Integrity Marketing Group - Clearwater, FL
posted about 2 months ago
Full-time - Entry Level
Clearwater, FL
Professional, Scientific, and Technical Services
About the position
The Health Insurance Claims Processor / Adjudication role at Integrity Marketing Group involves analyzing claims to determine insurance carrier liability and interpreting contract benefits according to specific processing guidelines. The position requires effective communication and organizational skills, as well as the ability to work independently in a fast-paced environment. The role is essential in ensuring accurate claims processing and maintaining positive relationships with policyholders and service providers.
Responsibilities
- 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 align with check cycle days to meet service guarantees.
- Maintain external contacts with policyholders, providers, agents, attorneys, and other carriers.
- Examine, perform, research, and make decisions necessary to properly adjudicate claims and written inquiries.
Requirements
- Good oral and written communication skills.
- Good PC application skills and typing speed of 30 wpm with accuracy.
- Previous health/Medicare/prescription claims adjudication experience is a plus.
- 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.
- Ability to calculate figures and co-insurance amounts.
- Ability to read and interpret EOBs.
- Ability to multitask, prioritize, problem-solve, and adapt to a fast-paced environment.
- High School diploma or GED equivalent.
- Minimum of one year related experience required.
Nice-to-haves
- Familiarity with Qiclink software is a plus.
- Experience in medical/insurance preferred.
- Experience with Medicare Supplement preferred.
Benefits
- Competitive compensation package
- Health insurance coverage
- Supportive work environment
- Opportunities for career advancement
