Claims Adjuster II

About Insurance Administrative Solutions

Insurance Administrative Solutions (IAS) is a third-party provider of comprehensive administrative solutions for our clients in the insurance industry. We offer a business process outsourcing solution that helps insurers optimize administrative workload, bolster their industry expertise, leverage emerging technologies, and streamline operations. With strong industry knowledge, we deliver value to our customers by providing compassionate customer service, efficient processing, and quality results. Here at IAS, we embrace the fact that great things are only accomplished by working as a team. We believe that all of our employees have valuable input no matter the level. Our highly collaborative team environment offers each of our employees a place where they can excel.

JOB SUMMARY: Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines. Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions. Coordinate daily workflow to coincide with check cycle days to meet all service guarantees. Maintain external contacts with policyholders, providers of service, agents, attorneys and other carriers as well as internal contacts with peers, management, and other support areas with a positive and professional approach.

Primary Responsibilities:

• Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.

• Interpret contract benefits in accordance with specific claim processing guidelines.

• Understand broad strategic concept of our business and link these to the day-to-day business functions of claims processing.

• In addition to being able to handle the initial claims that they were trained on, they will be able to handle the majority of claim types within the department.

• Minimal external contact with providers/agents/policyholders.

• Conducting investigations into claimant health history through review of medical records and billing documentation

Primary Skills & Requirements:

• Good oral and written communication skills

• Good PC application skills and typing to 30 wpm with accuracy and clarity of content.

• Previous health/Medicare/prescription claims adjudication experience a plus.

• Must have organizational and decision making skills.

• Team centered with excellent work ethic and reliability.

• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims.

• Familiarity with medical terminology, procedure and diagnosis codes preferred.

• Familiarity with Qiclink software a plus.

• Ability to calculate figures and co-insurance amounts.

• Ability to read and interpret EOB's.

• Ability to multitask, prioritize, problem-solve and effectively adapt to a fast-paced, changing environment in order to comply with service guarantees.

• Must be able to work independently and meet quality and production standards.

• Must have clear understanding of the policy benefits and procedures within the Claims unit.

• High School diploma or GED equivalent.

• Minimum of one (1) year related experience required.

• Experience in medical/insurance preferred.

• Experience with Medicare Supplement preferred.

• Previous experience with chart review

• Knowledge of medical terminology and conditions

• Knowledge of medical prognoses and treatment

• Excellent oral and written communication skills

• Intermediate experience with Microsoft Word and Excel

• Highest standards of accuracy and attention to detail

• Must be local to Clearwater, FL or residing in the nearby area.

Schedule:

• Monday to Friday

• 37 hour work week

About Integrity

Integrity is one of the nation's leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead.

Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge. Why? Because we put our people first! At Integrity, you can start a new career path at company you'll love, and we'll love you back. We're proud of the work we do and the culture we've built, where we celebrate your hard work and support you daily. Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.

Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are - in person, over the phone or online. Integrity's employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit Integrity.com.

Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.