Health Insurance Claims Adjuster – Medical Claims Adjudication (cms‑1500/ub‑04)
Insurance Administrative Solutions
Clearwater, Florida, US
Hybrid
Cms-1500/ub-04 claims experience
Interpret contract benefits
Recognize red flags for fraud
Insurance Administrative Solutions is seeking a Health Insurance Claims Adjuster with experience in medical claims adjudication. The role involves analyzing claims, interpreting contract benefits, and ensuring proper claims processing while working in a hybrid environment
Job Summary
Analyze claims to determine the extent of insurance carrier liability and interpret contract benefits in accordance with specific claims processing guidelines.
Adjusters who handle potential fraud or waste claims will investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner.
This role will begin as fully onsite to support learning and team integration, with hybrid work opportunities potentially introduced as proficiency is demonstrated.
Matching Summary
Match Score: 85
Insurance Administrative Solutions is seeking a Health Insurance Claims Adjuster with experience in medical claims adjudication. The role involves analyzing claims, interpreting contract benefits, and ensuring proper claims processing while working in a hybrid environment.
Skills & Requirements
Must-have
CMS-1500/UB-04 claims experience
Interpret contract benefits
Recognize red flags for fraud
External contact with providers
Calculate deductible and co-insurance
Nice-to-have
Adapt to different people and tasks
Multi-task and manage time effectively
Punctual and dependable
Key Requirements
Minimum 1 year health insurance claims adjudication