Senior Health Claims Adjudicator

Integrity Marketing Group; Clearwater (FL); On-site; USD 42,000 - 65,000; Full time

Job summary

Integrity, LLC is seeking an experienced claims adjudicator to analyze health insurance claims, interpret contract benefits, and adjudicate according to processing guidelines. You will coordinate with daily check cycles and document findings for each file, while upholding accuracy and compliance.

Required are 2–4 years in health insurance claims adjudication, familiarity with UB CMS-1450 and HCFA CMS-1500, strong communication and research skills, and knowledge of medical terminology.

Qualifications

• High school diploma or GED required.
• 2–4 years of health insurance claims adjudication experience.
• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required.
• Familiarity with medical terminology, procedures and diagnosis codes.
• Excellent communication and documentation skills.

Responsibilities

• Analyze claims to determine insurance carrier liability.
• Interpret benefits per specific claims processing guidelines.
• Coordinate daily workflow to align with check cycle days.
• Investigate potential fraud or waste and document findings clearly.
• Maintain notes and report on each file in a timely manner.
• Interact with providers, agents and policyholders.

Skills

Health insurance claims adjudication

CMS-1450 (UB) experience

CMS-1500 (HCFA) experience

Medical terminology

Communication skills

Documentation skills

Microsoft Office

Qiclink

Time management

Education

High school diploma or GED

Tools

Microsoft Office

Qiclink

Job description

Integrity, LLC is seeking an experienced claims adjudicator to analyze health insurance claims, interpret contract benefits, and adjudicate according to processing guidelines. You will coordinate with daily check cycles and document findings for each file, while upholding accuracy and compliance.

Required are 2–4 years in health insurance claims adjudication, familiarity with UB CMS-1450 and HCFA CMS-1500, strong communication and research skills, and knowledge of medical terminology.