Health Insurance Claims Adjudicator I

Integrity Marketing Group; Clearwater (FL); Vor Ort; USD 42.000 - 68.000; Vollzeit

Zusammenfassung

Integrity Marketing Group is seeking a Claims Adjudicator to analyze insurance claims and determine carrier liability. The role involves interpreting benefits per guidelines, coordinating daily workflows, and flagging potential fraud or waste.

Strong research, EOB reading, and communication skills are required. You will handle UB/institutional and CMS-1450/CMS-1500 claims, work with MS Office, and maintain records and provider contacts.

Qualifikationen

• 1+ year proven health insurance claims adjudication experience.
• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims.
• Familiarity with medical terminology and diagnosis codes.
• Excellent research and documentation skills; strong communication.

Aufgaben

• Examine, perform, research and determine adjudication decisions for claims and inquiries.
• Receive, organize and use information on benefits, contracts and policy decisions.
• Interpret contract benefits per specific claims guidelines.
• Coordinate daily workflow to align with check cycle days and service guarantees.
• Identify red flags for potential fraud or waste and escalate as needed.
• Investigate and document files; maintain clear system notes and timely reporting.
• Understand broad business concepts and link to day-to-day claims processing.
• Maintain external contacts with providers, agents and policyholders.

Kenntnisse

Claims adjudication

Medical terminology

Communication skills

EOB interpretation

Office software

Ausbildung

High school diploma or GED

Tools

CMS-1450

CMS-1500

Qiclink

MS Office

Jobbeschreibung

Integrity Marketing Group is seeking a Claims Adjudicator to analyze insurance claims and determine carrier liability. The role involves interpreting benefits per guidelines, coordinating daily workflows, and flagging potential fraud or waste.

Strong research, EOB reading, and communication skills are required. You will handle UB/institutional and CMS-1450/CMS-1500 claims, work with MS Office, and maintain records and provider contacts.