Health Insurance Claims Examiner

5 days ago

Clearwater, Florida, United States Insurance Administrative Solutions, LLC Full time
About Insurance Administrative Solutions, LLC

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. Our team of experts delivers value to our customers by providing compassionate customer service, efficient processing, and quality results.

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 utilize 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. This is a local position, requiring the candidate to be on-site.

Primary Responsibilities:
  • Examine and perform research to make decisions necessary to properly adjudicate claims and written inquiries.
  • Interpret contract benefits in accordance with specific claim processing guidelines.
  • Understand the 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:
  • Excellent oral and written communication skills
  • Proficient PC application skills and typing to 30 wpm with accuracy and clarity of content.
  • Previous health/Medicare/prescription claims adjudication experience is 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 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 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 is preferred.
  • Experience with Medicare Supplement is preferred.
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 a 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, 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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