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Insurance Examiner Jobs in Miami, FL (NOW HIRING)

Independent Living Systems

Claims Examiner

Miami, FL · On-site

The Claims Examiner plays an essential role by thoroughly reviewing and evaluating insurance claims to ensure accuracy, compliance, and appropriateness of payments. This position involves analyzing ...

Independent Living Systems

Claims Examiner

Miami, FL · On-site

The Claims Examiner plays an essential role by thoroughly reviewing and evaluating insurance claims to ensure accuracy, compliance, and appropriateness of payments. This position involves analyzing ...

TEW & TAYLOR

Remote Plans Examiner

Fort Lauderdale, FL · Remote

$80K - $100K/yr

Health insurance * Paid time off About Us: Tew & Taylor has been a trusted name in building code ... Certification as a Plans Examiner or the ability to obtain certification within six months of ...

TEW & TAYLOR

Remote Plans Examiner

Miami, FL · Remote

$80K - $100K/yr

Health insurance * Paid time off About Us: Tew & Taylor has been a trusted name in building code ... Certification as a Plans Examiner or the ability to obtain certification within six months of ...

Solis Health Plans

Claims Examiner

Doral, FL · On-site

$19 - $23/hr

Bachelor's degreepreferred Experience: * 2 years' experience with complex claims processing and/or auditing within the health insurance industry or medical healthcare deliverysystem * 2 years ...

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All JobsInsurance Examiner JobsInsurance Examiner Jobs in Miami, FL

Insurance Examiner information

See Miami, FL salary details

$38.3K

$58.9K

$88K

How much do insurance examiner jobs pay per year?

As of Sep 2, 2026, the average yearly pay for insurance examiner in Miami, FL is $58,917.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,600.00 and $62,600.00 per year, depending on experience, location, and employer.

What is an insurance examiner?

Insurance examiners are professionals who review insurance applications, claims, and policies to ensure compliance with government regulations and company standards. They assess the financial health of insurance companies, investigate claim validity, and help prevent fraud. Their work is essential in maintaining the integrity and reliability of the insurance industry. Insurance examiners often work for government agencies or private insurance firms, and their findings can impact licensing and policy decisions.

What are the key skills and qualifications needed to thrive as an insurance examiner?

To thrive as an Insurance Examiner, you need a solid understanding of accounting, finance, and insurance regulations, often supported by a bachelor's degree in a related field. Familiarity with auditing software, data analysis tools, and regulatory compliance systems is typically required. Attention to detail, analytical thinking, and strong communication skills are essential soft skills for success in this role. These skills ensure accurate evaluations of financial records and compliance, protecting policyholders and maintaining the stability of the insurance industry.

What are some common challenges insurance examiners face when reviewing insurance companies' financial statements?

A common challenge for Insurance Examiners is identifying inconsistencies or irregularities in complex financial statements, as insurance company accounting can involve intricate transactions and reserves. Examiners must stay up to date with changing regulations and industry standards, which can vary by state and specialty. Additionally, they often work under tight deadlines and must balance objectivity with effective communication when discussing findings with company management. Strong analytical skills and attention to detail are essential for success in this role.

What is the difference between Insurance Examiner vs Insurance Underwriter?

AspectInsurance ExaminerInsurance Underwriter
Required CredentialsHigh school diploma or equivalent; some roles may require insurance licenses or certificationsBachelor's degree often preferred; certifications like CPCU beneficial
Work EnvironmentOffice setting; reviewing claims and documentsOffice setting; assessing risk and approving policies
Employer & Industry UsageInsurance companies, government agenciesInsurance companies, brokerage firms
Common Search & Comparison IntentUnderstanding roles in claims reviewUnderstanding roles in policy issuance

Insurance Examiners focus on reviewing insurance claims and verifying information, while Insurance Underwriters evaluate risks to determine policy eligibility and pricing. Both roles are essential in the insurance industry but serve different functions in the claims and underwriting processes.

How to become an insurance examiner?

To become an insurance examiner, candidates typically need a high school diploma or equivalent, with some roles preferring or requiring a college degree in fields like finance, business, or insurance. Relevant skills include attention to detail, analytical ability, and knowledge of insurance policies and regulations. Certification or training programs may be available, and experience in insurance or claims processing can improve job prospects.

What do insurance examiners do?

Insurance examiners review insurance applications, verify applicant information, and assess risk to determine policy eligibility and premium rates. They often analyze medical records, financial documents, and may conduct interviews or inspections to ensure accuracy and compliance with company policies.

What are the most commonly searched types of Insurance Examiner jobs in Miami, FL?

The most popular types of Insurance Examiner jobs in Miami, FL are:

What are popular job titles related to Insurance Examiner jobs in Miami, FL?

For Insurance Examiner jobs in Miami, FL, the most frequently searched job titles are:

What job categories do people searching Insurance Examiner jobs in Miami, FL look for?

The top searched job categories for Insurance Examiner jobs in Miami, FL are:

Insurance Examiner jobs near you
Infographic showing various Insurance Examiner job openings in Miami, FL as of August 2026, with employment types broken down into 100% Full Time. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $58,917 per year, or $28.3 per hour.

Claims Examiner

Independent Living Systems

Miami, FL • On-site

Full-time

Posted 5 days ago

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Claims Examiner to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Claims Examiner plays an essential role by thoroughly reviewing and evaluating insurance claims to ensure accuracy, compliance, and appropriateness of payments. This position involves analyzing medical documentation, policy details, and billing information to determine the validity of claims and identify any discrepancies or potential fraud. The Claims Examiner collaborates with healthcare providers, and internal teams to resolve claim issues and facilitate timely reimbursement. By maintaining up-to-date knowledge of healthcare regulations and insurance policies, the Claims Examiner helps protect the organization from financial loss and supports the delivery of fair and efficient claims processing. Ultimately, this role contributes to the integrity and sustainability of the organization by ensuring claims are processed accurately and ethically.

Minimum Qualifications:

  • High school diploma or GED.
  • Minimum of 2 years experience in claims examination, medical billing, or healthcare insurance processing.
  • Strong understanding of medical terminology, insurance policies, and healthcare billing codes (e.g., ICD-10, CPT).
  • Proficiency with claims management software and Microsoft Office suite.

Preferred Qualifications:

  • Associate’s degree or Bachelor's degree in health administration, healthcare management, or a related discipline.
  • Certification such as Certified Professional Coder (CPC) or Certified Claims Professional (CCP).
  • Experience working within the health care and social assistance industry or with government healthcare programs.
  • Familiarity with regulatory frameworks such as HIPAA and the Affordable Care Act.

Responsibilities:

  • Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
  • Review and analyze health insurance claims for completeness, accuracy, and compliance with policy terms and regulatory requirements.
  • Verify medical codes, treatment documentation, and billing information to ensure services are properly covered and billed.
  • Investigate and resolve claim discrepancies by communicating with providers and internal stakeholders.
  • Identify and escalate potential fraudulent claims or billing errors to compliance or legal teams.
  • Maintain detailed records of claim evaluations and stay current with healthcare laws and industry standards to support audits and improve processing workflows.
  • Perform other duties as assigned.



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