Claims Processor Position Available In Miami-Dade, Florida
Tallo's Job Summary: Join our team at a Third-Party Administrator (TPA) company as a Medical Claims Processor. Review, process, and adjudicate medical claims accurately. Communicate with providers and policyholders, resolve discrepancies, and maintain claim records. Requirements include English fluency, healthcare insurance experience, and strong organizational skills. Full-time position with a pay range of $15.00 - $18.00 per hour.
Job Description
Claims Processor 4.0 4.0 out of 5 stars 9600 NW 38th Street, Doral, FL 33178 Job Overview We are seeking a detail-oriented and analytical Medical Claims Processor to join our team at a Third-Party Administrator (TPA) company specializing in health insurance. The ideal candidate will be responsible for reviewing, processing, and adjudicating medical claims accurately and efficiently. This role requires a strong understanding of healthcare billing and insurance policies, excellent organizational skills, and a commitment to delivering high-quality service to providers, policyholders, and internal teams. Responsibilities Review and process medical claims for accuracy and compliance with policy terms. Validate coding (ICD-10, CPT, HCPCS) and ensure appropriate documentation is attached. Communicate with providers, hospitals, and policyholders regarding claim status and necessary documentation. Resolve discrepancies and investigate complex or denied claims. Maintain accurate claim records in the processing system. Ensure claims are processed in accordance with federal, state, and company regulations, including HIPAA compliance. Collaborate with internal departments to resolve claim issues and support ongoing process improvement. Requirements Must be fluent in English (both spoken and written). Previous experience in medical claims processing or a related healthcare insurance role is preferred. Strong knowledge of health insurance terminology, claims adjudication, and medical coding. Detail-oriented with excellent problem-solving and time management skills. Proficient in data entry, claims software, and general office applications. Ability to work independently in a fast-paced, high-volume environment. High school diploma or equivalent required; additional training or certification in medical billing/coding is a plus.
Job Type:
Full-time Pay:
$15.00 – $18.00 per hour
Benefits:
Dental insurance Health insurance Paid time off Vision insurance
Schedule:
8 hour shift
Work Location:
In person
