Health Insurance Claims Adjuster (Medicare)

Insurance Administrative Solutions • Tampa, FL

7d • Onsite

About The Position

Analyze claims to determine the extent of the insurance carrier’s liability and interpret contract benefits according to claim-processing guidelines. Receive, organize, and use information about benefits, contract coverage, and policy decisions. Coordinate daily workflow with check-cycle days to meet service guarantees. Maintain professional contacts with policyholders, providers, agents, attorneys, other carriers, peers, management, and support areas. The position is local and is not remote at this time.

Requirements

• High school diploma or GED equivalent.
• At least one year of related experience.
• Good oral and written communication skills.
• PC application skills and typing ability of 30 words per minute with accuracy and clear content.
• Organizational and decision-making skills.
• Team-centered approach, excellent 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 EOBs.
• Ability to multitask, prioritize, problem-solve, and adapt to 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, and research claims and written inquiries, and make decisions necessary to adjudicate them properly.
• Interpret contract benefits in accordance with specific claim-processing guidelines.
• Connect the company’s broad strategic concepts to day-to-day claims-processing functions.
• Coordinate daily workflow with check-cycle days to meet service guarantees.
• Maintain external and internal contacts in a positive, professional manner; the essential duties specify minimal external contact with providers, agents, and policyholders.

Benefits

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

What This Job Offers

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