Top 172 Claims specialist Jobs in Miramar, Fl

Provider Network Configuration Specialist
Solis Health Plans —Doral, FL
- $25 - $27 an hour
- Full-time
- English
- Mid-level
- Office
- Health savings account
- Dental insurance
Quick Apply
Parts Buyer / Parts Procurement Specialist – High Volume Repair Facility
Oil Can Man —Fort Lauderdale, FL
- $20.06 - $25.18 an hour
- Full-time
- Mid-level
- In-person
- Communication skills
- Health insurance
- 401(k)
Quick Apply
Medical Billing Specialist
Meraki Behavioral Health —Miami Lakes, FL
- $20 - $25 an hour
- Full-time
- Background check
- Microsoft Excel
- Medical office experience
- Health insurance
- 401(k)
Quick Apply
8d
HEDIS Specialist
Vida Medical Centers —Miami Lakes, FL
- From $19 an hour
- Full-time
- Background check
- HIPAA
- US work authorization
- Paid holidays
- Health insurance
Quick Apply
4d
Medicaid LTC Billing Specialist
Marshall's Catering —Hollywood, FL
- $18 - $20 an hour
- Full-time
- Research
- Mid-level
- Office
- Dental insurance
- Paid time off
Quick Apply
Insurance Claims Billing & Collections Specialist
Public Adjusting Firm —Hollywood, FL
- $25 - $35 an hour
- Full-time
- Mid-level
- Office
- QuickBooks
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11d
Claims Processing Professional
OneHome —Miramar, FL
- $53,700 - $72,600 a year
- Full-time
- Spanish
- HIPAA
- English
- Paid parental leave
- Paid holidays
8d
Charge Correction Posting Specialist (Remote)
North American Partners in Anesthesia —Sunrise, FL
- Full-time
- Remote
- Microsoft Word
- Medical office experience
- HIPAA
- Health savings account
- AD&D insurance
Appeals and Grievances Specialist
Sidecar Health —Fort Lauderdale, FL
- $65,000 - $75,000 a year
- Remote
- Mid-level
- 3 years
- Analysis skills
- Paid holidays
- Health insurance
Quick Apply
8d
Medicaid Pending Billing Specialist - Remote
Polaris Pharmacy Services —Fort Lauderdale, FL
- Extended hours
- Remote
- Microsoft Excel
- Mid-level
- Finance
- Paid holidays
- Disability insurance
Quick Apply
HVAC Technical Support Specialist
CAREERXCHANGE —Doral, FL
- Spanish
- English
- Mid-level
- Paid holidays
- Paid time off
Quick Apply
Fraud Specialist
BrightStar Credit Union —Cooper City, FL
- $23.80 - $29.32 an hour
- Full-time
- Bachelor of Science
- Mid-level
- Office
- Health savings account
- Health insurance
Revenue Cycle Specialist
Broward Community —Hollywood, FL
- Full-time
- Background check
- Computer literacy
- Mid-level
- Paid holidays
- Dental insurance
Quick Apply
Health System Specialist (Credentialing & Privileging)
US Veterans Health Administration —Miami, FL
- $65,735 - $85,460 a year
- Online Application
- Background check
- Psychiatry
- Writing skills
- On-the-job training
4d
Claims Support Specialist
Global Excel Management —Miami, FL
- From $21 an hour
- Full-time
- Customer service
- English
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
10d
Senior Leave and Accommodation Specialist
Chewy —Plantation, FL
- Full-time
- Experience working with individuals with disabilities
- Mid-level
- Bachelor's degree
12d
Billing and Collections Specialist
Eye Associates of Plantation —Plantation, FL
- $23 - $25 an hour
- Full-time
- Customer service
- Medical office experience
- Mid-level
- Health insurance
- Paid time off
Quick Apply
CGA Production Support Specialist
Oscar Health —Miami, FL
- $43,966 - $57,706 a year
- Remote
- Google Workspace
- Mid-level
- High school diploma or GED
- Paid parental leave
- Paid holidays
Quick Apply
1d
Specialist, Admissions & Registration
Broward College —Davie, FL
- $36,800 - $43,240 a year
- Weekends as needed
- Background check
- Data analysis skills
- Mid-level
- Wellness program
- Paid parental leave
8d
Payment Processing Specialist - 994374
Nova Southeastern University —Fort Lauderdale, FL
- Weekends as needed
- Background check
- Microsoft Outlook
- Customer service
- Health insurance
- Dental insurance

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Provider Network Configuration Specialist

Solis Health Plans -
Doral, FL

Quick Apply

Job Details

Full-time
$25 - $27 an hour

Benefits

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

Qualifications

Teamwork
Spreadsheets
English
Databases
High school diploma or GED
Attention to detail
Cross-functional collaboration
Cross-functional communication
Data analysis software
Time management

Full Job Description

POSITION SUMMARY

The Network Data Specialist II is responsible for advanced management, analysis, configuration, and validation of provider data across enterprise provider, claims, and network management systems. This role ensures the accuracy, integrity, and operational readiness of complex provider data configurations that support claims adjudication, network operations, regulatory compliance, and business reporting.

The Network Data Specialist II serves as a subject matter resource for provider data processes, independently manages complex data activities, identifies opportunities for process improvements, and collaborates with Provider Relations, Credentialing, Claims, Network Operations, and IT teams to resolve data issues and enhance system performance.

