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Medical Claim Adjuster Jobs in Boca Raton, FL (NOW HIRING)

HUB

Senior Claims Consultant

Davie, FL

Medical/dental/visioninsurance and voluntary insurance options * Health Savings Account funding ... Will act as a liaison between clients, adjusters,defense counsel, insurance companies, claims ...

Kelley Uustal

Legal Assistant

Fort Lauderdale, FL · On-site

... adjuster still owes a callback, notices the moment a client's medical records are overdue, and ... claim. * Request, track, and update all liens (medical, health insurance, and governmental) to ...

Kelley Uustal

Legal Assistant

Fort Lauderdale, FL · On-site

... adjuster still owes a callback, notices the moment a client's medical records are overdue, and ... claim. * Request, track, and update all liens (medical, health insurance, and governmental) to ...

Kelley Uustal

Legal Assistant

Fort Lauderdale, FL · On-site

... adjuster still owes a callback, notices the moment a client's medical records are overdue, and ... claim. * Request, track, and update all liens (medical, health insurance, and governmental) to ...

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Showing results 1-20

All JobsMedical Claim Adjuster JobsMedical Claim Adjuster Jobs in Boca Raton, FL

Medical Claim Adjuster information

See Boca Raton, FL salary details

$38.1K

$70.7K

$92K

How much do medical claim adjuster jobs pay per year?

As of Aug 29, 2026, the average yearly pay for medical claim adjuster in Boca Raton, FL is $70,682.00, according to ZipRecruiter salary data. Most workers in this role earn between $61,300.00 and $79,500.00 per year, depending on experience, location, and employer.

What does a medical claim adjuster do?

A Medical Claim Adjuster reviews and evaluates insurance claims related to medical treatments and healthcare services. They assess the validity of claims, determine the amount payable under an insurance policy, and ensure claims are processed accurately and fairly. Their work involves investigating the details of each claim, communicating with healthcare providers and policyholders, and adhering to legal and company guidelines. Medical Claim Adjusters play a crucial role in preventing fraud and ensuring that claims are settled efficiently.

What skills and qualifications are needed to be a medical claim adjuster?

To thrive as a Medical Claim Adjuster, you need a solid understanding of medical terminology, insurance policies, and claims processing, often supported by a background in healthcare administration or insurance. Familiarity with claims management software, ICD and CPT coding systems, and sometimes state licensure or industry certifications is typically required. Strong analytical skills, attention to detail, and effective communication are crucial soft skills for reviewing claims and interacting with policyholders or healthcare providers. These competencies ensure accurate claim evaluations, minimize errors or fraud, and facilitate fair and timely resolutions.

What are common challenges faced by medical claim adjusters, and how can they be managed?

Medical Claim Adjusters often encounter challenges such as interpreting complex medical records, navigating evolving insurance policies, and communicating effectively with healthcare providers and claimants. Staying updated on industry regulations and utilizing claim management software can help manage these complexities. Additionally, strong organizational skills and ongoing professional development are key to balancing a high volume of cases and delivering accurate, timely decisions.

What is the difference between Medical Claim Adjuster vs Medical Claims Processor?

AspectMedical Claim AdjusterMedical Claims Processor
CredentialsInsurance licenses, certifications (e.g., CPC, CPC-A)None typically required, basic computer skills
Work EnvironmentInsurance companies, healthcare providers, remote or officeHealthcare offices, insurance companies, remote options
Job ResponsibilitiesReview, investigate, and approve or deny claimsEnter, process, and track claim data
Industry UsageCommonly used in insurance and healthcare sectorsUsed in insurance and healthcare settings

The main difference is that Medical Claim Adjusters evaluate and decide on claims, often requiring certifications, while Medical Claims Processors handle data entry and processing tasks. Both roles are essential in the claims workflow but differ in responsibilities and credentials.

Is it worth becoming a medical claim adjuster?

Medical claim adjusters evaluate insurance claims related to healthcare expenses, requiring knowledge of medical terminology and insurance policies. The role offers steady employment with opportunities for advancement and often requires certification or training in insurance adjusting. It can be a stable career for those interested in healthcare and insurance industries.

What are popular job titles related to Medical Claim Adjuster jobs in Boca Raton, FL?

For Medical Claim Adjuster jobs in Boca Raton, FL, the most frequently searched job titles are:

What job categories do people searching Medical Claim Adjuster jobs in Boca Raton, FL look for?

The top searched job categories for Medical Claim Adjuster jobs in Boca Raton, FL are:

What cities near Boca Raton, FL are hiring for Medical Claim Adjuster jobs?

Cities near Boca Raton, FL with the most Medical Claim Adjuster job openings:

Medical Claim Adjuster jobs near you
Infographic showing various Medical Claim Adjuster job openings in Boca Raton, FL as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 17% Part Time, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $70,682 per year, or $34 per hour.

Medical Case Manager

AmTrust Financial Services, Inc.

Boca Raton, FL • On-site

Full-time

Medical, Dental, Life, Retirement, PTO

Re-posted 13 days ago

Job description

Overview
AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.
PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer. Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim. These responsibilities may include utilization review, pharmacy oversight and care coordination.
This position is remote in Florida or Georgia.
Responsibilities
  • Uses clinical/nursing skills to determine whether all aspects of a patient's care, at every level, are medically necessary and appropriately delivered.
  • Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines.
  • Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary
  • Responsible for accurate comprehensive documentation of case management activities in case management system.
  • Uses clinical/nursing skills to help coordinate the individual's treatment program while maximizing quality and cost-effectiveness of care including direction of care to preferred provider networks where applicable.
  • Addresses need for job description and appropriately discusses with employer, injured employee and/or provider. Works with employers on modifications to job duties based on medical limitations and the employee's functional assessment.
  • Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution.
  • Communicates effectively with claims adjuster, client, vendor, supervisor and other parties as needed to coordinate appropriate medical care and return to work.
  • Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place
  • Objectively and critically assesses all information related to the current treatment plan to identify barriers, clarify or determine realistic goals and objectives, and seek potential alternatives.
  • Partners with the adjuster to develop medical resolution strategies to achieve maximal medical improvement or the appropriate outcome
  • Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
  • Engage specialty resources as needed to achieve optimal resolution (behavioral health program, physician advisor, peer reviews, medical director).
  • Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves
  • Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
  • Other duties as may be assigned.
  • Supports the organization's quality program(s).

Qualifications
Education & Licensing
  • Active unrestricted RN license in a state or territory of the United States required.
  • Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
  • Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
  • Ability to acquire, and maintain, appropriate Professional Certifications and Licenses to comply with respective state laws may be required
  • Preferred for license(s) to be obtained within three - six months of starting the job.
  • Written and verbal fluency in Spanish and English preferred

Experience
3+ years of related experience or equivalent combination of education and experience required to include 2+ years of direct clinical care OR 2+ years of case management/utilization management required.
Skills & Knowledge:
  • Knowledge of workers' compensation laws and regulations
  • Knowledge of case management practice
  • Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
  • Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
  • Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation
  • Knowledge of behavioral health
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Leadership/management/motivational skills
  • Analytic and interpretive skills
  • Strong organizational skills
  • Excellent interpersonal and negotiation skills
  • Ability to work in a team environment
  • Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding
Auditory/Visual: Hearing, vision and talking
The expected salary range for this role is $80,000.00-$88,000.00.
Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.
What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

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