Hybrid Health Insurance Claims Adjudicator

Insurance Administrative Solutions, L.L.C.; Clearwater (FL); Presencial; USD 42.000 - 56.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical/Dental/Vision Insurance – 80%/

401(k) Retirement Plan

Paid Holidays

PTO

Community Service PTO

FSA/HSA

Life Insurance

Short‑Term and Long‑Term Disability

Descripción de la vacante

Insurance Administrative Solutions, L.L.C. in Clearwater, FL, is hiring a Health Insurance Claims Adjuster to analyze medical claims and determine carrier liability.

The role starts fully onsite to support learning and team integration, with potential hybrid work later as proficiency grows. Responsibilities include examining and adjudicating claims, interpreting benefits per guidelines, and coordinating workflow to meet service guarantees.

Formación

• Minimum of 1 year proven health insurance claims adjudication experience.
• Familiarity with medical terminology and ICD coding is a plus.
• Experience reading EOBs/claims history and research skills.
• Proficiency with MS Office; Qiclink experience is a plus.

Responsabilidades

• Examine/perform/research & make decisions to adjudicate claims and inquiries.
• Organize and use information regarding benefits, contract coverage, and policy decisions.
• Interpret contract benefits per 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 as needed.
• Investigate and document potential fraud or waste claims with clear notes.
• Understand broad business goals and align daily claims processing activities.
• Maintain external contact with providers, agents, and policyholders.

Conocimientos

Health insurance claims adjudication

Microsoft Office

Qiclink

Educación

High school diploma or GED

Herramientas

Microsoft Office

Qiclink

Descripción del empleo

Insurance Administrative Solutions, L.L.C. in Clearwater, FL, is hiring a Health Insurance Claims Adjuster to analyze medical claims and determine carrier liability.

The role starts fully onsite to support learning and team integration, with potential hybrid work later as proficiency grows. Responsibilities include examining and adjudicating claims, interpreting benefits per guidelines, and coordinating workflow to meet service guarantees.