Long Term Care Health Insurance Claims Processor

1 month 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 customer service. Utilize applicable policy form, insurance law and internal procedures to answer inquiries and process requests for clients and department. Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines. Clear understanding of how various functions with the operation relate to and impact each other.

Primary Responsibilities:
  • Communicate effectively and professionally with providers, agents, policyholders and their representatives.
  • Prepare and copy documentation and /or files for client review.
  • Send out faxes / letters periodically to providers / policyholders.
  • Process ongoing caseload and make decisions necessary to properly adjudicate those 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 claim processing.
  • Communicate effectively and professionally with providers, agents, policyholders and their representatives and vendors.
  • Interact and communicate professionally with manager, supervisor, and other departments.
  • Maintain individual caseloads and internal reports for claim tracking purposes.
  • Coordinate tasks and schedules with team members for maximum team efficiency.
  • Review, utilize and maintain procedure manuals.
  • As needed miscellaneous duties/ projects as assigned by management.
Primary Skills & Requirements:
  • Good oral and written communication skills
  • Team focused with excellent work ethic and reliability required.
  • Must possess excellent verbal and written communication skills.
  • Ability to work independently and exhibit flexibility in performing multiple functions.
  • Ability to operate office equipment.
  • Good PC application skills a plus.
  • Excellent telephone and customer service skills.
  • Good attendance and work ethic.
  • Must have excellent organizational and decision making skills
  • Medical terminology and previous health/Medicare/Rx/Disability claims experience a plus.
  • Ability to calculate figures accurately.
  • Clear understanding of the policy benefits and procedures with in the Claim unit.
  • Must be able to manage time effectively with written correspondence, faxes, and referrals from other departments in order to comply with service guarantees.
  • Candidate must be local. This is not a remote position, at this time.
  • High School diploma or GED equivalent.
  • Prior claims processing, customer service, and clerical experience is preferred.
  • Medical terminology and previous Long Term Care Claim processing experience is a plus.
  • Insurance, PC, Windows, Word and Excel experience is required.
Schedule:
  • Monday to Friday
  • 37 hour work week


About Integrity

Integrity is one of the nation's leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead.

Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge. Why? Because we put our people first At Integrity, you can start a new career path at company you'll love, and we'll love you back. We're proud of the work we do and the culture we've built, where we celebrate your hard work and support you daily. Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.

Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are - in person, over the phone or online. Integrity's employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit Integrity.com.

Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.

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