Health Insurance Claims Specialist - Hybrid Role

Integrity Marketing Group; Clearwater (FL); On-site; USD 48,000 - 72,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Plan

Paid Holidays

PTO

FSA/HSA

Life Insurance

Disability Insurance

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Claims adjudication experience

Medical terminology

Reading EOBs

Time management

Communication

Documentation

Adaptability

Research skills

Deductible & coinsurance calculation

Customer service

Education

High school diploma or GED

Tools

Microsoft Office

Qiclink software

Job description

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.