Medical Claims Examiner

6 days ago

Clearwater, United States Premier Administrative Solutions Full time
Overview:

Make your application after reading the following skill and qualification requirements for this position.

Health Insurance Medical Claims Examiner
(Initial Training on Site - 30 days - Remote after training)

Must live within a reasonable commuting distance of Clearwater, FL

Monday-Friday Schedule with daytime hours

Responsibilities:

Summary:
The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines.

Essential Duties and Responsibilities:

Reviews and adjudicates medical claims based on health policy provisions and established guidelines
Requests additional information from members and providers as needed
Initiates and completes claim investigations when indicated including pre-existing conditions, accidents, medical necessity and appropriateness, eligibility and coordination of benefits
Documents fully claims referred to senior staff for review and determination
Maintains company production and quality standards
Participates in training

Other Responsibilities:

Adheres to the policies and procedures of Premier Administrative Solutions
Maintains strict confidentiality of client, company and personnel information
Demonstrates a strong commitment to the mission and values of the organization
Adheres to company attendance standards
Performs other duties as assigned

Supervisory Responsibilities: None

Competencies:

Strong organizational and interpersonal skills
Excellent written and verbal communication skills
Detail oriented
Ability to multi-task and work independently
Knowledge of medical and dental coding systems
Knowledge of medical terminology
Qualifications:

Qualifications:

Minimum two (2) years of medical claims processing experience

Education and/or Experience:

High school diploma or equivalent is required

Certificates, Licenses, Registrations:

None

Computer Skills:

Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook

Environmental Factors/Physical Demands:

Training is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.

  • Medical Claims Examiner

    3 weeks ago

    Clearwater, United States Premier Administrative Solutions Full time

    _______________________________Medical Claims Examiner_______________________________Health Insurance Medical Claims Examiner (Initial Training on Site - 30 days - Remote after training)Must live within a reasonable commuting distance from Clearwater, FL.Summary:The Medical Claims Examiner adjudicates medical claims based on health policy provisions and...

  • Medical Claims Examiner

    5 days ago

    Clearwater, FL, United States Premier Administrative Solutions Full time

    Overview: Health Insurance Medical Claims Examiner (Initial Training on Site - 30 days - Remote after training) Must live within a reasonable commuting distance of Clearwater, FL Monday-Friday Schedule with daytime hours Responsibilities: Summary: The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established...

  • Senior Claims Representative

    1 week ago

    Clearwater, United States Frank Winston Crum Insurance Full time

    FrankCrum is a Top Workplace! Frank Winston Crum Insurance (FWCI) issues Workers' Compensation and General Liability policies by offering flexible coverage and payment options to meet the varied needs of businesses. Over the years, FWCI has grown from a single-state insurance carrier to one that is licensed in 45 states and continues to expand. In addition...

  • Senior Claims Representative

    7 days ago

    Clearwater, United States Frank Winston Crum Insurance Full time

    FrankCrum is a Top Workplace! Frank Winston Crum Insurance (FWCI) issues Workers' Compensation and General Liability policies by offering flexible coverage and payment options to meet the varied needs of businesses. Over the years, FWCI has grown from a single-state insurance carrier to one that is licensed in 45 states and continues to expand. In addition...

  • Customer Service Representative

    2 weeks ago

    Clearwater, United States Pridestaff Full time

    Job OverviewWe are seeking highly skilled professionals with medical coding and insurance expertise to fill full-time claims adjuster roles with a leading company in Largo.This opportunity offers a great work-life balance, with first shift schedules and a competitive salary package that includes PTO and comprehensive insurance benefits.Key...

  • Long Term Care Health Insurance Claims Processor

    4 weeks ago

    Clearwater, United States Insurance Administrative Solutions Full time

    About Insurance Administrative Solutions Insurance Administrative Solutions, L.L.C. ("IAS"), 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. Job Summary Provide prompt and courteous...

  • Long Term Care Health Insurance Claims Processor

    4 weeks ago

    Clearwater, United States Insurance Administrative Solutions Full time

    About Insurance Administrative Solutions Insurance Administrative Solutions, L.L.C. ("IAS"), 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. Job Summary Provide prompt and courteous...

  • PRN Nurse Examiner RN or APRN

    4 weeks ago

    Clearwater, United States Suncoast Center Full time

    Minimum Qualifications:Education: Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN) Preferred: SANE (Sexual Assault Nurse Examiner) or training may be provided Licensure: Must hold a Florida license as an Advanced Practice Registered Nurse or a Registered Nurse. Experience: Registered Nurse with at least one year of experience in...

