Claims Adjudicator III – FEP & Subrogation

Florida Blue Group; Northern (KY); Hybrid; USD 25,000 - 39,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Retirement plan

Paid time off

Job summary

Florida Blue Group is seeking a Service Advocate III to review and adjudicate insurance claims, including subrogation and workers' compensation, in a structured environment with supervisory guidance. You will determine claim outcomes and assist with inquiries from members and providers.

The role involves using computerized systems, adhering to policies, and seeking process improvements within established procedures. Training is provided, with hours Monday–Friday and pay rate of $18.59 per hour.

Qualifications

• 0-1 years related work experience.
• No supervisory/management experience required
• High school diploma or GED

Responsibilities

• Review and adjudicate high risk claims.
• Process credit listing functions, aged listings and held claims.
• Process adjustments by working with ambulance services, inpatient facility services and others.
• Determine whether to return, deny or pay claims following contract benefit and organizational processing guidelines.
• Provide customer service and education to plan members and providers by answering more complex questions regarding insurance claims and policies.

Skills

0-1 years experience

Education

High School Diploma or GED

Job description

Florida Blue Group is seeking a Service Advocate III to review and adjudicate insurance claims, including subrogation and workers' compensation, in a structured environment with supervisory guidance. You will determine claim outcomes and assist with inquiries from members and providers.

The role involves using computerized systems, adhering to policies, and seeking process improvements within established procedures. Training is provided, with hours Monday–Friday and pay rate of $18.59 per hour.