high level of customer service to policyholders, providers, and internal stakeholders.
  • Review, evaluate, and adjudicate Long Term Care claims in accordance with policy provisions and established guidelines
  • Analyze claim documentation including invoices, care plans, and provider credentials
  • Apply knowledge of Coordination of Benefits (COB), Medicare, Medicaid, and other payer sources when applicable
  • Ensure claims are processed within established turnaround times and service level agreements (SLAs)
  • Communicate effectively with policyholders, providers, and internal teams regarding claim status, requirements, and determinations
  • Identify and request additional documentation when necessary to support claim decisions
  • Maintain accurate and detailed claim notes in system of record
  • Ensure compliance with HIPAA and all applicable regulatory and privacy requirements
  • Participate in quality assurance activities and implement feedback for continuous improvement
  • Support training and mentoring of new or junior staff as needed
  • Required Qualifications
    • 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
    • Strong understanding of Long-Term Care policies, benefits, and eligibility criteria preferred
    • Knowledge of medical terminology and healthcare documentation
    • Proficiency in claims systems and Microsoft Office (Excel, Word, Outlook)
    • Strong analytical and decision-making skills
    • Excellent written and verbal communication skills
    • Ability to manage multiple priorities in a fast-paced environment

    Core Competencies
    • Attention to Detail
    • Critical Thinking & Problem Solving
    • Customer Focus
    • Time Management & Productivity
    • Compliance & Risk Awareness
    • Team Collaboration

At Wellcove, we strive to create an inclusive culture for all. We understand the importance of listening and incorporating various perspectives at every level of service. Our company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability.

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