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Claims adjuster Jobs in St Petersburg, FL

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Claims adjuster • st petersburg fl

Last updated: 4 days ago

Senior Specialist, Provider Network Administration (Salesforce)

Molina HealthcareSaint Petersburg, FL, United States
Full-time

Provider Network Administration.Provider Network Administration is responsible for the accurate and timely validation, analysis, maintenance, and governance of critical provider information across ... Show more

Veterans Service Representative (Authorizer)

US Government JobsSaint Petersburg, FL, United States
Full-time

Veterans Service Representative (Authorizer).The incumbent will serve as a Veterans Service Representative (Authorizer) within the Veterans Benefits Administration (VBA), Office of Compensation Ser... Show more

Dental Office Manager

Crawford Implant and Laser Periodontics, LLCSt Petersburg, FL, US
$75,000.00 yearly
Full-time

Crawford Implant & Laser Periodontics, LLC.Our goal is to exceed expectations.We are seeking an experienced and motivated Dental Office Manager to lead our team and support our mission of excel... Show more

Ramp Captain

Evolution Parking & Guest ServicesSaint Petersburg, FL, United States
Full-time

The Guest Services Manager will be responsible for overseeing all aspects of the parking operations including, but not limited to, valet parking operations, maintaining Forbes guest service standar... Show more

Property & Casualty Claims Executive

HigginbothamSaint Petersburg, FL , US
Full-time

The Claims Executive is responsible for accurate reporting and filing of claim litigation to the respective Carrier, in addition to handling complex claims scenarios along with resolution of claims... Show more

Insurance Defense Associate Attorney

Reynolds Parrino Shadwick, P.A.St.Petersburg, FL, US
Full-time

AV-rated insurance defense firm, is seeking a motivated Associate Attorney to join our litigation team.This position focuses on defending third-party injury claims including premises liability and ... Show more

STATE VETERANS' SERVICE OFFICER - 50000973

State of FloridaBAY PINES, FL, US
Full-time

Working Title: STATE VETERANS' SERVICE OFFICER - 50000973.Posting Closing Date: 08/21/2026 .STATE VETERANS' SERVICE OFFICER.FLORIDA DEPARTMENT OF VETERANS’ AFFAIRS.Starting Annual Salary: $45,479.E... Show more

Business Office Assistant

St. Petersburg Oral SurgerySt Petersburg, US
Full-time

Petersburg Oral Surgery is looking for a Business Assistant to join our team.Heartland Dental believes that to provide exceptional lifetime care for patients, we must hire and grow team members who... Show more

Remote Insurance Experts - AI Trainer ($50-$60 per hour)

MercorSt. Petersburg, Florida, US
Remote
Full-time

Role Overview** - Mercor is seeking senior insurance professionals to build evaluation tasks for AI systems operating in Fortune 500 enterprise insurance and risk contexts.The workflows are calibra... Show more

Remote A/R Follow-up Manager - AI Trainer ($75-$75 per hour)

MercorSt. Petersburg, Florida, US
$75.00 hourly
Remote
Full-time

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems.We are seeking experienced A/R Follow-Up Managers to evaluate AI tools designed to automat... Show more

Medical Billing and Coding - Entry Level Training Program

Dreambound Inc.Pinellas Park, Florida, United States
Full-time

Note : This is an educational program, not a job.Successful completion of the program does not guarantee employment but will equip you with valuable skills for the healthcare job market.Looking to ... Show more

Commercial Claims Adjuster - Carrier or TPA - REMOTE

Work At Home Vintage ExpertsSaint Petersburg, FL, US
Remote
Full-time +2
Quick Apply

Put your Insurance Experience to work – FROM HOME!.Our unique platform provides you with.WHAT YOU’LL LOVE ABOUT WAHVE.We created a welcoming place to work with friendly and professional... Show more

Property & Casualty Claims Executive

HigginbothamSaint Petersburg, FL, United States
$10.00 hourly
Full-time

Position Summary: The Claims Executive is responsible for accurate reporting and filing of claim litigation to the respective Carrier, in addition to handling complex claims scenarios along with re... Show more

