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Medicaid Claims Processing Jobs in Florida (NOW HIRING)

1 Legacy, Inc

Manager I Claims

Miami, FL

Assure timely and accurate processing of Medicare claims and encounters, and respond to provider ... Minimum of 5 years of Medicare/Medicaid claims experience that demonstrates progressive growth ...

Humana

Claims Processing Professional

Miramar, FL · On-site

$53K - $72K/yr

As a Claims Processing Professional, you will: * Review and process healthcare claims within ... These efforts are leading to a better quality of life for people with Medicare and Medicaid ...

Humana

Claims Processing Professional

Miramar, FL · On-site

$53K - $72K/yr

As a Claims Processing Professional, you will: * Review and process healthcare claims within ... These efforts are leading to a better quality of life for people with Medicare and Medicaid ...

Humana

Claims Processing Professional

Miramar, FL · On-site

$53K - $72K/yr

As a Claims Processing Professional, you will: * Review and process healthcare claims within ... These efforts are leading to a better quality of life for people with Medicare and Medicaid ...

Humana, Inc.

Claims Processing Professional

Miramar, FL · On-site

$53K - $72K/yr

As a Claims Processing Professional, you will: * Review and process healthcare claims within ... These efforts are leading to a better quality of life for people with Medicare and Medicaid ...

Miccosukee Tribe of Indians

Be Seen First

Claims Processor

Miami, FL · On-site

$24 - $27/hr

... processing, submission, monitoring, and follow-up of healthcare claims to Medicare, Medicaid, and other third-party payers. This position supports the Health Department's revenue cycle by helping ...

Wellcove

Claims - Claims Examiner

Pensacola, FL · On-site

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 ...

1 Legacy, Inc

Manager I Claims

Doral, FL · On-site

Assure timely and accurate processing of Medicare claims and encounters, and respond to provider ... Extensive knowledge of claims policies and procedures, including industry standards from Medicaid ...

1 Legacy, Inc

Manager I Claims

Doral, FL · On-site

Assure timely and accurate processing of Medicare claims and encounters, and respond to provider ... Extensive knowledge of claims policies and procedures, including industry standards from Medicaid ...

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All JobsMedicaid Claims Processing JobsMedicaid Claims Processing Jobs in Florida

Medicaid Claims Processing information

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How much do medicaid claims processing jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for medicaid claims processing in Florida is $14.32, according to ZipRecruiter salary data. Most workers in this role earn between $12.21 and $15.43 per hour, depending on experience, location, and employer.

What is a Medicaid claims processing job?

A Medicaid Claims Processing job involves reviewing, verifying, and processing healthcare claims submitted by providers seeking reimbursement for services rendered to Medicaid beneficiaries. Workers in this role ensure claims comply with state and federal regulations, identify errors or discrepancies, and communicate with healthcare providers to resolve issues. They may also use specialized software to input and track claims, process denials or appeals, and ensure timely and accurate payments. Strong attention to detail, knowledge of Medicaid policies, and proficiency with healthcare billing codes are essential for success in this role.

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

Success in Medicaid Claims Processing requires excellent attention to detail, a thorough understanding of healthcare billing procedures, and familiarity with Medicaid regulations and insurance guidelines. Proficiency in medical billing software, claims management systems, and sometimes industry certifications such as Certified Professional Coder (CPC) is beneficial. Strong organizational skills, problem-solving abilities, and effective written and verbal communication help individuals excel in this role. These skills and qualifications are crucial for ensuring accurate, timely claims processing and compliance with ever-evolving Medicaid requirements.

What are some typical challenges faced in Medicaid claims processing, and how can I prepare for them?

