Health Insurance Claims Adjuster – Medical Claims Adjudication (cms‑1500/ub‑04)
Insurance Administrative Solutions
Clearwater, FL, United States
Hybrid
Medical claims adjudication
Cms-1500/ub-04 claims
Interpret contract benefits
Analyze claims to determine the extent of insurance carrier liability and interpret contract benefits in accordance with specific claims processing guidelines
Job Summary
Analyze claims to determine the extent of insurance carrier liability and interpret contract benefits in accordance with specific claims processing guidelines.
Examine, perform, research, and make decisions necessary to properly adjudicate claims and written inquiries, while coordinating daily workflow to meet service guarantees.
This role will begin as fully onsite to support learning and team integration, with potential for hybrid work opportunities as proficiency is demonstrated.
Matching Summary
Analyze claims to determine the extent of insurance carrier liability and interpret contract benefits in accordance with specific claims processing guidelines.
Skills & Requirements
Must-have
Medical Claims Adjudication
CMS-1500/UB-04 claims
Interpret contract benefits
Recognize red flags for fraud
External contact with providers
Nice-to-have
Adapt to different people
Rewarding and cutting edge culture
Family-like environment
Key Requirements
Minimum 1 year health insurance claims adjudication
Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims
Ability to calculate deductible and co-insurance amounts