Health Insurance Claims Adjudicator - Precision & Impact

Integrity Marketing Group; Clearwater (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

Integrity Marketing Group is seeking a claims adjudicator to analyze and process health insurance claims in Florida. You will interpret contract benefits, review EOBs, and ensure accurate adjudication per processing guidelines.

The role requires attention to detail, excellent communication, and the ability to manage multiple claim types while maintaining precise notes. You will coordinate workflow to align with check cycles, identify potential fraud, and report findings clearly.

Qualifications

• High school diploma or GED required.
• 2–4 years of health insurance claims adjudication experience.
• Insurance background preferred; Medical/prescription claims experience is a plus.
• Familiarity with UB/institutional CMS-1450 and HCFA CMS-1500 claims.
• Knowledge of medical terminology, procedures and diagnosis codes.
• Ability to read EOBs, claim history and conduct thorough research.
• Proficient in Microsoft Office; Qiclink familiarity is a plus.
• Strong communication and documentation skills.

Responsibilities

• Analyze and adjudicate healthcare claims per guidelines.
• Interpret benefits according to claims processing rules.
• Coordinate daily workflow to meet service guarantees.
• Identify red flags for fraud or waste and escalate.
• Maintain clear system notes and timely case reporting.
• Communicate with providers, agents and policyholders.
• Handle multiple claim types within the department.
• Learn broader business concepts and apply to daily tasks.

Skills

Health insurance claims adjudication

Medical terminology familiarity

Research skills

Excellent communication

Documentation skills

Education

High school diploma or GED

Tools

Qiclink software

Microsoft Office

CMS-1450 familiarity

Job description

Integrity Marketing Group is seeking a claims adjudicator to analyze and process health insurance claims in Florida. You will interpret contract benefits, review EOBs, and ensure accurate adjudication per processing guidelines.

The role requires attention to detail, excellent communication, and the ability to manage multiple claim types while maintaining precise notes. You will coordinate workflow to align with check cycles, identify potential fraud, and report findings clearly.