Health Insurance Claims Processor

4 weeks ago

Clearwater FL, United States Integrity Marketing Group Full time
About Insurance Administrative Solutions
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. Primary 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.
Primary Skills & 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.
Schedule:
  • Monday to Friday
  • 37 hour work week

  • Long Term Care Health Insurance Claims Processor

    2 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

    2 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...

  • Insurance Processor

    1 month ago

    Tallahassee, FL , USA, United States First Commerce Credit Union Full time

    Job SummaryWe are seeking a highly skilled Insurance Processor to join our team at First Commerce Credit Union. As an Insurance Processor, you will play a critical role in assisting our members with their insurance needs, ensuring that their loans are properly serviced, and providing exceptional customer service.Key Responsibilities:Process premiums for...

  • Medical Claims Examiner

    1 month ago

    Clearwater, United States CHS Inc Full time

    Job Summary:The Medical Claims Examiner role at CHS Inc involves adjudicating medical claims based on health policy provisions and established guidelines. This position requires strong organizational and interpersonal skills, excellent written and verbal communication skills, and the ability to multi-task and work independently.Responsibilities:Reviews and...

  • Senior Claims Manager of General Liability

    4 weeks ago

    Clearwater, Florida, United States Frank Winston Crum Insurance Full time

    Job DescriptionAt Frank Winston Crum Insurance, we are seeking a highly skilled and experienced Senior Claims Manager to join our team. This role will be responsible for overseeing the work activities of a team of claims professionals and ensuring that claims are effectively handled according to company protocols.Key Responsibilities:* Oversees the work...

  • Medical Claims Examiner

    4 weeks ago

    Clearwater, FL, United States Integrity Marketing Group Full time

    About Insurance Administrative SolutionsWe offer a business process outsourcing solution that helps insurers optimize administrative workload, bolster their industry expertise, leverage emerging technologies, and streamline operations.Our highly collaborative team environment offers each of our employees a place where they can excel.We're looking for a...

  • Health Insurance Call Center Representative

    2 weeks ago

    Clearwater, FL, United States Insurance Administrative Solutions, LLC Full time

    About Insurance Administrative SolutionsInsurance 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 industryexpertise, leverage emerging technologies,...

  • PT Health Insurance Call Center Representative

    2 weeks ago

    Clearwater, FL, United States Insurance Administrative Solutions, LLC Full time

    About Insurance Administrative SolutionsInsurance 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 industryexpertise, leverage emerging technologies,...

  • Claims Customer Service Representative

    6 months ago

    Clearwater, United States PrideStaff Full time

    In this Temp to Hire role, you will be handling claims from customers by phone and email and making decisions on the best way to handle the claim. This client handles Medicare/health insurance claims. Critical: During open season this client cannot accommodate any vacations or time off. Duties: Interpret contract benefits based on the claims submitted...

  • Medical Claims Examiner

    4 weeks ago

    Clearwater, 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, FLMonday-Friday Schedule with daytime hoursResponsibilities:Summary:The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established...

  • Medical Claims Examiner

    1 week 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...

  • Health Insurance Sales Representative

    4 weeks ago

    Clearwater, FL, United States Enhance Health PLLC Full time

    Job Title:ACA Health Insurance Sales AgentJob Type:Full-TimeWe are a growing insurance agency specializing in Affordable Care Act (ACA) health insurance.We offer a dynamic and rewarding environment where you can thrive while helping individuals and families access affordable healthcare options.Key Responsibilities:Assist clients with selecting and enrolling...

  • Health Insurance Sales Representative

    4 weeks ago

    Clearwater, FL, United States Enhance Health PLLC Full time

    About Enhance Health PLLCWe are a growing insurance agency specializing in Affordable Care Act (ACA) health insurance. Our mission is to provide individuals and families with access to affordable healthcare options.Job SummaryWe are seeking a motivated and experienced ACA Health Insurance Sales Agent to join our team. As an ACA agent, you will be responsible...

  • P&C Claims Associate

    3 weeks ago

    Clearwater, United States Marsh & McLennan Companies Full time

    AND RESPONSIBILITIES:Triage incoming emails in P&C Claim Inbox and report new claims to the applicable insurance carrier(s)Promptly and effectively manage the reporting of new claims. Ability to identify which policy(ies) apply to a claim incident/s Claims, Associate, Skills

  • Claims Coordinator

    3 weeks ago

    Maitland, FL, United States City Electric Supply Full time

    Claims Coordinator (Commercial Insurance) – Full Time - Non-ExemptCity Electric Supply (CES) – ONSITE - 2301 Maitland Center Parkway, Suite 300, Maitland, FL 32751Looking to start an exciting new career? City Electric Supply (CES) offers excellent career opportunities for people who are friendly and passionate about providing incredible customer service....

  • Workers Compensation Claims Adjuster

    3 weeks ago

    Coral Gables, FL, United States Ascendant Insurance Solutions Full time

    Ascendant Commercial Insurance is a full-service Florida based insurance company, seeking Workers' Compensation Adjusters to join the Claims team. We are a fast growing, diverse company, offering a complete suite of benefits and competitive compensation package.Ascendant is looking for the next generation of industry professionals! If you’re looking for a...

  • Insurance Claim Investigator

    4 weeks ago

    Crestview, FL, United States Allied Universal Full time

    At Allied Universal, we're seeking a skilled Surveillance Investigator to join our team. As a Surveillance Investigator, you'll play a critical role in conducting discreet mobile and stationary surveillance of claimants to confirm their current activities and capabilities.Responsibilities:Conduct independent investigations of insurance claims across various...

  • Health Insurance Agent

    2 months ago

    Clearwater, United States Enhance Health Full time

    Job Title: ACA Health Insurance Sales Agent Location: Clearwater, FL Job Type: Full-Time About Us: We are a growing insurance agency specializing in Affordable Care Act (ACA) health insurance. We offer a dynamic and rewarding environment where you can thrive while helping individuals and families access affordable healthcare options. Join our team and make...

  • Auto Damage Claims Appraiser

    3 weeks ago

    Coral Gables, FL, United States Ascendant Insurance Solutions Full time

    THIS IS A HYBRID POSITION. WE ARE SEEKING LOCAL APPLICANTS THAT RESIDE IN THE MIAMI-DADE OR BROWARD COUNTY, FLORIDA AREAS.Ascendant Claims Services LLC, (an affiliate of Ascendant Commercial Insurance Inc.), is a third-party claims administrator committed to providing best in class claims adjudication solutions. Excellence and professionalism in serving the...

  • Insurance Coverage Specialist

    4 weeks ago

    Clearwater, United States CCS Corp Full time

    Job Summary:We are seeking a skilled Insurance Coverage Specialist to join our team at CCS Corp. As a key member of our operations, you will be responsible for verifying patient insurance coverage and ensuring accurate and complete patient orders prior to shipment claim.Responsibilities: Verify insurance benefits for patients Evaluate insurance coverage to...