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Insurance Claim Review Jobs in Florida (NOW HIRING)

CCMSI

Workers' Compensation Claim Consultant

Maitland, FL · On-site

$70K - $90K/yr

Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices ... Medical, Dental, Vision, Life, and Disability Insurance * Retirement plans : 401(k) and Employee ...

Zelis

Clinical Nurse Reviewer

Saint Petersburg, FL

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 ...

FCCI Insurance Group

Surety Claim Specialist

Lake Mary, FL · On-site +1

$102K - $157K/yr

FCCI Insurance Group is a trusted provider of comprehensive property & casualty coverage in 20 ... reviews applicable statutes, and analyzes claim submissions involving commercial and contract ...

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Insurance Claim Review information

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 the key skills and qualifications needed to thrive as an Insurance Claim Review Specialist, and why are they important?

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 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 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 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 July 2026, with employment types broken down into 78% Full Time, 19% Part Time, 1% Temporary, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Workers' Compensation Claim Administrator

The Hartford

Lake Mary, FL • On-site, Remote

$51K - $77K/yr

Full-time

Posted 9 days ago

The Hartford rating

8.8

Company rating: 8.8 out of 10

Based on 120 frontline employees who took The Breakroom Quiz

57th of 299 rated insurance

Job description

Administrator Claims - CH10EN

We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals - and to help others accomplish theirs, too. Join our team as we help shape the future.

Workers' Compensation Claim Administrator

The Workers' Compensation Claim Administrator role will work within established procedures in adherence to statutory, regulatory, and ethical requirements. Our dynamic team of claim professionals provide superb customer service with the valuation, and disposition of claims while adhering to our corporate claim's excellence polices.

Responsibilities:

  • Effectively manage workers' compensation claims requiring coverage and compensability investigations as identified from First Notice of Loss in multiple jurisdictions.
  • Identify co-morbid conditions/prior conditions that may affect the original or ongoing compensability decision of the claim
  • Provide benefit oversight and file disposition appropriate for claim complexity and adherence to statutory guidelines for all claims
  • Leverage a network of internal partner resources such as: nurses, utilization review, and subject matter experts to help with disposition of the claim
  • Identify and investigate potential fraud red flags, inclusive of referral to SIU
  • Provide exceptional customer service by establishing and maintaining productive business relationships with internal and external customers through written and verbal communication
  • Utilize critical thinking skills to gather and analyze data information to inform critical claim decisions, such as coverage analysis, compensability decisions, escalation of injury complexity, attorney representation, and potential red flags
  • Leverage contemporary technology to achieve accurate and efficient claim outcomes

Qualifications:

  • Prior workers' compensation insurance claim handling is preferred
  • HS Diploma required, Bachelor's Degree is preferred
  • 2+ years of customer service experience preferred
  • Ability to meet productivity targets in a fast-paced, team-oriented environment
  • Excellent written and communication skills with the ability to resolve service issues
  • Possess strong time management and organizational skills
  • Ability to adapt and flourish using industry-changing workflows
  • Ability to self-manage competing priorities while delivering accurate work within key timelines
  • Strong computer proficiency in the MS Office Suite (Word, Excel, Outlook & PowerPoint)

Additional Details:

  • As a condition of your employment, you must obtain and maintain a State Adjuster's License to process Property & Casualty Insurance. Continued employment with The Hartford is contingent upon the successful passage of the Licensing exam within 1 year from your date of hire.

Work Arrangement:

  • This role can have a Hybrid or Remote work schedule. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Scottsdale, AZ, or Naperville, IL) will have the expectation of working in an office 3 days a week (Tuesday through Thursday).Candidates who do not live near an office will have aremote work schedule, with the expectation of coming into an office as business needs arise.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford's total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$51,769 - $77,653

Equal Opportunity Employer/Sex/Race/Color/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

About Us|Our Culture|What It's Like to Work Here|Perks & Benefits

What The Hartford employees say

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Benefits

Hours and flexibility

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Get the full story on Breakroom

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About Hartford

Sourced by ZipRecruiter

Hartford Financial Services Group, widely recognized as The Hartford, is a renowned company based in Hartford, CT, US. Established in 1810, it has evolved into an industry leader in the insurance and financial services sector, proudly serving more than one million businesses in the US. The Hartford is committed to offering a gamut of insurance products that include homeowners, automobile, and business insurance as well as employee benefits and mutual funds. The company’s core values revolve around customer-focused innovations, diversity and inclusion, and ethical dealings that have earned them a customer-centric reputation. This shapes their mission which revolves around aiding their clients to overcome unforeseen obstacles and enhancing their wealth over time. Among the company's noted accomplishments is being consistently listed among the World's Most Ethical Companies, a testament to their unwavering commitment towards responsible business practices.

Industry

Finance and insurance

Company size

10,000+ Employees

Headquarters location

Hartford, CT, US

Year founded

1810

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