Hybrid Health Insurance Claims Adjudicator

Integrity; Clearwater (FL); Hybrid; USD 45,000 - 60,000; Full time

Benefits offered by this job

Medical Insurance (80% employer-paid)

401(k) Retirement Plan

Paid Holidays

PTO

Job summary

Insurance Administrative Solutions, an Integrity company, is seeking a Health Insurance Claims Adjuster to analyze medical claims and determine carrier liability. The role begins onsite to support learning with potential hybrid options as the team grows.

The ideal candidate has knowledge of UB/HCFA claims and medical terminology, and strong research and documentation skills. Required are a high school diploma or GED and at least 1 year of claims adjudication experience in health insurance, with

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 excellent research skills.
• Familiarity with Microsoft Office products; familiarity with Qiclink software a plus.
• Ability to calculate deductible and co-insurance amounts.

Responsibilities

• Examine, research and adjudicate claims and inquiries.
• Organize and use information regarding benefits, coverage and policy decisions.
• Interpret contract benefits according to claim processing guidelines.
• Coordinate daily workflow to align with check cycle days and service guarantees.
• Identify red flags for potential fraud or waste and escalate accordingly.
• Investigate fraud/waste claims and document files with clear system notes.
• Maintain external contact with providers, agents and policyholders.

Skills

Attention to detail

Communication skills

Time management

Research skills

Education

High school diploma or GED

Tools

Qiclink

Microsoft Office

Job description

Insurance Administrative Solutions, an Integrity company, is seeking a Health Insurance Claims Adjuster to analyze medical claims and determine carrier liability. The role begins onsite to support learning with potential hybrid options as the team grows.

The ideal candidate has knowledge of UB/HCFA claims and medical terminology, and strong research and documentation skills. Required are a high school diploma or GED and at least 1 year of claims adjudication experience in health insurance, with