Claims Property Homeowners Adjuster Tampa Bay

Criterion Executive SearchTampa Bay, FL, USA
Full-time

Great opportunity for an inside Claims Examiner/Adjuster to join a stable homeowners insurance company in the Tampa Bay area.Seeking 5+ years of residential property claims experience managing dail... Show more

Veterans Service Representative (Authorizer)

US Department of Veterans AffairsSaint Petersburg, FL, United States
Full-time

Veterans Service Representative (Authorizer).Specific duties are as follows:.Serves as an Authorizer reviewing all required work of other Veterans Service Representatives when a second signature is... Show more

Key Accounts Program Manager- Workers’ Compensation – Transportation

Insurance Office of AmericaTreasure Island, FL, US
Full-time

Title: Key Accounts Program Manager – Commercial Lines.Remote, Florida Residents Only.Key Accounts, Large/Complex Commercial Risks .Please note: If this position is posted as either fully remote an... Show more

Remote Medical Billing Manager - AI Trainer ($80-$80 per hour)

MercorSt. Petersburg, Florida, US
$80.00 hourly
Remote
Full-time

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems.We are seeking experienced Billing and Claims Managers to support the evaluation of AI too... Show more

Remote Healthcare Administrative Specialist - AI Trainer ($40-$50 per hour)

MercorPinellas Park, Florida, US
$40.00 hourly
Remote
Full-time

About the Role** We're looking for professionals with deep, hands-on experience in the administrative and operational work that keeps healthcare organizations running — the "back office" of a medic... Show more

Ops Analyst, DRG

ZelisSaint Petersburg, FL, United States
$54,000.00 yearly
Full-time

The Operations Analyst, DRG will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams.Responsibilities include reporting, ... Show more

Director of Parish and School Security/Risk Management

The Catholic Diocese of St. PetersburgSaint Petersburg, FL, United States
Full-time

Director Of Parish And School Security And Risk Management.The Diocese of Saint Petersburg is seeking an experienced, mission-driven Director of Parish and School Security and Risk Management to pr... Show more

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Senior Specialist, Provider Network Administration (Salesforce)

Senior Specialist, Provider Network Administration (Salesforce)

Molina HealthcareSaint Petersburg, FL, United States
30+ days ago
Job type
  • Full-time
Job description

Provider Network Administration

Provider Network Administration is responsible for the accurate and timely validation, analysis, maintenance, and governance of critical provider information across claims, credentialing, contracting, and provider network systems. This role serves as a hybrid position focused on supporting provider lifecycle management operations through data analysis, reporting, workflow optimization, system enhancements, and cross-functional coordination.

The role partners closely with Network Operations, IT, PMO, Product Owners, Compliance, and business stakeholders to support operational initiatives, identify process improvement opportunities, enhance reporting capabilities, and improve provider data quality and operational performance.

Essential Job Duties

  • Assists in requirement gathering, providing solutions, training users in Salesforce, creating training manuals.
  • Generates and prepares provider-related data and reports, and ensures provider information in applicable computer system(s) is accurate.
  • Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and provider network administration business operations.
  • Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to network management (ER, network access fee, etc.); and mailing label extract generation.
  • Reviews/analyzes data by applying job knowledge to ensure appropriate information has been provided.
  • Maintains department quality standards for provider demographic data with affiliation and fee schedule attachment.
  • Ensures accurate entries of information into health plan systems.
  • Audits loaded provider records for quality and financial accuracy, and provides documented feedback.
  • Develops and maintains documentation and guidelines for all assigned areas of responsibility.
  • Assists in resolution of configuration issues with applicable teams.
  • Provides support for provider network administration projects.
  • Provides training and support to new and existing provider network administration team members.

Required Qualifications

  • At least 4 years of health care experience, to include experience in claims, provider services, provider network operations, and/or hospital/physician billing, or equivalent combination of relevant education and experience.
  • Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.
  • Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD-9/ICD-10) codes.
  • Attention to detail, and ability to facilitate accurate data entry/review.
  • Data entry/processing skills.
  • Customer service skills.
  • Ability to manage multiple priorities and meet deadlines.
  • Effective verbal and written communication skills.
  • Microsoft Office suite (including intermediate Excel skills) and applicable software programs proficiency.

Preferred Qualifications

  • Salesforce
  • Intermediate to Advanced Excel
  • QNXT
  • Managed Care background

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V