Claims Customer Service Representative I

Integrity; Clearwater (FL); On-site; USD 36,000 - 54,000; Full time

Job summary

Integrity is seeking a detail‑oriented professional to adjudicate telephone and written inquiries, interpreting contract benefits per guidelines. You will communicate outcomes to policyholders, agents and providers while maintaining organized information and professional relationships with internal teams.

Responsibilities include timely claim status updates, creating correspondence, and handling refunds as needed.

Qualifications

• High School Diploma or GED required.
• 0-2 years of experience in a fast-paced call center or relevant experience.
• Experience in medical/insurance preferred.
• Experience with Medicare Supplement preferred.

Responsibilities

• Accurately adjudicate telephone and written inquiries and communicate decisions clearly to policyholders, agents, and providers.
• Provide timely claim status updates and maintain accurate policy files and audit trails.
• Prepare and follow up on refund request letters as needed and create customer correspondence.
• Answer incoming calls and make outbound calls to obtain or provide information, ensuring professional interactions.

Skills

Call center experience

Medical/Insurance knowledge

Medicare supplement

Diploma/GED

Education

High School Diploma or GED

Job description

Job Summary

Examine, perform, research and make the decisions necessary to properly adjudicate telephone and written inquiries. Interpret contract benefits in accordance with specific claims processing guidelines. Communicate problems relevant to the claims processing system to the appropriate team. Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions. Maintain external contacts with policyholders, providers of service, agents, attorneys and other carriers as well as internal contacts with peers, management, and other support areas with a positive and professional approach.

Job Summary

Examine, perform, research and make the decisions necessary to properly adjudicate telephone and written inquiries. Interpret contract benefits in accordance with specific claims processing guidelines. Communicate problems relevant to the claims processing system to the appropriate team. Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions. Maintain external contacts with policyholders, providers of service, agents, attorneys and other carriers as well as internal contacts with peers, management, and other support areas with a positive and professional approach.

Primary Responsibilities

• Accurately interpret contract benefits and communicate details to policyholders, agents, and providers in a positive, professional manner.
• Provide clear and timely claim status updates to policyholders and providers.
• Prepare, send, and follow up on refund request letters as necessary.
• Create and deliver correspondence to customers as needed.
• Answer incoming calls and place outbound calls to provide or obtain information, ensuring all interactions are helpful, professional, and timely.
• Document all calls while in progress and fully update policy files or imaging systems to maintain a clear audit trail.
• Transfer calls to appropriate departments to ensure customer needs are met efficiently.
• Actively participate in cross-training and group training sessions to enhance team efficiency and uphold service standards.
• Maintain open communication with supervisors, team leads, and colleagues to ensure accurate responses and prevent duplication of efforts.
• Perform other duties as assigned to support the needs of the team.

Primary Skills & Requirements

• High School Diploma or GED equivalent
• 0-2 years of experience in a fast-paced call center or relevant experience
• Experience in medical/insurance preferred.
• Experience with Medicare Supplement preferred.

About Integrity

Integrity is one of the nation’s leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead.

Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge. Why? Because we put our people first! At Integrity, you can start a new career path at company you’ll love, and we’ll love you back. We’re proud of the work we do and the culture we’ve built, where we celebrate your hard work and support you daily. Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.

Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are — in person, over the phone or online. Integrity’s employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit Integrity.com.

Integrity, LLc is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.