Health Insurance Claims Adjuster Ii

Insurance Administrative Solutions

Clearwater, FL, US
Not specified; not specified; benefits: medical/de...
Two to four years of health insurance claims experience
Experience with ub/institutional cms-1450 claims
Experience with hcfa/professional cms-1500 claims
The role involves analyzing claims to determine the extent of insurance carrier liability and interpreting contract benefits according to specific guidelines

Job Summary

  • The role involves analyzing claims to determine the extent of insurance carrier liability and interpreting contract benefits according to specific guidelines.
  • Employees will maintain external contact with providers, agents, and policyholders while coordinating daily workflow to meet service guarantees.
  • The company offers a competitive compensation package including Medical/Dental/Vision Insurance, 401(k), Paid Holidays, PTO, and Life Insurance.

Matching Summary

The role involves analyzing claims to determine the extent of insurance carrier liability and interpreting contract benefits according to specific guidelines.

Salary

Not specified; Not specified; Benefits: Medical/Dental/Vision, 401(k), Paid Holidays, PTO, FSA/HSA, Life Insurance, Short-Term/Long-Term Disability

Skills & Requirements

Must-have

  • Two to four years of health insurance claims experience
  • Experience with UB/institutional CMS-1450 claims
  • Experience with HCFA/professional CMS-1500 claims
  • Ability to read and interpret EOBs claim history
  • Ability to calculate deductible and co-insurance amounts

Nice-to-have

  • Familiarity with medical terminology and diagnosis codes
  • Familiarity with Qiclink software
  • Agent license without active appointments
  • Excellent communication and documentation skills
  • Ability to adapt to different types of people

Key Requirements

  • High school diploma or GED equivalent
  • 2-4 years proven health insurance claims adjudication experience
  • Required experience with CMS-1450 and CMS-1500 claims

Work Rights

Not specified

Tailored Resume

Cover Letter