Insurance Claims Processor/Insurance Claims Adjuster (Medicare)
Company: Integrity Marketing Group
Posted on: November 24, 2022
About Integrity Integrity is one of the nation's leading
independent distributors of life, health and wealth insurance
products with a data and technology focus. We are an omnichannel
insurtech company innovating insurance with a singular purpose: to
help people protect their life, health and wealth so they can make
the most of what life brings. Headquartered in Dallas, Texas,
Integrity is committed to making insurance simpler and more human,
so everyone can plan for the good days ahead. Integrity's 5,500
employees currently support over 420,000 independent agents who
serve the needs of more than 2.2 million clients annually. For more
information, visit .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 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.ESSENTIAL DUTIES & RESPONSIBILITIES (other
duties may be assigned as necessary):
- Examine/perform/research & make decisions necessary to properly
adjudicate claims and written inquiries.
- Interpret contract benefits in accordance with specific claim
- Understand broad strategic concept of our business and link
these to the day-to-day business functions of claims
- Minimal external contact with
providers/agents/policyholders.QUALIFICATIONS: To perform this job
successfully, an individual must be able to perform each essential
duty satisfactorily. The requirements listed below are
representative of the knowledge, skill, and/or ability required.
- Candidate must be local. This is not a remote position, at this
- 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
- 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
- Must be able to work independently and meet quality and
- 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.EDUCATION and/or EXPERIENCE REQUIRED:
- High School diploma or GED equivalent.
- Minimum of one (1) year related experience required.
- Experience in medical/insurance preferred.
- Experience with Medicare Supplement preferred.Benefits:
- Medical/Dental/Vision Benefits first of the month after hire
- 401(k) Company matching and contributions are immediately
- 15 days PTO after 90 days
- Referral program
- 11 Paid Holidays
- Employee Assistance Program
- Tuition ReimbursementSchedule:
- Monday to Friday
- 37 hour work weekintegrity and IAS are Equal Opportunity
Keywords: Integrity Marketing Group, Clearwater , Insurance Claims Processor/Insurance Claims Adjuster (Medicare), Other , Clearwater, Florida
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