Health Insurance Claims Adjuster

About Insurance Administrative Solutions

Insurance Administrative Solutions, L.L.C. (“IAS”), an Integrity company headquartered in Clearwater, Florida, is a third-party administrator providing business process outsourcing for insurance carriers. Formed in 2002, IAS administers policies for insureds residing all across the United States.

Primary Responsibilities

• Analyze claims to determine the extent of insurance carrier liability.
• Interpret contract benefits in accordance with specific claims processing guidelines.
• Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.
• Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions.
• Cook up daily workflow to coincide with check cycle days to meet all service guarantees.
• Basically, an adjuster will need to recognize red flags for potential fraud or waste and escalate accordingly.
• Adjusters who handle the 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.
• Understand broad strategic concept of our business and link these to the day-to-day business functions of claims processing.
• Maintain external contact with providers/agents/policyholders.

Primary Skills & Requirements

• A high school diploma or GED equivalent
• Minimum of 1 year proven health insurance claims adjudication experience
• Insurance background preferred; previous Medical/prescription claims preferred
• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required
• Familiarity with medical terminology, procedures and diagnosis codes preferred
• Ability to read and interpret EOB’s claim history, and excellent research skills
• Familiarity with Microsoft Office products; familiarity with Qiclink software a plus
• Ability to calculate deductible and co-insurance amounts
• Ability to adapt and respond to different types of people and tasks
• Excellent communication and documentation skills
• Ability to multi-task, prioritize, and manage time effectively and efficiently
• Reliable transportation and the ability to be punctual and dependable

Benefits

• Medical/Dental/Vision Insurance
• 401(k) Retirement Plan
• Paid Holidays
• PTO
• Community Service PTO
• FSA/HSA
• Life Insurance
• Short-Term and Long-Term Disability

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!

Why Integrity?

• Start a new career path at a company you’ll love
• We’ll love you back
• Hyper-growth company with tons of professional opportunities
• Competitive compensation package, including benefits that make work more fun and give you and your family peace of mind

Equal Opportunity Employer

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.