Claims Adjuster II

Integrity • Clearwater, FL

115d

About The Position

Insurance Administrative Solutions, L.L.C. (“IAS”), an Integrity partner headquartered in Clearwater, Florida, is a third-party administrator providing business process outsourcing for insurance carriers. Formed in 2002, IAS administers policies for insureds residing all across the United States. The Claims Adjuster II will analyze claims to determine the extent of insurance carrier liability and interpret contract benefits in accordance with specific claims processing guidelines.

Requirements

• A high school diploma or GED equivalent.
• Two to four years of proven health insurance claims adjudication experience.
• Insurance background preferred; previous Medical/prescription claims preferred.
• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required.
• Familiarity with medical terminology, procedures and diagnosis codes preferred.
• Ability to read and interpret EOB’s claim history, and excellent research skills.
• Familiarity with Microsoft Office products; familiarity with Qiclink software a plus.
• 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.

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.
• Handle the majority of claim types within the department.
• Maintain external contact with providers/agents/policyholders.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1-10 employees