Top 29 Examiner Jobs in Miami, Fl

Claim Examiner I
Doral Office Services —Doral, FL
- $19 - $23 an hour
- Weekends as needed
- Background check
- Spanish
- Ability to walk for extended periods
- Health insurance
- Dental insurance
Quick Apply
Special Projects Administrator 1 (Medical Examiner)
Miami-Dade County —Miami-Dade County, FL
- $67,819.07 - $119,003.17 a year
- Full-time
- Research
- Mid-level
- Office
Claims Examiner
Stellar Human Resource Services LLC —Miami, FL
- Full-time
- Entry level
Quick Apply
Commercial Title Examiner
Pathfinders Inc —Florida
- $70,000 - $100,000 a year
- Full-time
- Remote
- Customer service
- Research
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
DOT Medical Examiner
Occupational Services —Davie, FL
- $70 an hour
- Part-time
- Mid-level
- Pre-employment physical examination
- In-person
- Paid time off
- 401(k) matching
Quick Apply
5d
Building Plans Examiner and/or Inspector
C A P Engineering Inc —Miami, FL
- Urgently hiring
- Research
- Mid-level
- Office
Quick Apply
Medicaid Claims Examiner
DOCTORS HEALTHCARE PLANS, INC. —Coral Gables, FL
- Full-time
- Research
- Mid-level
- High school diploma or GED
Quick Apply
3d
Plumbing Plans Examiner
PMM CONSULTING ENGINEERS CORP —Miami, FL
- Weekends as needed
- Office
- Residential
- US work authorization
Quick Apply
Mechanical Plans Examiner
PMM CONSULTING ENGINEERS CORP —Miami, FL
- Weekends as needed
- Office
- Residential
- US work authorization
Quick Apply
Fire Plans Examiner & Inspector
C A P Engineering Inc —Fort Lauderdale, FL
- Full-time
- Construction site
- Writing skills
- Travel
- Disability insurance
- Health insurance
Quick Apply
Landscape Plans Examiner
C A P Engineering Inc —Miami, FL
- Urgently hiring
- Management
- Construction site
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Security Officer Part Time Credential Examiner
Allied Universal —Miami, FL
- $21.91 an hour
- Full-time
- 18 years or older
- Pass drug screening
- High school diploma or GED
- Paid training
- Opportunities for advancement
Quick Apply
Electrical Plans Examiner and/or Inspector
C A P Engineering Inc —Miami, FL
- Urgently hiring
- Construction site
- Mid-level
- Travel
- Disability insurance
- Health insurance
Quick Apply
Medical Examiner Information Technology Senior Software Developer
Miami-Dade County —Miami-Dade County, FL
- $96,561.50 - $161,053.46 a year
- Full-time
- 5 years
- Bachelor's degree
- Mentoring
9d
Mechanical Inspector and/or Plans Examiner
C A P Engineering Inc —Miami, FL
- Urgently hiring
- Construction site
- Mid-level
- Residential
Quick Apply
Electrical Inspector and Plans Examiner
SAFEbuilt —Cutler Bay, FL
- Construction site
- Mid-level
- Residential
- Paid training
- Paid holidays
Quick Apply
Senior Workers' Compensation Claims Examiner - Federal Claims
AIG Claims, Inc. —Miami, FL
- $73,000 - $96,000 a year
- Email
- Customer service
- Writing skills
- Office
- Health insurance
Quick Apply
Plumbing Inspector and/or Plans Examiner
C A P Engineering Inc —Miami, FL
- Urgently hiring
- Construction site
- Mid-level
- Travel
- Disability insurance
- Health insurance
Quick Apply
Structural Plans Examiner
PMM CONSULTING ENGINEERS CORP —Miami, FL
- Weekends as needed
- Office
- Residential
- US work authorization
Quick Apply
HIGHWAY SAFETY SPECIALIST (WT: MV COMPLIANCE EXAMINER)MV COMPLIANCE EXAMINER)
The State of Florida —Opa-locka, FL
- $38,681.76 a year
- Overtime
- Background check
- Microsoft Excel
- Dealership
- Paid parental leave
- Paid holidays
9d

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Claim Examiner I

Doral Office Services -
Doral, FL

Quick Apply

Job Details

Full-time
$19 - $23 an hour

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
401(k) matching

Qualifications

Appeals
Spanish
Teamwork
Medicare
Managed care
Medicare coding guidelines
Managed care organization experience
Health insurance policy knowledge
Regulatory compliance in claims processing
English
Medical claims processing software
High school diploma or GED
ICD-10
Medicare regulations
Attention to detail
Medical insurance appeals management
Centers for Medicare & Medicaid Services (CMS) billing regulations
Productivity software
Insurance claims appeal handling

