Entry-Level Health Insurance Claims Adjudicator

Integrity; Clearwater (FL); Sur place; USD 42 000 - 65 000; Plein temps

Avantages offerts par ce poste

Competitive compensation package

Résumé du poste

Integrity is seeking an insurance claims adjudicator to analyze and adjudicate health insurance claims, interpreting contract benefits per specific guidelines.

The role involves organizing information on benefits, coordinating workflow with check cycles, and identifying potential fraud or waste. A high school diploma or GED is required, with 1 year of claims adjudication experience preferred; knowledge of UB/ CMS-1450 and HCFA/ CMS-1500 is expected.

Qualifications

• Requires high school diploma or GED.
• Minimum 1 year health insurance claims adjudication experience.
• Insurance background preferred; medical/prescription claims experience preferred.
• Experience with UB/institutional CMS-1450 and HCFA CMS-1500 claims required.
• Familiarity with medical terminology, procedures and diagnosis codes preferred.

Responsabilités

• Analyze and adjudicate claims and inquiries.
• Organize and utilize information on benefits, coverage, and policy decisions.
• Interpret contract benefits per claims processing guidelines.
• Coordinate daily workflow to align with check cycles and service guarantees.
• Identify red flags for fraud or waste and escalate as needed.
• Investigate and document potential fraud or waste claims with system notes.

Connaissances

Claims adjudication

Medical terminology

CMS-1450 (UB)

CMS-1500 (HCFA)

Qiclink

Microsoft Office

Deductible calculation

Communication

Documentation

Time management

Agent license (inactive)

Formation

High school diploma or GED

Outils

Qiclink software

Microsoft Office

Description du poste

Integrity is seeking an insurance claims adjudicator to analyze and adjudicate health insurance claims, interpreting contract benefits per specific guidelines.

The role involves organizing information on benefits, coordinating workflow with check cycles, and identifying potential fraud or waste. A high school diploma or GED is required, with 1 year of claims adjudication experience preferred; knowledge of UB/ CMS-1450 and HCFA/ CMS-1500 is expected.