Claims Compliance & Review Specialist

Independent Living Systems; Miami (FL); On-site; USD 45,000 - 65,000; Full time

Job summary

Independent Living Systems (ILS) in Miami, FL is seeking a full-time Claims Examiner to review health insurance claims for accuracy and compliance. You will analyze medical documentation, verify codes (ICD-10, CPT), and collaborate with providers and internal teams to resolve discrepancies and ensure timely reimbursement.

The ideal candidate has a minimum of 2 years in claims examination or related healthcare billing, a solid grasp of medical terminology, and experience with claims management

Qualifications

• High school diploma or GED.
• Minimum of 2 years experience in claims examination, medical billing, or healthcare insurance processing.
• Strong understanding of medical terminology, insurance policies, and healthcare billing codes (ICD-10, CPT).
• Proficiency with claims management software and Microsoft Office suite.

Responsibilities

• Review and analyze health insurance claims for completeness, accuracy, and compliance with policy terms and regulatory requirements.
• Verify medical codes, treatment documentation, and billing information to ensure services are properly covered and billed.
• Investigate and resolve claim discrepancies by communicating with providers and internal stakeholders.
• Identify and elevate potential fraudulent claims or billing errors to compliance or legal teams.
• Maintain detailed records of claim evaluations and stay current with healthcare laws and industry standards to support audits and improve processing workflows.

Skills

Medical terminology

ICD-10 coding

CPT coding

Claims management software

Microsoft Office

Education

Associate’s degree in health administration

Bachelor’s degree in health administration

Tools

Claims management software

MS Office

Job description

Independent Living Systems (ILS) in Miami, FL is seeking a full-time Claims Examiner to review health insurance claims for accuracy and compliance. You will analyze medical documentation, verify codes (ICD-10, CPT), and collaborate with providers and internal teams to resolve discrepancies and ensure timely reimbursement.

The ideal candidate has a minimum of 2 years in claims examination or related healthcare billing, a solid grasp of medical terminology, and experience with claims management