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, coordinating daily workflow to meet service guarantees.
Maintain external contact with providers/agents/policyholders and recognize red flags for potential fraud or waste, escalating and investigating accordingly.
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 and tasks
Work-life balance focus
Rewarding and cutting edge environment
Hyper-growth company opportunities
Key Requirements
Minimum 1 year health insurance claims adjudication