Health Insurance Claims Processor / Adjudication (Medicare)

Insurance Administrative Solutions • Clearwater, FL

115d

About The Position

Insurance Administrative Solutions (IAS) is a third-party provider of comprehensive administrative solutions for our clients in the insurance industry. We offer a business process outsourcing solution that helps insurers optimize administrative workload, bolster their industry expertise, leverage emerging technologies, and streamline operations. With strong industry knowledge, we deliver value to our customers by providing compassionate customer service, efficient processing, and quality results. Here at IAS, we embrace the fact that great things are only accomplished by working as a team. We believe that all of our employees have valuable input no matter the level. Our highly collaborative team environment offers each of our employees a place where they can excel. Job Summary Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines. Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions. Coordinate daily workflow to coincide with check cycle days to meet all service guarantees. Maintain external contacts with policyholders, providers of service, agents, attorneys and other carriers as well as internal contacts with peers, management, and other support areas with a positive and professional approach. Candidate must be local. This is not a remote position, at this time.

Requirements

• Good oral and written communication skills
• Good PC application skills and typing to 30 wpm with accuracy and clarity of content.
• Previous health/Medicare/prescription claims adjudication experience a plus.
• Must have organizational and decision making skills.
• Team centered with excellent work ethic and reliability.
• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims.
• Familiarity with medical terminology, procedure and diagnosis codes preferred.
• Familiarity with Qiclink software a plus.
• Ability to calculate figures and co-insurance amounts.
• Ability to read and interpret EOB's.
• Ability to multitask, prioritize, problem-solve and effectively adapt to a fast-paced, changing environment in order to comply with service guarantees.
• Must be able to work independently and meet quality and production standards.
• Must have clear understanding of the policy benefits and procedures within the Claims unit.
• Honesty, as well as respect, for the company and its policies & procedures is crucial.
• High School diploma or GED equivalent.
• Minimum of one (1) year related experience required.
• Experience in medical/insurance preferred.
• Experience with Medicare Supplement preferred.

Responsibilities

• Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.
• Interpret contract benefits in accordance with specific claim processing guidelines.
• Understand broad strategic concept of our business and link these to the day-to-day business functions of claims processing.
• Minimal external contact with providers/agents/policyholders.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED
• Number of Employees: 251-500 employees