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
Analyze claims to determine the extent of insurance carrier liability
Job Summary
Analyze claims to determine the extent of insurance carrier liability.
Based on established guidelines and/or historical knowledge an adjuster will need to recognize red flags for potential fraud or waste and escalate accordingly.
This role will begin as fully onsite to support learning and team integration.
Matching Summary
Analyze claims to determine the extent of insurance carrier liability.
Skills & Requirements
Must-have
CMS-1500/UB-04 claims experience
Interpret contract benefits
Recognize red flags for fraud
External contact with providers/agents/policyholders
Microsoft Office products familiarity
Nice-to-have
Adapt to different people and tasks
Punctual and dependable
Key Requirements
Minimum 1 year health insurance claims adjudication experience
Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims