Integrity
Health Insurance Claims Processor / Adjudication
Integrity, Clearwater, Florida, United States, 34623
Health Insurance Claims Processor / Adjudication
Integrity
is hiring for a Health Insurance Claims Processor / Adjudication role at
Insurance Administrative Solutions, L.L.C. ("IAS"), an Integrity company headquartered in Clearwater, Florida.
Location: Clearwater, FL
Job Summary Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines.
Primary Responsibilities
Examine, perform, research, and make decisions necessary to properly adjudicate claims and written inquiries.
Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions.
Interpret contract benefits in accordance with specific claim processing guidelines.
Coordinate daily workflow to coincide with check cycle days to meet all service guarantees.
Recognize red flags for potential fraud or waste and take appropriate actions.
Investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner.
Understand broad strategic concept of our business and link these to the day-to-day functions of claims processing.
Maintain external contact with providers/agents/policyholders.
Primary Skills & Requirements
A high school diploma or GED equivalent.
Minimum of 1 year proven health insurance claims adjudication experience.
Insurance background preferred; previous Medical/prescription claims preferred.
Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required.
Familiarity with medical terminology, procedures and diagnosis codes preferred.
Ability to read and interpret EOB’s claim history, and excellent research skills.
Familiarity with Microsoft Office products; familiarity with Qiclink software a plus.
Ability to calculate deductible and co‑insurance amounts.
Ability to adapt and respond to different types of people and tasks.
Excellent communication and documentation skills.
Ability to multi‑task, prioritize, and manage time effectively and efficiently.
Reliable transportation and the ability to be punctual and dependable.
Benefits Available
Medical/Dental/Vision Insurance
401(k) Retirement Plan
Paid Holidays
PTO
Community Service PTO
FSA/HSA
Life Insurance
Short-Term and Long-Term Disability
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 offers a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.
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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is hiring for a Health Insurance Claims Processor / Adjudication role at
Insurance Administrative Solutions, L.L.C. ("IAS"), an Integrity company headquartered in Clearwater, Florida.
Location: Clearwater, FL
Job Summary Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines.
Primary Responsibilities
Examine, perform, research, and make decisions necessary to properly adjudicate claims and written inquiries.
Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions.
Interpret contract benefits in accordance with specific claim processing guidelines.
Coordinate daily workflow to coincide with check cycle days to meet all service guarantees.
Recognize red flags for potential fraud or waste and take appropriate actions.
Investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner.
Understand broad strategic concept of our business and link these to the day-to-day functions of claims processing.
Maintain external contact with providers/agents/policyholders.
Primary Skills & Requirements
A high school diploma or GED equivalent.
Minimum of 1 year proven health insurance claims adjudication experience.
Insurance background preferred; previous Medical/prescription claims preferred.
Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required.
Familiarity with medical terminology, procedures and diagnosis codes preferred.
Ability to read and interpret EOB’s claim history, and excellent research skills.
Familiarity with Microsoft Office products; familiarity with Qiclink software a plus.
Ability to calculate deductible and co‑insurance amounts.
Ability to adapt and respond to different types of people and tasks.
Excellent communication and documentation skills.
Ability to multi‑task, prioritize, and manage time effectively and efficiently.
Reliable transportation and the ability to be punctual and dependable.
Benefits Available
Medical/Dental/Vision Insurance
401(k) Retirement Plan
Paid Holidays
PTO
Community Service PTO
FSA/HSA
Life Insurance
Short-Term and Long-Term Disability
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 offers a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.
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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