Health Insurance Claims Adjuster

Integrity Marketing Group; Clearwater (FL); Presencial; USD 48 000 - 72 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Plan

Paid Holidays

PTO

FSA/HSA

Life Insurance

Disability Insurance

Resumo da oferta

Insurance Administrative Solutions, L.L.C. (IAS), an Integrity company headquartered in Clearwater, Florida, is a third-party administrator providing business process outsourcing for insurance carriers.

This Health Insurance Claims Adjuster role begins onsite in Clearwater with potential hybrid options later. Analyze medical claims to determine carrier liability, interpret contract benefits, and support learning and team integration in a collaborative environment.

Qualificações

• Minimum 1 year proven health insurance claims adjudication experience.
• Familiarity with medical terminology, procedures and diagnosis codes.
• Ability to read and interpret EOBs and claim history.
• Strong documentation and communication skills.
• Reliability and time-management abilities.
• Familiarity with MS Office and Qiclink software is a plus.
• Experience calculating deductible and coinsurance amounts.
• Ability to adapt to different people and tasks.

Responsabilidades

• Examine, adjudicate and research claims to determine carrier liability.
• Organize and use information regarding benefits, contract coverage and policy decisions.
• Interpret benefits according to claim processing guidelines.
• Coordinate workflow to align with check cycle days and service guarantees.
• Identify red flags for potential fraud or waste and act accordingly.
• Investigate, document and report on files/cases in a timely manner.
• Understand business operations and relate them to daily claims processing.
• Maintain external contact with providers, agents and policyholders.

Conhecimentos

Claims adjudication experience

Medical terminology

Reading EOBs

Time management

Communication

Documentation

Adaptability

Research skills

Deductible & coinsurance calculation

Customer service

Formação académica

High school diploma or GED

Ferramentas

Microsoft Office

Qiclink software

Descrição da oferta de emprego

Health Insurance Claims Adjuster Insurance Administrative Solutions Clearwater, FL

About Insurance Administrative Solutions Insurance Administrative Solutions, L.L.C. (“IAS”), an Integrity company headquartered in Clearwater, Florida, is a third-party administrator providing business process outsourcing for insurance carriers. Formed in 2002, IAS administers policies for insureds residing all across the United States.

Job Summary

Analyze medical claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines. Work location: At IAS, we value flexibility and recognize the importance of work‑life balance. This role will begin as fully onsite to support learning and team integration. As proficiency is demonstrated, hybrid work opportunities may be introduced, dependent on business needs and department practices.

Primary Responsibilities

other duties may be assigned as necessary:

• 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.
• Based on established guidelines and/or historical knowledge an adjuster will need to recognize red flags for potential fraud or waste and accelerate accordingly.
• Adjusters who handle the potential fraud or waste claims will investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner.
• Understand broad strategic concept of our business and link these to the day‑to‑day business functions of claims processing.
• Maintain external contact with providers/agents/policyholders.

Primary Skills & Requirements

• A high school diploma or GED equivalent
• Minimum of 1 year proven health insurance claims adjudication experience.
• Insurance background preferred; previous Medical/prescription claims preferred.
• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required.
• Familiarity with medical terminology, procedures and diagnosis codes preferred.
• Ability to read and interpret EOB’s claim history, and excellent research skills.
• Familiarity with Microsoft Office products; familiarity with Qiclink software a plus.
• Ability to calculate deductible and co-insurance amounts.
• Ability to adapt and respond to different types of people and tasks.
• Excellent communication and documentation skills.
• Ability to multi-task, prioritize, and manage time effectively and efficiently.
• Reliable transportation and the ability to be punctual and dependable.

Benefits Available

Medical/Dental/Vision Insurance - 80% employer-paid 401(k) Retirement Plan Paid Holidays PTO Community Service PTO FSA/HSA Life Insurance Short-Term and Long-Term Disability

About Integrity

Integrity Integrity is one of the nation’s leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead. Integrity offers you the opportunity to start a career in a family‑like environment that is rewarding and cutting edge. Why? Because we put our people first! At Integrity, you can start a new career path at company you’ll love, and we’ll love you back. We’re proud of the work we do and the culture we’ve built, where we celebrate your hard work and support you daily. Joining us means being part of a hyper‑growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind. Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are — in person, over the phone or online. Integrity’s employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit Integrity.com.

Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities. Please note that all official communications from Integrity will come from @integrity.com or Workday domains.

Founded in 2006, Integrity develops and distributes life and health insurance products and wealth products with carrier partners and markets these products through our vast distribution network. Our omnichannel platform helps provide life and health insurance and wealth management services to Americans to fit their unique needs. Wherever you are in life, the future can be a leap of faith.