A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
Florida Auto PIP / Medical Payments Adjuster We are seeking a detail-oriented and experienced Florida Auto PIP / Medical Payments Adjuster to join our claims team. This position is responsible for handling Personal Injury Protection (PIP) and Medical Payments claims in accordance with Florida statutes, policy provisions, Medicaid and Medicare fee schedule and company guidelines. The ideal candidate will have strong knowledge of Florida PIP regulations, and the ability to manage claims efficiently while providing excellent service to insureds and medical providers.
Key Responsibilities:
Review medical bills, records, and documentation for accuracy and compliance Apply Florida PIP statutes and fee schedules to determine appropriate payments Communicate with insureds, claimants, attorneys, and medical providers Good faith settlements/negotiations with provides offices Document claim activity and maintain accurate claim files Issue payments and explanations of benefits (EOBs) as appropriate Identify potential fraud indicators and escalate when necessary Maintain compliance with company procedures and regulatory requirements Manage claim workload to meet productivity and quality standards
Qualifications:
Some Florida PIP or Medical Payments claims handling experience Some knowledge of Florida PIP statutes and fee schedules Experience reviewing medical bills and medical documentation Excellent organizational and time management skills Strong bilingual written and verbal communication skills Ability to work independently and manage a high-volume caseload Claims system experience preferred
Preferred:
Florida Adjuster License (620 or equivalent) Experience with medical payments, excel and/or medical coding
ABOUT US
We are a fast-growing, bilingual insurance agency serving clients across Florida and Texas! Our team helps families and businesses protect what matters most — through auto, home, life, and commercial insurance solutions built around each client's needs. We are not your average insurance agency. We invest in our people, recognize performance, and create real paths for growth — from your first day in the office to owning your own location. If you are bilingual, driven, and want a career that rewards your work, you have found the right team.
WHY JOIN US
We know talented bilingual insurance professionals have options. Here is what makes us different: ✓ Real base pay — Competitive salary based on experience and license held ✓ Paid Time Off — 1 week PTO to start, growing with tenure ✓ Medical Insurance — Comprehensive health coverage for you ✓ Sick Time — Dedicated sick time separate from your PTO ✓ Dental & Vision — Comprehensive dental and vision coverage ✓ Performance Bonus — Structured plan tied directly to your results ✓ Supplemental Plans — Voluntary supplemental options available ✓ Employee Referral — Earn rewards for bringing great talent in ✓ Basic Life Insurance — Company-paid life insurance ✓ Career Growth Path — CSR Agent Team Lead Manager Owner ✓ 401(k) with Match — Invest in your retirement savings with us! ✓ Training & Development — Ongoing sales, product, customer service & compliance training
OUR CORE VALUES
"The harder we work, the luckier we are." ️ PROTECT Safety for our communities We ensure the safety of our communities by offering robust insurance options for life's many facets. Quality and comprehensiveness are the hallmarks of our coverage. HELP Swift, personalized support Our agents are ready to assist with any insurance questions, providing swift and personalized support to guide clients through their options. PROMOTE Investing in our workforce We invest in the future of our workforce with career paths and training for aspiring agents, contributing to the growth of the insurance sector. BUILD Trust & transparency Our client relationships are built on trust and transparency, with each interaction tailored to meet individual insurance needs.
EDUCATE & GUIDE
Clarity & empowerment Clarity and empowerment are the goals of our resources, aimed at helping clients make informed insurance decisions. PROVIDE Accessible solutions We deliver affordable and innovative insurance solutions made readily accessible through tools like our app, enhancing convenience for our clients.
