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Insurance Claim Review Jobs in Florida (NOW HIRING)

Zelis

Clinical Nurse Reviewer

Saint Petersburg, FL · On-site

Conduct prompt claim review to support internal inventory management to achieve greatest possible ... Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare ...

Zelis

Clinical Nurse Reviewer

Saint Petersburg, FL · On-site

Conduct prompt claim review to support internal inventory management to achieve greatest possible ... Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare ...

Zelis

Clinical Nurse Reviewer

Saint Petersburg, FL · On-site

Conduct prompt claim review to support internal inventory management to achieve greatest possible ... Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare ...

Zelis

Inpatient DRG Reviewer

Saint Petersburg, FL · On-site

$79K - $99K/yr

Conduct prompt claim review to support internal inventory management to achieve greatest savings ... Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare ...

Morgan & Morgan, P.A.

Case Developer

Longwood, FL · On-site

$36K/yr

Review files for potential issues that could affect the clients claim * Review and Prepare RFH ... insurance, 401(k) plan, paid time off and paid holidays. Equal Opportunity Statement Morgan ...

Zelis

Inpatient DRG Reviewer

Saint Petersburg, FL · On-site

Conduct prompt claim review to support internal inventory management to achieve greatest savings ... Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare ...

FCCI Insurance Group

Claim Assistant

Sarasota, FL · On-site

$18.58 - $28.62/hr

Medical, Vision, Dental & Life Insurance * Employee Referral Bonus * Paid Volunteer Time * 401(k) ... For further information, please review the Know Your Rights notice from the Department of Labor.

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All JobsInsurance Claim Review JobsInsurance Claim Review Jobs in Florida

Insurance Claim Review information

What is insurance claim review?

Insurance claim review is the process by which insurance companies evaluate claims submitted by policyholders to determine their validity and the extent of coverage. Claims reviewers carefully examine documentation, such as medical records, police reports, or repair estimates, to ensure all policy requirements are met. This process helps prevent fraud, ensures claims are paid accurately, and maintains the integrity of the insurance system. Claim reviewers may also communicate with claimants, request additional information, or work with other professionals to make informed decisions.

What are the key skills and qualifications needed to thrive as an insurance claim review specialist?

To thrive as an Insurance Claim Review Specialist, you typically need a strong understanding of insurance policies, claims processes, and relevant regulations, often backed by a degree in business, finance, or a related field. Familiarity with claims management software, document management systems, and sometimes certifications such as AIC (Associate in Claims) are commonly required. Attention to detail, analytical thinking, and effective communication are critical soft skills for evaluating claims and interacting with policyholders. These skills ensure accurate, timely, and fair claim resolutions that uphold company standards and customer satisfaction.

What are some common challenges faced in an insurance claim review role, and how can they be managed effectively?

One of the most common challenges in Insurance Claim Review is managing a high volume of claims while maintaining accuracy and compliance with regulatory standards. Claims can often be complex, requiring careful analysis of policy terms, medical or incident documentation, and communications with policyholders or third parties. Effective time management, attention to detail, and strong communication skills are essential. Collaborating closely with other departments, such as underwriting and legal, can also help resolve ambiguous cases more efficiently. Ongoing training and keeping up with changes in industry regulations further support success in this role.

What is the difference between Insurance Claim Review vs Insurance Adjuster?

AspectInsurance Claim ReviewInsurance Adjuster
CredentialsTypically requires insurance or claims processing certificationsRequires licensing and adjuster certifications
Work EnvironmentOffice-based, reviewing claims remotely or on-siteFieldwork, inspecting damages, meeting clients
Employer & Industry UsageInsurance companies, third-party claims servicesInsurance companies, independent adjusting firms
Search & Comparison IntentUnderstanding claim review roles, job dutiesAssessing damage, settling claims

Insurance Claim Review professionals focus on evaluating and verifying insurance claims, often working in an office setting. Insurance Adjusters, on the other hand, inspect damages firsthand and negotiate settlements. Both roles require insurance-related certifications but differ in work environment and responsibilities.