One of the main challenges in Medicaid Claims Processing is staying up-to-date with frequently changing policies, billing codes, and compliance requirements, which can vary by state and program. Professionals in this role must pay close attention to detail to avoid errors and denials, often working with tight deadlines and large volumes of claims. To prepare, it's helpful to become familiar with Medicaid guidelines, maintain strong organizational habits, and proactively seek out updates in regulations or coding standards. Collaborating with other team members, such as care coordinators and billing specialists, is essential to ensure claims are accurate and properly documented. Ongoing learning and adaptability are key for long-term success in this dynamic environment.

How to get a job as a Medicaid Claims Processing specialist?

To become a Medicaid Claims Processing specialist, candidates typically need a high school diploma or equivalent, with some roles requiring postsecondary education or certifications in healthcare administration or related fields. Relevant skills include knowledge of healthcare billing, claims processing software, and federal Medicaid policies; experience in healthcare or insurance is often preferred. Applying through healthcare organizations, government agencies, or insurance companies and demonstrating attention to detail and familiarity with claims systems can improve job prospects.

Is a Medicaid claims processing job in demand?

Medicaid claims processing jobs are in steady demand due to ongoing healthcare coverage needs and the complexity of processing claims. These roles often require knowledge of healthcare regulations and claims management software, making them essential in healthcare administration and insurance companies.

What are the most commonly searched types of Medicaid Claims Processing jobs in Florida?

The most popular types of Medicaid Claims Processing jobs in Florida are:

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

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

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

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

Medicaid Claims Processing jobs near you
Infographic showing various Medicaid Claims Processing job openings in Florida as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $29,790 per year, or $14.3 per hour.

Medicaid Claims Examiner

DOCTORS HEALTHCARE PLANS, INC.

Coral Gables, FL • On-site

Full-time

Medical

Posted 11 days ago

Job description

Position Purpose:  The Medicaid Claims Examiner is responsible for reviewing, analyzing, processing, and adjudicating Medicaid claims to ensure compliance with federal and state regulations, provider contracts, and health plan policies. The examiner investigates claim discrepancies, resolves pended claims, and ensures accurate and timely reimbursement while maintaining high standards of quality and productivity.
Essential Duties and Responsibilities:         
  • Review and process Medicaid professional, institutional, and ancillary claims.
  • Analyze claims for completeness, accuracy, medical necessity, and policy compliance.
  • Apply Medicaid benefits, provider contract provisions, fee schedules, and reimbursement methodologies.
  • Research and resolve claim edits, denials, suspensions, and payment discrepancies.
  • Verify member eligibility, authorization requirements, coordination of benefits (COB), and third-party liability information.
  • Interpret and apply CMS, state Medicaid, and health plan guidelines during claims adjudication.
  • Communicate with providers, internal departments, and vendors to obtain missing or clarifying information.
  • Inter-department collaboration for timely Medicaid encounter remediation and resubmission to the State.
  • Management and remediation of Medicaid encounter rejections
  • Collaborating with provider relations and other departments, as necessary for timely encounter resubmission to the Agency for Healthcare Administration
  • Maintain accurate documentation of claim determinations and adjustments.
  • Meet departmental productivity, accuracy, and turnaround-time standards.
  • Participate in audits, quality reviews, and process improvement initiatives.
Required Qualifications:
  • High School Diploma or GED required; Associate's or Bachelor's degree preferred.
  • 1-3 years of healthcare claims processing experience; Medicaid experience preferred.
  • Knowledge of medical terminology, CPT, HCPCS, ICD-10, revenue codes, and billing practices.
  • Understanding of Medicaid regulations, CMS guidelines, and managed care operations.
  • Proficiency with claims processing systems and Microsoft Office applications.
  • Strong analytical, organizational, and problem-solving skills.
  • Excellent verbal and written communication skills.
Preferred Qualifications:
  • Experience with Medicaid Managed Care Organizations (MCOs).
  • Familiarity with provider contracts and reimbursement methodologies.
  • Knowledge of coordination of benefits (COB), subrogation, and fraud, waste, and abuse (FWA) principles.

Note:  This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).  Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.   

No Third Party Agencies or Submissions Will Be Accepted.   
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP   
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.


 

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