Full Job Description

POSITION SUMMARY

The Claims Examiner I is responsible for the accurate and timely adjudication of healthcare claims within a managed care environment, with a focus on Dual Eligible Special Needs Plans (DSNP) and Medicare lines of business. This role involves applying benefit plans, policies, and regulatory guidelines to ensure proper claim processing, including new claims, reprocessed claims, overturned disputes, and appeals. The Claims Examiner plays a critical role in maintaining compliance, ensuring payment accuracy, and supporting members and Provider satisfaction.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job, an individual must perform each essential function satisfactorily, with or without reasonable accommodation, including, but not limited to:

Key Responsibilities

Review, analyze, and process medical claims in accordance with Medicare and DSNP benefit structures, policies, and procedures.
Accurately adjudicate new day claims, ensuring proper application of benefits, coding edits, and pricing methodologies.
Reprocess claims resulting from overturned disputes and appeals, ensuring adjustments reflect updated determinations and regulatory requirements.
Evaluate and process claim disputes and reconsiderations, including those that result in overturn decisions requiring correction and re-adjudication.
Handle appeals-related claim adjustments, ensuring timely and accurate implementation of appeal outcomes.
Interpret provider contracts, fee schedules, and reimbursement methodologies to ensure correct payment.
Ensure compliance with CMS (Centers for Medicare & Medicaid Services), state regulations, and internal policies.
Identify and escalate complex claim issues, system errors, or potential compliance risks.
Maintain productivity and quality standards, meeting turnaround time requirements for all claim types.
Document claim processing activities clearly and accurately in system notes.
Collaborate with internal departments such as Provider Relations, Appeals & Grievances, and Configuration teams to resolve claim issues.
Participate in audits, quality reviews, and continuous improvement initiatives.

QUALIFICATIONS AND EDUCATION

Required Qualifications

High school diploma or equivalent; associate or bachelor’s degree preferred.
Minimum of 2–4 years of claims processing experience in a managed care or health insurance environment.
Strong knowledge of Medicare and DSNP claims processing guidelines, including benefit application and coordination of benefits (COB).
Experience handling claims reprocessing, disputes, and appeals (including overturned cases).
Familiarity with CPT, HCPCS, and ICD-10 coding.
Understanding of provider contracts and reimbursement methodologies.
Strong analytical and problem-solving skills with high attention to detail.
Ability to manage multiple priorities in a fast-paced environment.
Proficiency in claims processing systems and Microsoft Office applications.

Preferred Qualifications

Knowledge of CMS regulations and audit requirements.
Prior experience working with dual-eligible populations.
Medicare, Part C claims processing experience.

Core Competencies

Accuracy and attention to detail
Regulatory compliance awareness
Critical thinking and decision-making
Time management and productivity
Communication and collaboration

WORKING CONDITIONS

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

· The noise level in the work environment is usually moderate.

· Works in the field

· Interacts with patients, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.

This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lifts, and moves intermittently during working hours. May be sitting for a prolonged period.

The work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. May require some OT during varying seasons of the year.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

PERFORMANCE MEASUREMENTS

· Duties accomplished at the end of the day/month.

· Attendance/punctuality.

· Compliance with Company regulations.

· Safety and Security.

· Quality of work.

This Job Description may be modified at any time at the discretion of the employer as business operations may deem necessary. This does not constitute an employment agreement and may not include all duties.

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple competing tasks and demands and to seek supervisory assistance as appropriate.

Employee Acknowledgement:

I have read this job description and understand what is expected of me while I occupy this role.

Pay: $19.00 - $23.00 per hour

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Paid time off
Vision insurance

Application Question(s):

Are you willing to take and pass a Drug Test and Background Check Screening?

Language:

English (Required)
Spanish (Required)

Ability to Commute:

Doral, FL 33178 (Required)

Work Location: In person

Quick Apply

Refine Your Search

examiner jobs in miami, fl

Claim Examiner I

Special Projects Administrator 1 (Medical Examiner)

Claims Examiner

Commercial Title Examiner

DOT Medical Examiner

Building Plans Examiner and/or Inspector

Medicaid Claims Examiner

Plumbing Plans Examiner

Mechanical Plans Examiner

Fire Plans Examiner & Inspector

Landscape Plans Examiner

Security Officer Part Time Credential Examiner

Electrical Plans Examiner and/or Inspector

Medical Examiner Information Technology Senior Software Developer

Mechanical Inspector and/or Plans Examiner

Electrical Inspector and Plans Examiner

Senior Workers' Compensation Claims Examiner - Federal Claims

Plumbing Inspector and/or Plans Examiner

Structural Plans Examiner

HIGHWAY SAFETY SPECIALIST (WT: MV COMPLIANCE EXAMINER)MV COMPLIANCE EXAMINER)

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