Health Insurance Claims Adjuster (Medicare)

Integrity Marketing Group • Clearwater, FL

5d • Onsite

About The Position

Insurance Administrative Solutions (IAS), a third-party provider of administrative solutions to the insurance industry, is hiring a Health Insurance Claims Adjuster focused on Medicare claims. The role analyzes claims to determine an insurance carrier’s liability, interprets contract benefits according to claims-processing guidelines, and uses information about benefits, coverage, and policy decisions to adjudicate claims and written inquiries. The adjuster coordinates daily workflow with check-cycle days to meet service guarantees and maintains professional contact with internal and external parties. This is an onsite position for a local candidate; it is not remote at this time.

The position requires a high school diploma or GED and at least one year of related experience. Experience in medical or insurance claims, Medicare Supplement, and familiarity with medical terminology and coding are preferred. The schedule is Monday through Friday, with a 37-hour work week.

Requirements

• High school diploma or GED equivalent.
• At least one year of related experience.
• Good oral and written communication skills.
• Good PC application skills and typing ability of 30 words per minute with accuracy and clarity.
• Organizational and decision-making skills.
• Team-centered approach, strong work ethic, and reliability.
• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims.
• Ability to calculate figures and coinsurance amounts.
• Ability to read and interpret explanations of benefits (EOBs).
• Ability to multitask, prioritize, problem-solve, and adapt effectively in a fast-paced, changing environment to meet service guarantees.
• Ability to work independently and meet quality and production standards.
• Clear understanding of policy benefits and procedures within the Claims unit.
• Honesty and respect for company policies and procedures.

Nice To Haves

• Previous health, Medicare, or prescription claims adjudication experience.
• Medical or insurance experience.
• Medicare Supplement experience.
• Familiarity with medical terminology, procedure codes, and diagnosis codes.
• Familiarity with Qiclink software.

Responsibilities

• Examine, perform research, and make decisions needed to properly adjudicate claims and written inquiries.
• Analyze claims to determine the extent of insurance carrier liability.
• Interpret contract benefits in accordance with specific claims-processing guidelines.
• Receive, organize, and use information regarding benefits, contract coverage, and policy decisions.
• Coordinate daily workflow with check-cycle days to meet service guarantees.
• Understand broad business strategy and connect it to day-to-day claims-processing functions.
• Maintain professional internal and external contacts, including with providers, policyholders, agents, attorneys, other carriers, peers, management, and support areas.

Benefits

• Medical, dental, and vision benefits beginning the first of the month after hire.
• 401(k) with company matching and contributions that are immediately vested.
• 15 days of PTO after 90 days.
• Referral program.
• 11 paid holidays.
• Employee Assistance Program.
• Tuition reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED