Entry-Level Health Insurance Claims Adjudicator

Integrity Marketing Group; Clearwater (FL); Vor Ort; USD 42.000 - 62.000; Vollzeit

Zusammenfassung

Integrity is hiring in Florida for a claims adjudicator role focused on analyzing health insurance claims and interpreting benefits per processing guidelines. Responsibilities include adjudicating claims, handling inquiries, organizing information, and coordinating workflows to meet service guarantees.

The role requires at least 1 year of health insurance claims adjudication experience, familiarity with medical terminology, and strong communication and documentation skills.

Qualifikationen

• A high school diploma or GED equivalent.
• Minimum of 1 year proven health insurance claims adjudication experience.
• Insurance background preferred; previous Medical/prescription claims preferred.
• Familiarity with medical terminology, procedures and diagnosis codes preferred.
• Ability to read and interpret EOB’s claim history, and excellent research skills.

Aufgaben

• Examine, perform, research and make decisions to properly adjudicate claims and written inquiries.
• Receive, organize and utilize information regarding benefits, contract coverage, and policy decisions.
• Interpret contract benefits according to claim processing guidelines.
• Coordinate daily workflow to align with check cycle days to meet service guarantees.
• Recognize red flags for potential fraud or waste and elevate accordingly for investigation and reporting.
• Maintain external contact with providers, agents and policyholders.

Kenntnisse

Claims adjudication

Medical terminology

Documentation skills

Communication skills

Qiclink software

Ausbildung

High school diploma or GED

Tools

Qiclink

Jobbeschreibung

Integrity is hiring in Florida for a claims adjudicator role focused on analyzing health insurance claims and interpreting benefits per processing guidelines. Responsibilities include adjudicating claims, handling inquiries, organizing information, and coordinating workflows to meet service guarantees.

The role requires at least 1 year of health insurance claims adjudication experience, familiarity with medical terminology, and strong communication and documentation skills.