Medical Claims Examiner

3 weeks ago


Tampa, United States NA Full time
Job Description

Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services

•Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria

• Review different lines of business to include Medicare, Medicaid and Commercial services adherence to the contracts and timeliness guidelines

• Authorize claim payments within established limits; otherwise forward to Claims Manager

• Potentially process refunds appeals, disputes and adjustments (when applicable);

• Identify process improvement opportunities within the claim department and recommend system enhancements

• Handles any additional responsibility which may be assigned

Education :

• High School Diploma or equivalent required

Experience :

• Minimum of one-year experience working closely with health claims or in a claims processing/adjudication environment; required

. Abundance of opportunities for promotion within for those looking for upward mobility

.Meeting and exceeding metrics is rewarded

Technical Skills / Knowledge:

• Understanding of health claims processing/adjudication

• Ability to perform basic to intermediate mathematical computation routines

• Medical terminology strongly preferred

• Understanding of ICD-9 & ICD-10

• Basic MS office computer skills

• Ability to work independently or within a team

• Time management skills

Will go remote after 6 months of employment.

  • Tampa, United States Packard Claims Administration Full time

    Job DescriptionJob DescriptionPackard Claims Administration is a fast paced and growing TPA looking for a Workers Compensation Claims Examiner to join our team. We pride ourselves on having a family oriented environment that makes for an enjoyable place to work.Responsibilities:Must have and maintain a FL adjusters license (620 Florida All lines Adjusting...


  • Tampa, United States Hancock Claims Consultants Technicians Full time

    Job DescriptionJob DescriptionAt Hancock Claims Consultants, we are at the forefront of claims resolution services, offering nationwide coverage, swift and comprehensive claims inspections, and unparalleled quality and precision. Our established process ensures top-tier claims support, ranging from rapid catastrophe response to direct inspections.In...

  • Claims Examiner

    3 weeks ago


    Tampa, United States Homeowners Choice Property & Casualty Insurance Company Full time

    Job DescriptionJob DescriptionJOB SUMMARYThe Claims Examiner – Inside Desk Adjuster has direct responsibility for homeowners' property insurance claims, starting with contacting the insured upon the loss through claims resolution. The Claims Examiner provides world class customer service to our insurance policyholders by empathetically handling each...

  • Claims Examiner

    2 months ago


    Tampa, United States Homeowners Choice Property & Casualty Insurance Company Full time

    Job DescriptionJob DescriptionJOB SUMMARYThe Claims Examiner – Inside Desk Adjuster has direct responsibility for homeowners' property insurance claims, starting with contacting the insured upon the loss through claims resolution. The Claims Examiner provides world class customer service to our insurance policyholders by empathetically handling each...

  • Claims Examiner

    3 days ago


    Tampa, United States Homeowners Choice Property & Casualty Insurance Company Full time

    Job DescriptionJob DescriptionJOB SUMMARYThe Claims Examiner – Inside Desk Adjuster has direct responsibility for homeowners' property insurance claims, starting with contacting the insured upon the loss through claims resolution. The Claims Examiner provides world class customer service to our insurance policyholders by empathetically handling each...


  • Tampa, United States SNI Companies Full time

    Job Description Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria •Review different lines of business to include Medicare, Medicaid...


  • Tampa, United States SNI Companies Full time

    Job Description Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria •Review different lines of business to include Medicare, Medicaid...


  • Tampa, United States SNI Companies Full time

    Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria • Review different lines of business to include Medicare, Medicaid and...


  • Tampa, United States SNI Companies Full time

    Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria • Review different lines of business to include Medicare, Medicaid and...


  • Tampa, United States Staffing Now Full time

    Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Clients internal criteria • Review different lines of business to include Medicare, Medicaid and Commercial...


  • Tampa, United States SNI Companies Full time

    Job Description Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria •Review different lines of business to include Medicare, Medicaid...


  • Tampa, United States SNI Companies Full time

    Job Description Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services • Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria • Review different lines of business to include Medicare,...


  • Tampa, United States NA Full time

    Job Description Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria • Review different lines of business to include Medicare,...


  • Tampa, United States Staffing Now Full time

    Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria • Review different lines of business to include Medicare, Medicaid and Commercial...


  • Tampa, United States SNI Companies Full time

    Job Description Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria •Review different lines of business to include Medicare, Medicaid...


  • Tampa, United States SNI Companies Full time

    Job Description Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services • Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria • Review different lines of business to include Medicare,...


  • Tampa, United States SNI Companies Full time

    Job Description Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria • Review different lines of business to include Medicare,...


  • Tampa, United States SNI Companies Full time

    Job Description Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria •Review different lines of business to include Medicare, Medicaid...


  • Tampa, Florida, United States SNI Companies Full time

    Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services •Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria • Review different lines of business to include Medicare, Medicaid and Commercial...


  • Tampa, United States Safepoint MGA, LLC Full time

    **Job Summary** Manages a pending caseload of low to moderate severity and complexity homeowners claims in a team environment. Ensures prompt, effective, and courteous handling of all claims to policyholders and claimants with special emphasis on complying with appropriate guidelines. **Duties and Responsibilities** - Interview and correspond with...