Health Insurance Claims Adjuster | Hybrid Work & Benefits

Integrity; Clearwater (FL); Hybrid; USD 44,000 - 64,000; Full time

Benefits offered by this job

Medical/Dental/Vision Insurance

401(k) Retirement Plan

Paid Holidays PTO

Community Service PTO

FSA/HSA

Life Insurance

Short-Term and Long-Term Disability

Job summary

Insurance Administrative Solutions, L.L.C. in Clearwater, FL is seeking a Health Insurance Claims Adjuster to analyze medical claims and interpret contract benefits according to processing guidelines.

The role supports learning onsite with potential hybrid work as proficiency grows, aligning with service guarantees. The ideal candidate has 1+ year of health insurance claims adjudication experience, familiarity with CMS-1450/ CMS-1500 formats, and strong communication skills to document findings

Qualifications

• 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 EOBs, claim history, and maintain clear documentation.
• Familiarity with Microsoft Office products; Qiclink software a plus.
• Ability to calculate deductible and co-insurance amounts.
• Excellent communication and documentation skills.
• Reliable transportation and punctuality.

Responsibilities

• Examine, perform, research and adjudicate claims to determine liability.
• Receive, organize and use information on benefits, contract coverage and policy decisions.
• Interpret contract benefits per specific claim processing guidelines.
• Coordinate daily workflow to align with check cycle days and service guarantees.
• Recognize red flags for potential fraud or waste and elevate accordingly.
• Investigate, document, and report on each file/case in a timely manner.
• Understand the broad business concept and link to day-to-day claims processing.
• Maintain external contact with providers, agents and policyholders.

Skills

Claims adjudication

Microsoft Office

Communication

Documentation

Education

High School Diploma or GED

Tools

Qiclink

CMS-1450

CMS-1500

Job description

Insurance Administrative Solutions, L.L.C. in Clearwater, FL is seeking a Health Insurance Claims Adjuster to analyze medical claims and interpret contract benefits according to processing guidelines.

The role supports learning onsite with potential hybrid work as proficiency grows, aligning with service guarantees. The ideal candidate has 1+ year of health insurance claims adjudication experience, familiarity with CMS-1450/ CMS-1500 formats, and strong communication skills to document findings