Medicare Claims Adjudicator — Local, Team‑Driven

Insurance Administrative Solutions, L.L.C.; Clearwater (FL); On-site; USD 38,000 - 60,000; Full time

Benefits offered by this job

Medical/Dental/Vision Benefits

401(k) Company matching

PTO 15 days after 90 days

Referral program

11 Paid Holidays

Employee Assistance Program

Tuition Reimbursement

Job summary

Insurance Administrative Solutions, L.L.C. is hiring for a claims adjudication role focused on analyzing claims to determine carrier liability and interpreting contract benefits per processing guidelines.

The candidate will coordinate daily workflow to meet service guarantees and maintain professional contact with policyholders and providers. The position requires local presence in Florida, strong communication, and the ability to work independently in a fast-paced environment while upholding

Qualifications

• High School diploma or GED equivalent.
• Minimum of one year related experience required.
• Experience in medical/insurance preferred.
• Experience with Medicare Supplement preferred.

Responsibilities

• Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.
• Interpret contract benefits in accordance with specific claim processing guidelines.
• Understand broad strategic concept of our business and link these to the day-to-day business functions of claims processing.
• Minimal external contact with providers/agents/policyholders.

Skills

Communication skills

Typing to 30 wpm

Claims adjudication

Organizational skills

Decision making

Teamwork

Medical terminology

EOB interpretation

Multitasking

Independence

Policy benefits knowledge

Education

High school diploma

One year related experience

Medical/insurance experience

Medicare Supplement experience

Tools

Qiclink software

CMS-1450 familiarity

CMS-1500 familiarity

Job description

Insurance Administrative Solutions, L.L.C. is hiring for a claims adjudication role focused on analyzing claims to determine carrier liability and interpreting contract benefits per processing guidelines.

The candidate will coordinate daily workflow to meet service guarantees and maintain professional contact with policyholders and providers. The position requires local presence in Florida, strong communication, and the ability to work independently in a fast-paced environment while upholding