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Health Insurance Claims Processor
2 months ago
Insurance Administrative Solutions, LLC is a leading provider of comprehensive administrative solutions for the insurance industry. We offer a business process outsourcing solution that helps insurers optimize their administrative workload, leverage emerging technologies, and streamline operations.
Job SummaryWe are seeking a highly skilled Claims Examiner to join our team. The successful candidate will be responsible for analyzing claims to determine the extent of insurance carrier liability, interpreting contract benefits in accordance with specific claims processing guidelines, and coordinating daily workflow to meet all service guarantees.
Primary Responsibilities:- Examine and adjudicate claims and written inquiries, making decisions necessary to properly process claims.
- Interpret contract benefits in accordance with specific claims processing guidelines.
- Understand the strategic concept of our business and link it to the day-to-day business functions of claims processing.
- Minimal external contact with providers, agents, and policyholders.
- Excellent oral and written communication skills.
- Good PC application skills and typing to 30 wpm with accuracy and clarity of content.
- Previous experience in health, Medicare, or prescription claims adjudication is a plus.
- Strong 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 is preferred.
- Familiarity with Qiclink software is a plus.
- Ability to calculate figures and co-insurance amounts.
- Ability to read and interpret EOBs.
- Ability to multitask, prioritize, problem-solve, and effectively adapt to a fast-paced, changing environment to comply with service guarantees.
- Must be able to work independently and meet quality and production standards.
- Must have a clear understanding of policy benefits and procedures within the Claims unit.
- Honesty and respect for the company and its policies and procedures are crucial.
- High School diploma or GED equivalent.
- Minimum of one (1) year related experience required.
- Experience in medical or insurance is preferred.
- Experience with Medicare Supplement is preferred.
- Monday to Friday.
- 37 hour work week.
