UNKNOWN

FEED

Adjusters who handle the potential fraud or waste claims will investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner. Primary Skills & Requirements other duties may be assigned as necessary : Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.

Integrity Marketing Group

Health Insurance Claims Adjuster-2

sourcestack_via_bold

The Epic Applications Analyst III drives performance improvement through data reporting, advanced configuration, and proactive system enhancements, ensuring reliable, secure, and user-friendly application functionality. Partners with cross-functional teams manage major EHR upgrades, requests for enhancements, testing cycles, and change management initiatives to drive performance improvement.

Expert In Recruitment Solutions

Epic Certified Applications Analyst III Claims

jobdiva

Research and determine Reinsurance/Stoploss plan year, identify claim payments made by client versus the Stoploss carriers, and interpret complex plan language to ensure accurate handling of complex adjustments. Review, research, and adjust complex Reinsurance/Stoploss medical claims, splitting claims into multiple claim statuses; adjudicates high-dollar complex, sensitive, and/or specialized medical claims in accordance with claim processing guidelines.

HOUR

<p>CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all. </p>

CVS Health Corp

Reinsurance/Stoploss Medical Claims Adjustor

linkup_via_bold

Adjusters who handle the potential fraud or waste claims will investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner. Insurance Administrative Solutions, L.L.C. ("IAS"), an Integrity company headquartered in Clearwater, Florida, is a third-party administrator providing business process outsourcing for insurance carriers.

Integrity Marketing Group, LLC

Health Insurance Claims Adjuster

Medical Health Insurance Claims Adjuster

The Claims Department Manager partners closely with the Director of Claims and other organizational leaders to identify and communicate business needs, implement operational improvements, support strategic initiatives, and drive process efficiencies. This position oversees claims supervisors, claim support functions, and operational initiatives to ensure timely, accurate and compliant processing of claims while meeting client, regulatory, financial, and customer service expectations.

Insurance Administrative Solutions LLC

Manager, Claims

As a Claims Examiner at Allianz Partners, you'll help customers navigate important moments with clarity and care-backed by the resources of a global industry leader. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us.

Allianz SE

Claims Examiner

Provides senior level support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication, and recommends solutions to resolve issues.

Molina Healthcare Inc

Senior Examiner, Claims (Remote)-Must reside in Florida

Perform pre-payment audits and post payment audits to validate claims for appropriate coding and documentation (including but not limited to CPT, HCPCS, ICD-10 coding) and validate accurate claim adjudication rules and fee schedules were applied. You'll perform pre-payment and post-payment validations, support operational reporting and testing, and manage data submissions while ensuring claims align with established policies, guidelines, contractual agreements, and provider rates.

Leon Health Inc

Claims Auditor

FULL_TIME

YEAR

Position Purpose: The Claims Examiner is responsible for providing expertise and/or claims support in reviewing, researching, investigating, processing and adjusting claims and other duties as necessary. 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.

DOCTORS HEALTHCARE PLANS, INC.

Claims Examiner II

partner JazzHR

We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams.

Wisconsin Physicians Service Insurance Corp

Claims Examiner III - LPN

Maintain external contacts with policyholders, providers of service, agents, attorneys and other carriers as well as internal contacts with peers, management, and other support areas with a positive and professional approach. Communicate openly with Supervisor, Team Lead and other team members to ensure accurate responses and avoid duplication of efforts.

Claims Customer Service Representative

ea_via_bold

Maintain professional and positive relationships with external contacts such as policyholders, service providers, agents, attorneys, and other insurance carriers, as well as internal connections including coworkers, management, and support staff. Answer incoming calls and place outbound calls to provide or obtain information, ensuring all interactions are helpful, professional, and timely.

Claims Customer Service Representative II

Responsibilities: Support an AI/ML initiative focused on training document-understanding models using healthcare Explanation of Benefits (EOB) documents. Our client, an IT Services and Consulting company, is looking for a Healthcare Claims Data Analyst - AI/ML Annotation for their Tampa, FL location.

Iconma LLC

Healthcare Claims Data Analyst - AI/ML Annotation

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. 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.

Independent Living Systems LLC

Under the direct supervision of the Manager of Revenue Cycle Operations, the Contractual Claims Analyst is responsible for the day-to-day review, analysis, and resolution of assigned medical claims, with primary emphasis on contractual reimbursement accuracy, underpayments, payment variances, and payer compliance with negotiated reimbursement terms . Proactively review, research, and resolve assigned accounts involving contractual underpayments, payment variances, incorrect contractual adjustments, and other payer reimbursement discrepancies .

Health Business Solutions LLC

CLAIMS ANALYST - CONTRACTUAL

HiringThing

You'll be a key point of contact between shipboard medical teams, cruise line partners, and internal stakeholders — bringing structure and follow-through to a fast-moving, detail-heavy process. OneSpaWorld is a global leader in health, wellness, and beauty services at sea and on land, operating spa and wellness centers aboard cruise ships and at destination resorts.

OneSpaWorld

Claims Coordinator

With more than 7,000 professionals worldwide and a collective portfolio exceeding $18 billion in premium placed in 2024, our combined organization delivers a diverse trading platform for insurance carriers as well as expanded access and niche solutions for brokers and customers navigating complex and hard-to-place risks. The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role.

Brown & Brown Inc

Travel Claims Examiner and Customer Service Representative

Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. As Claims Adjustments and Data Capture Clerk - Tallahassee, FL (Hybrid), you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve - a community's most vulnerable.

Gainwell Technologies LLC

Claims Adjustments and Data Capture Clerk - Tallahassee, FL (Hybrid)

Recognized on Fortune magazine\''s list of the "World\''s Most Admired Companies", Fortune World's 25 Best Workplaces, as well as the Fortune 100 Best Companies to Work For, MetLife, through its subsidiaries and affiliates, is one of the world's leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. All employment decisions are made without regards to race, color, national origin, religion, creed, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, marital or domestic/civil partnership status, genetic information, citizenship status (although applicants and employees must be legally authorized to work in the United States), uniformed service member or veteran status, or any other characteristic protected by applicable federal, state, or local law ("protected characteristics").

Claims Processor Jobs in Florida

Health Insurance Claims Adjuster-2 Integrity Marketing Group

Epic Certified Applications Analyst III Claims Expert In Recruitment Solutions

Reinsurance/Stoploss Medical Claims Adjustor CVS Health Corp

Health Insurance Claims Adjuster Integrity Marketing Group, LLC

Medical Health Insurance Claims Adjuster Integrity Marketing Group, LLC

Manager, Claims Insurance Administrative Solutions LLC

Claims Examiner Allianz SE

Senior Examiner, Claims (Remote)-Must reside in Florida Molina Healthcare Inc

Claims Auditor Leon Health Inc

Claims Examiner II DOCTORS HEALTHCARE PLANS, INC.

Claims Examiner III - LPN Wisconsin Physicians Service Insurance Corp

Claims Customer Service Representative Integrity Marketing Group

Claims Customer Service Representative II Integrity Marketing Group

Healthcare Claims Data Analyst - AI/ML Annotation Iconma LLC

Claims Examiner Independent Living Systems LLC

CLAIMS ANALYST - CONTRACTUAL Health Business Solutions LLC

Claims Coordinator OneSpaWorld

Travel Claims Examiner and Customer Service Representative Brown & Brown Inc

Claims Adjustments and Data Capture Clerk - Tallahassee, FL (Hybrid) Gainwell Technologies LLC

Individual Disability Claims Specialist II MetLife Inc

Similar Job Searches

Stand out to leading employers.