Top 158 third party administrator Jobs in miami, fl

Health Claims Examiner
National Employee Benefits Administrators, Inc. (NEBA) —Pembroke Pines, FL
- From $19 an hour
- Full-time
- Writing skills
- Medical office experience
- Basic math
- Health insurance
- Dental insurance
Quick Apply
HR Safety and Workers Compensation Coordinator
Carisam —Doral, FL
- $50,000 a year
- Multiple hires
- Mid-level
- 3 years
- Bachelor's degree
Quick Apply
5d
Health Plan Enrollment Specialist II
National Employee Benefits Administrators, Inc. (NEBA) —Pembroke Pines, FL
- $18 - $20 an hour
- Full-time
- Hybrid work
- Spanish
- Customer service
- Word processing
- Health insurance
- Dental insurance
Quick Apply
IT Security Analyst -537257
Florida International University —Miami, FL
- $65,000 - $70,000 a year
- Weekends as needed
- Background check
- Computer Science
- HIPAA
Director of TPA Operations
Provider Network Solutions LLC —Miami, FL
- $100,000 - $120,000 a year
- Full-time
- 7 years
- HIPAA
- Finance
Quick Apply
5d
IT Systems Administrator
OLIPOP —Miami, FL
- $110,000 - $120,000 a year
- Remote
- 5 years
- Continuous improvement
- SharePoint
Quick Apply
5d
Administrative Specialist II
City of Hollywood, FL —Hollywood, FL
- $22.57 - $34.31 an hour
- 8 hour shift
- Microsoft Excel
- Basic math
- Urgent Care
- Wellness program
- Paid holidays
10d
Auto Claims Manager
TheBest Claims Solutions —Miami, FL
- $100,000 - $130,000 a year
- Management
- 3 years
- Bachelor's degree
Auto PD Supervisor
TheBest Claims Solutions —Miami, FL
- $70,000 - $80,000 a year
- Remote
- Mid-level
- Supervising experience
- Bachelor's degree
Auto Claims Manager
TheBest Claims Solutions —Fort Lauderdale, FL
- $100,000 - $130,000 a year
- Management
- 3 years
- Bachelor's degree
Auto PD Supervisor
TheBest Claims Solutions —Fort Lauderdale, FL
- $70,000 - $80,000 a year
- Remote
- Mid-level
- Supervising experience
- Bachelor's degree
Application Developer II
Florida International University —Miami, FL
- $60,000 - $70,000 a year
- Online Application
- Background check
- Computer Science
- System design
- Flexible schedule
8d
Property Clerk
HOLLYWOOD, FL —Hollywood, FL
- $23.72 - $36.05 an hour
- Full-time
- Computer literacy
- Writing skills
- Urgent Care
- Wellness program
- Paid holidays
Payroll Administrator - Shared Services
Watsco, Inc —Coconut Grove, FL
- Urgently hiring
- Research
- Mid-level
- Office
Quick Apply
9d
Communications Manager
City of Hollywood, FL —Hollywood, FL
- $88,845.44 - $142,152.70 a year
- Full-time
- Bilingual
- Background check
- Clean driving record
- Wellness program
- Health savings account
10d
Administrative Specialist I
City of Hollywood, FL —Hollywood, FL
- $19.95 - $30.33 an hour
- 8 hour shift
- Background check
- Basic math
- Urgent Care
- Wellness program
- Paid holidays
3d
Revenue Cycle Reimbursement Specialist
Growth Orthopedics —Miami, FL
- Remote
- Microsoft Outlook
- Computer literacy
- Mid-level
Quick Apply
Payroll Administrator - Shared Services
Watsco —Coconut Grove, FL
- Urgently hiring
- Research
- Mid-level
- Office
9d
IT Security Analyst
Florida International University —Miami, FL
- $65,000 - $70,000 a year
- Weekends as needed
- Background check
- Computer Science
- HIPAA
- Flexible schedule
Contact Center Associate 2 (H)
University of Miami —Medley, FL
- Full-time
- Remote
- HIPAA
- Mid-level
- High school diploma or GED
- Health insurance
- Dental insurance

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Health Claims Examiner

National Employee Benefits Administrators, Inc. (NEBA) -
Pembroke Pines, FL

Quick Apply

Job Details

Full-time
From $19 an hour

Benefits

Health insurance
Dental insurance
Paid time off
Employee assistance program
Vision insurance
Life insurance
Retirement plan

Qualifications

Health insurance co-pays
Medicare
Medical software
Writing skills
Medical office experience
Basic math
Regulatory compliance in claims processing
HIPAA
Medical claims processing software
High school diploma or GED
Medicare regulations
Healthcare privacy protection
Medical billing
Health information regulatory compliance
Medical explanation of benefits reviews
Medical billing regulations compliance
Technical Proficiency

Full Job Description

Position: Health Claims Examiner

We are looking for a highly motivated individual with claims processing experience for a busy health claims department. The ideal candidate will be creative, observant and very attentive to detail. You will need to be an organized self-starter that is diligent and responsive, take initiative, work well independently, maintain a positive attitude and strive to maintain the company's culture. Excellent communication, computer and problem-solving skills, and a willingness to work alongside the other members of the department are critical. The department processes a variety of claims, including medical, dental, vision, life, and short-term disability.

