Health Insurance Claims Adjudicator (Hybrid)

Integrity; Tampa (FL); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical/Dental/Vision Insurance - 80%

401(k) Retirement Plan

Paid Holidays

PTO

FSA/HSA

Life Insurance

Short-Term and Long-Term Disability

Job summary

Insurance Administrative Solutions, an Integrity company, is seeking an Insurance Claims Adjudicator to evaluate medical claims and determine carrier liability in line with processing guidelines.

The role starts onsite in Clearwater, FL with potential hybrid options as you gain proficiency, requiring strong attention to detail, excellent communication, and ability to manage complex claim data.

Qualifications

• High school diploma or GED equivalent.
• Minimum of 1 year proven health insurance claims adjudication experience.
• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required.

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 decisions.
• 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 and complete system notes and report on each file/case timely.
• Understand broad strategic concept of our business and link to day-to-day claims processing.
• Maintain external contact with providers/agents/policyholders.

Skills

Claims adjudication

Communication skills

Documentation skills

MS Office

Qiclink

Time management

Problem solving

Education

High school diploma or GED

Tools

CMS-1450

CMS-1500

Microsoft Office

Job description

Insurance Administrative Solutions, an Integrity company, is seeking an Insurance Claims Adjudicator to evaluate medical claims and determine carrier liability in line with processing guidelines.

The role starts onsite in Clearwater, FL with potential hybrid options as you gain proficiency, requiring strong attention to detail, excellent communication, and ability to manage complex claim data.