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Insurance Claims Processing Jobs in Florida (NOW HIRING)

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

Independent Living Systems

Claims & Billing Analyst

Miami, FL · On-site

$45K - $61K/yr

Minimum of 2 years of experience in medical billing, claims processing, or revenue cycle management. * Strong knowledge of healthcare billing codes, insurance claim procedures, and payer guidelines.

Healthcare Support Staffing

Claims Processor

Tampa, FL · On-site

$14 - $17/hr

Minimum 2 year medical claims processing experience Knowledge of health benefit plans and health ... of commercial insurance primary & secondary payors. Strong data entry skills. Additional ...

Oates Energy

Claims Processor

Jacksonville, FL · Remote

$36 - $49/hr

Hold 1-3 years of relevant professional experience within the insurance industry, preferably in claims processing or a comparable area. * Possess a robust grasp of insurance contracts, operational ...

Capital Health Plan

Claims Examiner I

Tallahassee, FL · On-site

In this full-time role, you will help ensure insurance claims are reviewed, evaluated, and processed accurately according to departmental policies, provider agreements, and member benefits. WHAT'S IN ...

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Insurance Claims Processing information

What is insurance claims processing?

Insurance claims processing is the procedure by which insurance companies review, investigate, and settle claims made by policyholders. This process involves verifying the details of a claim, ensuring it meets the terms of the policy, and determining the appropriate payout or action. Claims processors handle documentation, communicate with claimants, and may work with other parties like adjusters or healthcare providers. The goal is to ensure claims are resolved efficiently, accurately, and fairly according to policy guidelines.

What are the key skills and qualifications needed to thrive in insurance claims processing?

To excel in Insurance Claims Processing, you need strong attention to detail, analytical abilities, and a foundational understanding of insurance policies or claims procedures, often supported by a high school diploma or associate degree. Familiarity with claims management software, databases, and sometimes industry certifications like AIC (Associate in Claims) is common. Effective communication, problem-solving skills, and the ability to manage stressful situations make someone stand out in this role. These competencies are critical for ensuring claims are processed accurately, efficiently, and in compliance with regulatory standards.

What are some common challenges faced in insurance claims processing, and how can new team members effectively manage them?

In insurance claims processing, new team members often encounter challenges such as handling high volumes of claims, interpreting complex policy language, and communicating effectively with policyholders and other stakeholders. To manage these challenges, it's important to develop strong organizational skills, stay detail-oriented, and proactively seek clarification when unsure about policy terms or procedures. Collaborating with experienced colleagues and taking advantage of ongoing training opportunities can also help new processors build confidence and efficiency in their daily tasks.

What is the difference between Insurance Claims Processing vs Insurance Adjuster?

AspectInsurance Claims ProcessingInsurance Adjuster
CredentialsTypically requires a high school diploma or equivalent; certifications like CPCU or AIC are commonRequires a high school diploma; certifications like AIC or state licensing often needed
Work EnvironmentOffice-based, processing claims via computer systemsField and office work, inspecting damages and interviewing claimants
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, independent adjusting firms
Primary FocusReviewing and processing insurance claims efficientlyAssessing damages and determining claim validity and payout

While both roles are essential in the insurance industry, Insurance Claims Processing focuses on handling and managing claims paperwork, whereas Insurance Adjusters evaluate damages and determine claim settlements. Understanding these differences helps job seekers identify the right career path within the insurance sector.

How to get a job as an insurance claims processor?

To become an insurance claims processor, candidates typically need a high school diploma or equivalent, with some roles preferring postsecondary training or certifications in insurance or claims processing. Relevant skills include attention to detail, communication, and familiarity with claims management software. Gaining experience through internships or entry-level positions can improve job prospects, and some employers may require background checks or specific licensing depending on the state or company policies.

Is insurance claims processing a stressful job?

Insurance claims processing can be a stressful job due to tight deadlines, high workload, and the need for accuracy in evaluating claims. It often requires strong attention to detail, communication skills, and the ability to handle difficult customer interactions, which can contribute to job-related stress.

What does an insurance claims processing do?

An insurance claims processor reviews and evaluates insurance claims to determine coverage and payout amounts. They verify policy details, gather necessary documentation, and ensure claims are processed accurately and efficiently, often using claims management software. Attention to detail and knowledge of insurance policies are essential for this role.

What are popular job titles related to Insurance Claims Processing jobs in Florida?

For Insurance Claims Processing jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Insurance Claims Processing jobs in Florida look for?

The top searched job categories for Insurance Claims Processing jobs in Florida are:

What cities in Florida are hiring for Insurance Claims Processing jobs?

Cities in Florida with the most Insurance Claims Processing job openings:

Insurance Claims Processing jobs near you
Infographic showing various Insurance Claims Processing job openings in Florida as of August 2026, with employment types broken down into 100% Full Time. Highlights an 83% In-person, and 17% Remote job distribution.

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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