POSITION PURPOSE: The Health and Welfare Claims Examiner is responsible for the accurate and timely adjudication of medical, dental, vision, and life benefit claims in accordance with plan documents and regulatory guidelines. This role ensures financial integrity by verifying benefit limits and coordinating coverage, while directly supporting the Member Services team to resolve complex inquiries and deliver an exceptional experience to plan participants and providers.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

To be successful in this role, an individual must be able to perform in a satisfactory manner the functions listed below. We will make reasonable accommodations to enable individuals with disabilities to perform these functions.

ESSENTIAL FUNCTIONS

Claims Examiner Responsibilities

· Accurately adjudicate multi-line benefit claims, encompassing medical, dental, vision, and life insurance, while maintaining high production and quality standards.

· Interpret complex plan documents, Summary Plan Descriptions (SPDs), and Summary of Benefit Coverage (SBCs) to ensure accurate application of deductibles, coinsurance, out-of-pocket maximums, and fee schedules.

· Maintain strict compliance with HIPAA regulations and identify potential fraud, waste, or third-party liability issues.

· Apply Coordination of Benefits (COB) and Medicare Secondary Payer rules to determine correct primary and secondary liability.

· Serve as a subject matter expert for Member Services, analyzing historical claim processing to support the resolution of complex provider and member inquiries.

· Execute financial claim adjustments and refund processing in alignment with senior level examiner authorities (Level II Examiners only).

· Perform rigorous quality assurance and auditing of processed claims to guarantee alignment with fund benefit structures and regulatory requirements (Auditor Level only).

· Perform additional departmental duties and support special projects as required to meet operational goals.

OTHER FUNCTIONS

· Performs other administrative duties as assigned.

EDUCATION AND/OR EXPERIENCE

To perform this job successfully, an individual must have the following education and/or experience.

· High School Diploma of GED equivalent

· Level I (Entry Level): 1-2 years of experience in healthcare billing, medical office administration, or health insurance customer service.

· Level II Examiner: 3-5 years of direct experience adjudicating complex medical, dental, vision, and life claims within a third party administrator (TPA), insurance carrier, or Taft-Hartley trust fund.

· Auditor Level: 5+ years of claims adjudication experience, with at least 1-2 years specifically in a quality assurance, auditing, or senior peer review role.

KNOWLEDGE, SKILLS, AND ABILITIES

The requirements listed below are representative of the knowledge, skills, and/or abilities required to perform each essential duty satisfactorily. We will make reasonable accommodations to enable individuals with disabilities to perform these functions.

· Medical Coding: Strong familiarity with ICD-10, CPT, HCPCS, and CDT (dental) coding systems. Professional certifications like CPC (Certified Professional Coder) or CBCS (Certified Billing and Coding Specialist) are a major plus but not always mandatory for examiners.

· Regulatory Knowledge: Solid understanding of ERISA, HIPAA, COBRA, Coordination of Benefits (COB), and Medicare Secondary Payer (MSP) rules.

· Technical Proficiency: Experience using proprietary claims processing software and intermediate MS Excel skills.

· Mathematical Aptitude: Strong basic math skills for calculating deductibles, co-insurance, out-of-pocket maximums, and prorated benefits.

· Analytical Thinking: The ability to read dense Summary Plan Designs (SPDs) and apply logic to complex billing scenarios

PHYSICAL DEMANDS

The physical demands described here are representative of those an individual must meet in order to successfully perform the essential functions of this job. We will make reasonable accommodations to enable individuals with disabilities to perform these functions.

· Primarily involves sitting for extended periods (up to 8 hours per day) at a workstation or desk.

· Frequent and repetitive use of hands, wrists, and fingers for data entry, typing, mousing, and operating standard office equipment.

· Requires close visual acuity to read, analyze, and interpret dense text, medical codes, and financial data on dual computer monitors for long durations.

· Ability to effectively communicate, express, or exchange ideas verbally and in writing with members, providers, and internal teams.

· Occasional light lifting, carrying, pushing, or pulling of office objects (such as files, paper reams, or laptops) up to 10–15 pounds.

· Standard, climate-controlled office environment with a moderate noise level (e.g., computers, printers, and light vocal traffic).

· Remote Work Option: Must possess a secure, private, and distraction-free home office space with reliable high-speed internet access capable of maintaining HIPAA compliance.

LOCATION

This is a full-time position based in office or remotely. The typical work schedule is Monday through Friday, 8AM – 5PM.

Job Type: Full-time

Pay: From $19.00 per hour

Benefits:

Dental insurance
Employee assistance program
Health insurance
Life insurance
Paid time off
Retirement plan
Vision insurance

Physical Setting:

Office

Application Question(s):

What is your hourly rate expectation?

Education:

High school or equivalent (Preferred)

Experience:

Healthcare: 2 years (Required)
Medical billing: 1 year (Required)

Work Location: In person

Quick Apply

Refine Your Search

third party administrator jobs in miami, fl

Health Claims Examiner

HR Safety and Workers Compensation Coordinator

Health Plan Enrollment Specialist II

IT Security Analyst -537257

Director of TPA Operations

IT Systems Administrator

Administrative Specialist II

Auto Claims Manager

Auto PD Supervisor

Auto Claims Manager

Auto PD Supervisor

Application Developer II

Property Clerk

Payroll Administrator - Shared Services

Communications Manager

Administrative Specialist I

Revenue Cycle Reimbursement Specialist

Payroll Administrator - Shared Services

IT Security Analyst

Contact Center Associate 2 (H)

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