Health Insurance Claims Adjuster
Not Disclosed•Full-TimeOn-site
location_on1605, Harbor Drive, Clearwater, Pinellas County, Florida, 33755, United States
About the Company
Insurance Administrative Solutions, L.L.C. (IAS), an Integrity company, is a third-party administrator providing business process outsourcing for insurance carriers. Headquartered in Clearwater, Florida, and formed in 2022, IAS administers policies for insureds residing all across the United States.
Integrity is one of the nation's leading independent distributors of life, health, and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Driven by a singular purpose to help people protect their life, health, and wealth, Integrity offers a family-like environment that is both rewarding and cutting-edge. We put our people first, celebrating hard work and supporting daily growth within a hyper-growth company.
About the Role
As a Health Insurance Claims Adjuster, you will analyze claims to determine the extent of insurance carrier liability and interpret contract benefits in accordance with specific claims processing guidelines. This role is central to ensuring accurate adjudication of claims and written inquiries while maintaining the integrity of the claims process.
In this position, you will coordinate daily workflow to meet service guarantees and recognize red flags for potential fraud or waste, escalating issues as necessary. You will investigate potential fraud claims, track them via clear system notes, and report on each file in a timely manner. The role requires understanding the broad strategic concepts of the business and linking them to day-to-day functions, while maintaining external contact with providers, agents, and policyholders.
Equal Opportunity
Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.
Work location
Work model: On-site
1605, Harbor Drive, Clearwater, Pinellas County, Florida, 33755, United States
Clearwater, Florida
Key Responsibilities
- check_circleAnalyze claims to determine the extent of insurance carrier liability
- check_circleInterpret contract benefits in accordance with specific claims processing guidelines
- check_circleExamine and research information to adjudicate claims and written inquiries
- check_circleCoordinate daily workflow to meet service guarantees and check cycle days
- check_circleIdentify red flags for potential fraud or waste and escalate accordingly
- check_circleInvestigate potential fraud claims, track via system notes, and report accurately
- check_circleMaintain external contact with providers, agents, and policyholders
Requirements
- verifiedHigh school diploma or GED equivalent
- verifiedMinimum of 1 year proven health insurance claims adjudication experience
- verifiedExperience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required
- verifiedAbility to calculate deductible and co-insurance amounts
Nice to Have
Insurance background; previous Medical/prescription claims experience; familiarity with medical terminology, procedures and diagnosis codes; familiarity with Qiclink software.
Benefits & Perks
check_circleMedical, Dental, and Vision Insurancecheck_circle401(k) Retirement Plancheck_circlePaid Holidayscheck_circlePaid Time Off (PTO)Community Service PTO
Similar Job Opportunities
Skills, education and keywords
Skills: Health Insurance Claims Adjudication, Ub/institutional (CMS-1450), Hcfa/professional (CMS-1500), Medical Terminology, Diagnosis Codes, Microsoft Office, Qiclink.
Education: High school diploma or GED equivalent required.
Frequently asked questions about Health Insurance Claims Adjuster at Integrity
What does a Health Insurance Claims Adjuster at Integrity do?expand_more
Day-to-day, the Health Insurance Claims Adjuster at Integrity will analyze claims to determine the extent of insurance carrier liability; interpret contract benefits in accordance with specific claims processing guidelines; examine and research information to adjudicate claims and written inquiries; and coordinate daily workflow to meet service guarantees and check cycle days.
What are the requirements for this Health Insurance Claims Adjuster role?expand_more
To qualify for the Health Insurance Claims Adjuster at Integrity position, applicants should have: 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; and Ability to calculate deductible and co-insurance amounts.
Where is the Health Insurance Claims Adjuster role at Integrity located?expand_more
Health Insurance Claims Adjuster at Integrity is based in 1605, Harbor Drive, Clearwater, Pinellas County, Florida, 33755, United States. This is a on-site role.
Is this Health Insurance Claims Adjuster job remote, hybrid, or on-site?expand_more
Integrity has listed this Health Insurance Claims Adjuster role as on-site.
How much experience is required for this Health Insurance Claims Adjuster role?expand_more
Health Insurance Claims Adjuster at Integrity typically requires 1+ years of relevant experience at the mid level level.
What skills do you need for the Health Insurance Claims Adjuster role at Integrity?expand_more
Key skills for Health Insurance Claims Adjuster at Integrity include Health Insurance Claims Adjudication; Ub/institutional (CMS-1450); Hcfa/professional (CMS-1500); Medical Terminology; Diagnosis Codes; Microsoft Office; and Qiclink.
What education is required for Health Insurance Claims Adjuster at Integrity?expand_more
Educational requirements for this role: High school diploma or GED equivalent required.
What category does the Health Insurance Claims Adjuster role belong to?expand_more
Health Insurance Claims Adjuster at Integrity is part of the admin job category on Recrutus.