Healthcare Claims Integrity Specialist

Independent Living Systems, llc; Miami (FL); On-site; USD 42,000 - 65,000; Full time

Job summary

Independent Living Systems is seeking a Claims Examiner in Miami, FL to thoroughly review and evaluate insurance claims for accuracy and compliance. You will analyze medical documentation, policy terms, and billing data to determine validity, collaborating with providers and internal teams to resolve issues and ensure timely reimbursement.

The role requires 2+ years in claims/exam, familiarity with ICD-10/CPT, and proficiency in claims software and MS Office.

Qualifications

• High school diploma or GED required.
• At least 2 years in claims examination, medical billing, or healthcare insurance processing.
• Strong understanding of medical terminology, insurance policies, and healthcare billing codes (ICD-10, CPT).
• Proficiency with claims management software and Microsoft Office suite.

Responsibilities

• Review health insurance claims for completeness, accuracy, and policy compliance.
• Verify medical codes, documentation, and billing details to ensure proper coverage.
• Investigate discrepancies by communicating with providers and internal teams.
• Escalate potential fraud or billing errors to compliance or legal teams.
• Maintain detailed records to support audits and improve workflows.

Skills

Medical terminology

Insurance policies

Billing codes

Attention to detail

Education

Associate’s or Bachelor’s degree in health administration/healthcare management

CPC or CCP certification (preferred)

Tools

Claims management software

Microsoft Office

Job description

Independent Living Systems is seeking a Claims Examiner in Miami, FL to thoroughly review and evaluate insurance claims for accuracy and compliance. You will analyze medical documentation, policy terms, and billing data to determine validity, collaborating with providers and internal teams to resolve issues and ensure timely reimbursement.

The role requires 2+ years in claims/exam, familiarity with ICD-10/CPT, and proficiency in claims software and MS Office.