1 year health insurance claims adjudication experience
Experience with ub/institutional cms-1450 claims
Experience with hcfa/professional cms-1500 claims
D&D Insurance Agency Inc is seeking a Health Insurance Claims Adjuster to analyze medical claims and determine insurance carrier liability. The successful candidate will have at least one year of experience in health insurance claims adjudication and will work in a hybrid environment, initially starting onsite
Job Summary
The role involves analyzing medical claims to determine the extent of insurance carrier liability and interpreting contract benefits according to specific guidelines.
Adjusters must recognize red flags for potential fraud or waste and escalate accordingly while maintaining external contact with providers and policyholders.
This position offers a competitive compensation package including medical/dental/vision insurance, a 401(k) retirement plan, and paid holidays.
Matching Summary
Match Score: 85
D&D Insurance Agency Inc is seeking a Health Insurance Claims Adjuster to analyze medical claims and determine insurance carrier liability. The successful candidate will have at least one year of experience in health insurance claims adjudication and will work in a hybrid environment, initially starting onsite.
Skills & Requirements
Must-have
1 year health insurance claims adjudication experience
Experience with UB/institutional CMS-1450 claims
Experience with HCFA/professional CMS-1500 claims
Ability to calculate deductible and co-insurance amounts
Nice-to-have
Familiarity with Qiclink software
Previous Medical/prescription claims preferred
Familiarity with medical terminology and diagnosis codes
Excellent communication and documentation skills
Key Requirements
High school diploma or GED equivalent
Minimum 1 year proven health insurance claims adjudication experience
Reliable transportation and ability to be punctual