ESSENTIAL DUTIES & RESPONSIBILITIES

· Load contracted (participating) providers into provider and claims systems in accordance with executed provider agreements and configuration requirements.

· Load and maintain non-participating provider records to ensure accurate claims processing and pricing.

· Maintain accurate, complete, and up-to-date provider data across all claims and provider databases.

Provider Data Management

Ensure integrity of critical provider information including:

· Provider demographics

· Tax ID and billing information

· Specialty and taxonomy codes

· Network participation status

· Contract effective dates and terms

· Validate provider data accuracy prior to system loading and ongoing updates.

· Apply advanced business rules and system requirements to ensure accurate provider setup across downstream applications.

· Identify data trends, recurring issues, and opportunities to improve provider data accuracy and operational efficiency.

System Maintenance & Data Synchronization

· Perform advanced provider data synchronization across multiple claims, provider, and configuration platforms.

· Analyze discrepancies between systems and source documentation and coordinate corrective actions.

· Ensure consistency of provider information across enterprise platforms.

· Identify and resolve data discrepancies between systems and source documentation.

· Support updates to provider files based on contracting, credentialing, or network changes.

Provider Relations & Credentialing Collaboration

· Partner with Provider Relations, Credentialing, Claims, and Network Operations teams to resolve complex provider data issues..

· Work closely with Credentialing teams to ensure only appropriately credentialed providers are loaded and active in systems.

· Validate credentialing status and ensure alignment with network participation requirements prior to system activation.

· Support resolution of provider data issues identified by internal stakeholders or external providers.

· Provide recommendations regarding provider data processes, workflows, and configuration improvements.

Non-Participating Provider Configuration

· Manage complex non-participating provider configurations to support accurate claims routing, pricing logic, and out-of-network processing.

· Ensure non-participating provider data supports correct claims adjudication and out-of-network processing rules.

· Maintain accurate classification of provider participation status across systems.

Provider Rosters & Reporting

· Manage monthly provider roster updates, including additions, terminations, and changes.

· Reconcile provider rosters received from external sources against internal systems.

· Validate and distribute provider roster files to appropriate internal stakeholders.

· Support reporting needs related to provider network composition and data accuracy.

· Identify trends and recommend improvements related to provider data management.

Quality Assurance & Compliance

· Validate provider data against contractual requirements, network standards, and system specifications.

· Ensure compliance with internal policies and regulatory requirements related to provider data management.

· Maintain audit-ready documentation of provider data changes and updates.

Support internal and external audits by providing accurate documentation and detailed data analysis.

SUPERVISORY RESPONSIBILITY

· No.

QUALIFICATIONS & EDUCATION

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Minimum Qualifications

· High School Diploma or GED required.

· Minimum of 3 years of experience in healthcare provider data management, claims systems, credentialing support, or managed care operations.

· Experience working with provider databases, claims systems, or network configuration tools.

· Equivalent combination of education and experience may be considered.

· Strong analytical skills with the ability to identify issues, analyze root causes, and implement solutions.

· advanced proficiency with Microsoft Excel and data analysis tools.

· Strong communication skills with the ability to collaborate across multiple business functions.

Preferred Qualifications

· Experience in managed care health plan or health insurance environment.

· Familiarity with provider credentialing and contracting processes.

· Understanding of provider taxonomy, NPI, and healthcare provider identifiers.

· Experience managing provider rosters or large-scale data files.

· Knowledge of claims adjudication systems and network configuration rules.

· Experience mentoring team members or serving as a subject matter expert.

Skills & Competencies

· Strong attention to detail and data accuracy

· Ability to manage large volumes of provider data efficiently

· Strong analytical and problem-solving skills

· Understanding of healthcare provider data structures and systems

· Ability to collaborate effectively with cross-functional teams

· Strong organizational and time management skills

· Ability to work independently in a production-driven environment

Additional Notes

The Network Data Specialist plays a critical role in ensuring the accuracy and integrity of provider data across the health plan’s systems. This position directly impacts claims accuracy, provider payment, for Recruitment purposes this position has been posted as Provider Network Configuration Specialist

Pay: $25.00 - $27.00 per hour

Benefits:

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

Language:

English (Required)

Ability to Commute:

Doral, FL 33192 (Required)

Work Location: In person

Quick Apply

Refine Your Search

claims specialist jobs in miramar, fl

Provider Network Configuration Specialist

Parts Buyer / Parts Procurement Specialist – High Volume Repair Facility

Medical Billing Specialist

HEDIS Specialist

Medicaid LTC Billing Specialist

Insurance Claims Billing & Collections Specialist

Claims Processing Professional

Charge Correction Posting Specialist (Remote)

Appeals and Grievances Specialist

Medicaid Pending Billing Specialist - Remote

HVAC Technical Support Specialist

Fraud Specialist

Revenue Cycle Specialist

Health System Specialist (Credentialing & Privileging)

Claims Support Specialist

Senior Leave and Accommodation Specialist

Billing and Collections Specialist

CGA Production Support Specialist

Specialist, Admissions & Registration

Payment Processing Specialist - 994374

I want to receive the latest job alert for claims specialist in miramar, fl

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