Health Insurance Claims Adjudicator – Detail-Driven & Fraud-Aware

Insurance Administrative Solutions, L.L.C.; Clearwater (FL); On-site; USD 42,000 - 64,000; Full time

Job summary

Integrity, LLC in Florida seeks an experienced claims adjudicator to analyze health insurance claims and determine carrier liability. You will interpret benefits according to processing guidelines and manage daily intake of information on coverage and policy decisions.

The role requires reviewing EOBs, researching claims, and maintaining complete system notes while coordinating with providers and policyholders.

Qualifications

• Health insurance claims adjudication experience.
• Familiarity with medical terminology, procedures and diagnosis codes.
• Excellent communication and documentation skills.

Responsibilities

• Examine, perform, research and make decisions to adjudicate claims and inquiries.
• Receive and organize information regarding benefits, contract coverage, and policy decisions.
• Interpret contract benefits per processing guidelines.
• Coordinate daily workflow to meet service guarantees.

Skills

Health insurance claims adjudication

Medical terminology familiarity

Communication & documentation

Education

High school diploma or GED

Tools

Microsoft Office

Qiclink software

Job description

Integrity, LLC in Florida seeks an experienced claims adjudicator to analyze health insurance claims and determine carrier liability. You will interpret benefits according to processing guidelines and manage daily intake of information on coverage and policy decisions.

The role requires reviewing EOBs, researching claims, and maintaining complete system notes while coordinating with providers and policyholders.