Health Insurance Claims Adjuster – Medical Claims Adjudication (cms‑1500/ub‑04)
Lion Street
Clearwater, FL, United States
On-site
Cms-1500/ub-04 claims experience
Interpret contract benefits
Recognize red flags for fraud
Lion Street is seeking a Health Insurance Claims Adjuster for medical claims adjudication in Clearwater, FL. The ideal candidate should possess at least one year of experience in health insurance claims, particularly with CMS-1500 and UB-04 forms, and demonstrate strong analytical and communication skills
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.
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
Match Score: 85
Lion Street is seeking a Health Insurance Claims Adjuster for medical claims adjudication in Clearwater, FL. The ideal candidate should possess at least one year of experience in health insurance claims, particularly with CMS-1500 and UB-04 forms, and demonstrate strong analytical and communication skills.
Skills & Requirements
Must-have
CMS-1500/UB-04 claims experience
Interpret contract benefits
Recognize red flags for fraud
External contact with providers/agents/policyholders
Nice-to-have
Familiarity with medical terminology
Familiarity with Qiclink software
Adapt to different people and tasks
Key Requirements
Minimum of 1 year health insurance claims adjudication experience
Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims