Health Insurance Claims Adjudicator

integritymarketing; Clearwater (FL); On-site; USD 52,000 - 75,000; Full time

Benefits offered by this job

Competitive compensation package

Comprehensive benefits

Job summary

Integrity Marketing is seeking a Health Insurance Claims Adjudicator to analyze and adjudicate claims in accordance with processing guidelines. You will review benefits, contract coverage, and policy decisions while coordinating with the workflow to meet service guarantees.

Ideal candidates have 2–4 years of health insurance claims adjudication experience, familiarity with CMS-1450/ CMS-1500, and strong communication and research skills.

Qualifications

• Two to four years of proven health insurance claims adjudication experience.
• Familiarity with medical terminology, procedures and diagnosis codes.
• Ability to read and interpret EOB's claim history, and excellent research skills.
• Familiarity with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims.
• Strong organizational and documentation abilities.

Responsibilities

• Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.
• Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decision.
• Interpret contract benefits in accordance with specific claim processing guidelines.
• Coordinate daily workflow to coincide with check cycle days to meet all service guarantees.
• Recognize red flags for potential fraud or waste and elevate accordingly.
• Investigate, track via clear system notes and report on each file/case in a timely manner.
• Understand the strategic concept of the business and link to day-to-day claims processing.
• Handle the initial claims trained on and most other claim types within the department.
• Maintain external contact with providers/agents/policyholders.

Skills

Claims adjudication

Attention to detail

Communication

Multi-tasking

Research

Organization

Interpersonal skills

Education

High school diploma or GED

Tools

CMS-1450

CMS-1500

Qiclink

Microsoft Office

Job description

Integrity Marketing is seeking a Health Insurance Claims Adjudicator to analyze and adjudicate claims in accordance with processing guidelines. You will review benefits, contract coverage, and policy decisions while coordinating with the workflow to meet service guarantees.

Ideal candidates have 2–4 years of health insurance claims adjudication experience, familiarity with CMS-1450/ CMS-1500, and strong communication and research skills.