Health Insurance Claims Analyst

7 days ago


Largo, Florida, United States Pridestaff Full time
Job Opportunity:
Pridestaff is seeking a detail-oriented and experienced Health Insurance Claims Adjuster to ensure fair and accurate claims evaluations. The ideal candidate will have a strong understanding of health insurance policies, excellent investigative skills, and the ability to work with sensitive and confidential information.

**Key Responsibilities:**
- Investigate and evaluate health insurance claims to ensure accuracy and compliance with policy terms.
- Assess the validity of claims by gathering and analyzing relevant information, including medical records, policy documents, and claimant statements.
- Collaborate with policyholders, healthcare providers, and internal departments to resolve discrepancies and clarify policy terms.
- Make informed decisions regarding claim approvals, denials, or adjustments based on policy guidelines and regulations.
- Respond to complaints and inquiries from policyholders, providing clear explanations and resolutions.
- Maintain detailed records of claims investigations, decisions, and communications.
- Stay up-to-date with industry regulations, policy changes, and best practices to ensure compliance and efficiency in claims processing.

**Requirements:**
- Minimum of 3 years of experience as a Health Insurance Claims Adjuster or in a similar role.
- High school diploma or equivalent; additional certification in insurance or healthcare is a plus.
- Strong understanding of health insurance policies, claims processing, and relevant regulations.
- Excellent investigative and analytical skills, attention to detail, and ability to work with sensitive and confidential information.
- Strong verbal and written communication skills to effectively interact with claimants, healthcare providers, and internal teams.
- Ability to handle complex claims and complaints with a focus on fair and efficient resolution.

**Salary:** $55,000 - $65,000 per year

**Benefits:**
- Competitive salary range
- Opportunities for professional growth and development
- Collaborative and dynamic work environment

**About Pridestaff:**
Pridestaff is a national staffing organization delivering innovative solutions to employers. With locations across the United States, we partner with clients and candidates to ensure a successful match of employee talent with customer needs.

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