Health Insurance Claims Adjuster – Medical Claims Adjudication (cms‑1500/ub‑04)
Insurance Administrative Solutions
Clearwater, FL, United States
Hybrid
Cms-1500/ub-04 claims experience
Interpret contract benefits
Analyze claims for liability
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.
Adjusters will investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner when handling potential fraud or waste claims.
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
CMS-1500/UB-04 claims experience
Interpret contract benefits
Analyze claims for liability
Recognize red flags for fraud
External contact with providers
Nice-to-have
Adapt to different people and tasks
Team integration and learning
Work-life balance focus
Key Requirements
Minimum 1 year health insurance claims adjudication