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Integrity · 4 months ago

Health Insurance Claims Adjuster II

Clearwater, FL

Full-time

Onsite

Entry, Mid Level

2+ years exp

Integrity Marketing Group is a leading independent distributor of life, health, and wealth insurance products. They are seeking a Health Insurance Claims Adjuster II to analyze claims, determine insurance carrier liability, and ensure compliance with claims processing guidelines.

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Responsibilities

Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries

Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decision

Interpret contract benefits in accordance with specific claim processing guidelines

Coordinate daily workflow to coincide with check cycle days to meet all service guarantees

Understand broad strategic concept of our business and link these to the day-to-day business functions of claims processing

In addition to being able to handle the initial claims that they were trained on, they will be able to handle the majority of claim types within the department

Maintain external contact with providers/agents/policyholders

Qualification

Health insurance claims adjudicationUB/institutional claimsHCFA/professional claimsMedical terminologyMicrosoft OfficeResearch skillsMulti-taskingCommunication

Required

A high school diploma or GED equivalent

Two to four years of proven health insurance claims adjudication experience

Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required

Ability to read and interpret EOB's claim history, and excellent research skills

Ability to calculate deductible and co-insurance amounts

Ability to adapt and respond to different types of people and tasks

Excellent communication and documentation skills

Ability to multi-task, prioritize, and manage time effectively and efficiently

Reliable transportation and the ability to be punctual and dependable

Preferred

Insurance background preferred; previous Medical/prescription claims preferred

Familiarity with medical terminology, procedures and diagnosis codes preferred

Familiarity with Microsoft Office products; familiarity with Qiclink software a plus

Benefits

Medical/Dental/Vision Insurance

401(k) Retirement Plan

Paid Holidays

PTO

Community Service PTO

FSA/HSA

Life Insurance

Short-Term and Long-Term Disability

Company

Integrity

Integrity is a leader in providing holistic life, health and wealth planning and solutions designed to help Americans prepare for the good days ahead.

Founded in 2006

Dallas, Texas, USA

5001-10000 employees