  • Medical Billing Specialist 1 or 2

    5 months ago

    Clearwater, United States Pinellas County FL Full time

    Come work in a fast-paced high-energy office, utilizing your medical billing expertise. Pinellas County Ambulance Billing is one of the largest ambulance providers in the country and is the exclusive ambulance provider for Pinellas County. Our vision is to be nationally recognized as the industry leader in ambulance billing. This position is within the...

  • Medical Billing Specialist

    5 months ago

    Clearwater, United States Pinellas County FL Full time

    Pinellas County Ambulance Billing is one of the largest ambulance providers in the country and is the exclusive ambulance provider for Pinellas County. Our vision is to be nationally recognized as the industry leader in ambulance billing. If you thrive in a fast-paced, challenging environment in a dynamic industry, this is the opportunity you have been...

  • Medical Assistant

    3 weeks ago

    Clearwater, United States StaffEx Full time

    Position: Medical Assistant or LPNLocation: Clearwater, FL 33761Industry: GeriatricsPay rate: $20-25/hr depending on experienceTop reason you want to work for this company:If you are looking for a family oriented practice that cares for each team member and makes their employees feel valued and empowered, then this is the place for you!MedicalDentalVision...

  • CNA or Medical Assistant Float

    3 hours ago

    Clearwater, United States Florida Medical Clinic Full time

    Our Vision is to be the best choice for healthcare in our community Job Title: CNA or Medical Assistant FloatDepartment: AdministrationReports to: Supervisor Job Summary: Assists providers and manages clinical functions in the department **TRAVEL TO VARIOUS LOCATIONS AS NEEDED**WHAT DOES FLORIDA MEDICAL CLINIC ORLANDO HEALTH HAVE TO OFFER ITS EMPLOYEES? We...

  • Medical Billing Specialist

    1 week ago

    Clearwater, Florida, United States Orthopaedic Solutions Management Full time

    At Orthopaedic Solutions Management, we are committed to delivering exceptional patient care and outstanding customer service. As a Medical Billing Specialist with an orthopedic focus, you will play a vital role in our team's success.About the RoleWe are seeking a highly skilled and experienced Medical Billing Specialist to join our team. In this role, you...

  • Certified Medical Assistant with Bilingual Capabilities

    1 week ago

    Clearwater, United States Victor Arboleda MD PA Full time

    About the RoleWe are seeking a highly skilled and compassionate Certified Medical Assistant to join our team at Victor Arboleda MD PA. As a bilingual phlebotomist and medical assistant, you will be responsible for providing top-notch patient care and support in a fast-paced yet serene internal medicine practice.Key Responsibilities:Collect blood samples from...

  • Medical Imaging Specialist

    4 days ago

    Clearwater, United States Solomon Page Full time

    About the JobWe are seeking a highly skilled Medical Imaging Specialist to join our team on a travel assignment in Clearwater, Florida.The ideal candidate will have experience in Interventional Radiology and be able to work independently with minimal supervision.Job DetailsLocation: Clearwater, FloridaDuration: 13 weeksStart Date: January 6th, 2025Shift: 10...

  • Insurance Verification Representative

    1 month ago

    Clearwater, United States CCS Corp Full time

    Overview: Are you looking for a purposeful career that will make a difference in the patient community? At CCS, our approach to at-home patient care is redefining chronic care management. We are seeking individuals that will thrive in a patient-centric dynamic environment. If you are an attentive listener, fast-thinker, and problem-solver, with the ability...

  • Insurance Verification Representative

    2 weeks ago

    Clearwater, United States CCS Corp Full time

    Overview: Are you looking for a purposeful career that will make a difference in the patient community? At CCS, our approach to at-home patient care is redefining chronic care management. We are seeking individuals that will thrive in a patient-centric dynamic environment. If you are an attentive listener, fast-thinker, and problem-solver, with the ability...

  • Medical Assistant

    5 months ago

    Clearwater, United States MD Now Full time

    Description This position is incentive eligible. IntroductionAre you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a(an) Medical Assistant today with MD Now.BenefitsMD Now, offers a total rewards package...

  • Medical Assistant

    4 weeks ago

    Clearwater, United States HCA Florida South Tampa Surgical Specialists Full time

    Description IntroductionAre you looking for a work environment where diversity and inclusion thrive? Submit your application for our Medical Assistant opening with HCA Florida South Tampa Surgical Specialists today and find out what it truly means to be a part of the HCA Healthcare team.BenefitsHCA Florida South Tampa Surgical Specialists, offers a total...

  • Senior Paralegal

    1 month ago

    Clearwater, United States Frank Winston Crum Insurance Full time

    FrankCrum is a Top Workplace! Frank Winston Crum Insurance (FWCI) issues Workers' Compensation and General Liability policies by offering flexible coverage and payment options to meet the varied needs of businesses. Over the years, FWCI has grown from a single-state insurance carrier to one that is licensed in 45 states and continues to expand. In addition...