Senior Health Claims Adjuster II

Integrity; Clearwater (FL); On-site; USD 55,000 - 70,000; Full time

Job summary

Integrity is seeking a Claims Adjuster II in Clearwater, FL to analyze claims and determine carrier liability while interpreting contract benefits per processing guidelines. The role involves handling diverse claim types, documenting meticulously, and communicating with providers and policyholders.

Qualified candidates have 2–4 years of health insurance claims adjudication experience, knowledge of CMS-1450/ CMS-1500, and strong research and Excel skills.

Qualifications

• Two to four years of health insurance claims adjudication experience.
• Familiarity with CMS-1450 (UB) and CMS-1500 claims.
• Ability to read EOBs and maintain clear system notes.
• Excellent communication and documentation skills.

Responsibilities

• Analyze claims to determine liability and benefits.
• Review contracts, coverage, and guidelines for proper adjudication.
• Maintain external contact with providers, agents, and policyholders.
• Identify red flags for fraud and escalate when needed.

Skills

Claims adjudication

Medical terminology

Research skills

Communication

Documentation

Microsoft Office

Qiclink

Time management

Education

High school diploma or GED

Tools

Qiclink

Microsoft Office

Job description

Integrity is seeking a Claims Adjuster II in Clearwater, FL to analyze claims and determine carrier liability while interpreting contract benefits per processing guidelines. The role involves handling diverse claim types, documenting meticulously, and communicating with providers and policyholders.

Qualified candidates have 2–4 years of health insurance claims adjudication experience, knowledge of CMS-1450/ CMS-1500, and strong research and Excel skills.