Medical Claims Examiner
Alivi TPA of Florida, LLC
Location: Miami, FL 33101, US
Employment Type: FULL_TIME
Industry: Advertising and Public Relations
Occupational Category: 13-1031.00 – Business and Financial Operations
Posted: Tuesday, 13 October 2026
Valid Through: Thursday, 12 November 2026
Job Description
Alivi TPA of Florida, LLC is hiring a Medical Claims Examiner in Miami, FL. This is a full-time position.
Highly complex medical claim reviewAdvance claim adjudicationAdvance claim history analysisReview medical record documentation to determine coding coverageComplex appeals and reconsiderationsEscalated claim resolutionComplex provider and payer issuesComplex duplicate claim investigationsPayer Audit-related claim reviewsComplex void and replace processingAdvance reprocessing resolutionResearch of system and adjudication issuesReview of recurring claim-processing problemsIdentify opportunities for process improvementAssist with system and workflow validationProvide subject-matter expertise to Levels 1 and 2Provide guidance and mentoring to Claims team membersAssist with training and knowledge transferSupport development and refinement of claims proceduresServe as a senior escalation and subject -matter resource for complex claim issues
Education Requirements
high school
Skills
Please see the job description for required or recommended skills.
Benefits
Please see the job description for benefits.
Index requested: 10/13/2026 19:24:00 • Indexed: 10/13/2026 19:24:00