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Integrity · 3 weeks ago

Health Insurance Claims Processor / Adjudication

Clearwater, FL

Full-time

Onsite

Entry Level

1+ years exp

Integrity Marketing Group is a leading independent distributor of insurance products, and they are seeking a Health Insurance Claims Processor / Adjudication to analyze claims and determine insurance carrier liability. The role involves interpreting contract benefits, adjudicating claims, and maintaining communication with various stakeholders.

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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 decisions

Interpret contract benefits in accordance with specific claim processing guidelines

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

Based on established guidelines and/or historical knowledge an adjuster will need to recognize red flags for potential fraud or waste and escalate accordingly

Adjusters who handle the potential fraud or waste claims will investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner

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

Maintain external contact with providers/agents/policyholders

Qualification

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

Required

A high school diploma or GED equivalent

Minimum of 1 year 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