What are popular job titles related to Insurance Claim Review jobs in Florida?

For Insurance Claim Review jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Insurance Claim Review jobs in Florida look for?

The top searched job categories for Insurance Claim Review jobs in Florida are:

What cities in Florida are hiring for Insurance Claim Review jobs?

Cities in Florida with the most Insurance Claim Review job openings:

Insurance Claim Review jobs near you
Infographic showing various Insurance Claim Review job openings in Florida as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Sub-Servicing Hazard Claim Specialist

Lakeview Loan Servicing

Coral Gables, FL • On-site

Full-time

Posted 24 days ago

Job description

Overview
The Sub-Servicing Oversight Team is responsible for managing the performance of approved Sub-Servicers. The Sub-Servicing Hazard Claim Specialist will focus on overseeing property and casualty (P&C) hazard claims filed by both borrowers and lenders. This individual will perform exception reviews and end-to-end administration of hazard claims, including identification of damaged properties, claim filing, and ensuring hazard claims are settled promptly and fairly. They will monitor, oversee, and drive solutions to mitigate losses. The Sub-Servicing Hazard Claim Specialist will provide monthly Quality Assurance results to the sub-servicers and subservicing oversight teams to ensure performance and accountability. This team member will play a key role in ensuring that sub-servicers are servicing Lakeview's portfolio appropriately and that hazard claims are handled efficiently and in compliance with Lakeview's standards. This role can be 100% remote or hybrid out of our Coral Gables, FL office. The pay range for this position is $26.00 to $29.00 per hour and includes bonus eligibility.
Responsibilities
  • Perform day-to-day oversight of sub-servicing activities, with a focus on hazard claims, including property preservation, damaged property identification, and insurance claim filing.
  • Review property condition reports and photos to identify insurable damages, research dates of loss, and ensure claims are filed promptly and with the appropriate insurance carrier.
  • Gather and submit documents to the insurance carrier to drive the claim toward settlement.
  • Analyze repair bids and insurance scopes to determine whether claims are settled fairly, identifying opportunities for supplemental requests if necessary.
  • Draft supplemental requests and denial disputes to advocate for insurance coverage, if necessary.
  • Provide exception review findings to Lakeview leadership and sub-servicers.
  • Facilitate or provide subject matter expertise in addressing issues in loan-level reviews with sub-servicers pertaining to property preservation and hazard claims.
  • Responsible for monitoring FHLMC, FNMA, GNMA (FHA, VA, USDA) reports and scorecards to identify areas of concern and perform reviews of exceptions captured in the reports and/or scorecards.
  • Other duties as assigned.

Qualifications
  • Strong critical thinking and dispute resolution skills with the ability to analyze and interpret property insurance policy language.
  • Ability to navigate multiple systems, communicate persuasively, and work autonomously.
  • Knowledge of property and casualty insurance, HUD guidelines, and residential construction matters is a plus.
  • 2+ years of experience in one or more of the following: P&C insurance, hazard claims, property preservation, or default mortgage servicing.
  • Experience with Microsoft Office, especially Excel and Word.
  • SQL (Structured Query Language) experience a plus.
  • Experience with ICE/Black Knight/LoanSphere/LPS Desktop and claim-related systems preferred.
  • Ability to work in a fast-paced environment with a positive attitude; team player
  • High school diploma/GED required; College degree preferred (experience can substitute for education)

Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit and use hands to handle, touch or feel objects, tools, or controls. The employee frequently is required to talk and hear. The noise level in the work environment is usually moderate. The employee is occasionally required to stand; walk; reach with hands and arms. The employee is rarely required to stoop, kneel, crouch, or crawl. The employee must regularly lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.
EEOC
Lakeview is an Equal Employment Opportunity employer. All aspects of consideration for employment and employment with the Company are governed on the basis of merit, competence and qualifications without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, or any other category protected by federal, state, or local law.

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